Hello. I read this Bipolar community frequently and rarely post, but your question prompted me to reply.
I was diagnosed with bipolar as an adult about 15 years ago. My wife and I have 2 sons, ages 23 and 21 that still live with us. Your son's behavior reminds me of some things are younger son is going through, but no where near that level.
Doing the 'tough love' thing may work, but I'm sure you are aware of all the risks involved with that approach. Mostly would be separation and losing your relationship with your son for a very long time. I'm sure you have tried to reason with him and make him understand that he needs medical help as well as therapy. I am surprised that you posted that he can not get medicaid because he is not working. I was under the impression anyone who qualified financially could get medicaid. Have you gone to their website? Here is a link: http://www.medicaid.gov/index.html .
Persistence may give your results eventually. Do no give up on him, but keep showing that you love him and just want the best for him. I know how hard this is for you and your husband, but keep trying. Hopefully he will eventually listen and take steps to get the help he needs.