Filial responsibility is the legal term for the duty owed by an adult child to their parents for their parents' life necessities. It’s commonly an issue when a parent is in need of long-term health care but is unable to pay for it.
To fully explain filial responsibility, let’s take a closer look at an example, as well as relevant laws at both the federal and state levels. We’ll also consider how filial responsibility has come into play during the COVID-19 pandemic.
Lower- and middle-income households rarely have to worry about these laws if the parent has applied and qualifies for Medicaid. However, that situation can change when care is necessary before the parent has qualified for Medicaid, at least when adult children are deemed to have sufficient incomes to pick up the tab.
What Is Filial Responsibility?
Many states have laws that require adult children to be financially responsible for their parents' necessities of life when the parents don't have the means to pay for them on their own. The extent of this responsibility can vary by state. Nursing homes and other long-term care facilities can use these laws as a means to seek reimbursement from adult children for unpaid bills.
An Example of Filial Responsibility Law
Filial responsibility laws were rarely enforced in years past, but a 2012 case in Pennsylvania bucked that trend.
The Pennsylvania Superior Court upheld a lower court's decision in Health Care & Retirement Corporation of America v. Pittas to hold an adult son liable for almost $93,000—a debt that resulted from six months' skilled nursing care and treatment received by his mother at a Pennsylvania facility.
The court concluded that the state didn't have a duty to consider the woman's other possible sources of payment, including a husband and two other adult children, or the fact that an application for Medicaid assistance was pending at the time.
The woman had left the country—and had left the debt behind—by the time the trial court first heard the case, and some reports have mentioned that she had pension income that resulted in her ultimately being denied Medicaid.
Instead, the court found that the facility had adequately met its burden of proof that this particular son had the means to pay the bill of nearly $93,000. The Superior Court ruled that the trial court was correct in holding the son responsible for paying it.
This Pennsylvania case demonstrates the importance of long-term care planning from the perspectives of both elderly parents and their children. Without proper planning and legal advice from an experienced elder law attorney, some adult children might very well be on the hook for thousands of dollars worth of care required by their aging parents.
States With Filial Responsibility Laws
More than half of all states and Puerto Rico hold adult children financially accountable in some way as of 2021. They include Alaska, Arkansas, California, Connecticut, Delaware, Georgia, Indiana, Kentucky, Louisiana, Massachusetts, Mississippi, Montana, Nevada, New Jersey, North Carolina, North Dakota, Ohio, Oregon, Pennsylvania, Puerto Rico, Rhode Island, South Dakota, Tennessee, Utah, Vermont, Virginia, and West Virginia.
Maryland repealed its filial responsibility law in 2017, and New Hampshire took steps to limit children's responsibilities.
Arkansas requires adult children to pay only for mental health care. Connecticut's law applies only to parents who are younger than age 65, and adult children in Nevada are only liable if they've signed a written promise to pay for care.
Most states take an adult child's ability to pay into account. People without sufficient incomes to pay are not held liable for these debts.
Federal law forbids nursing facilities from requiring payment guarantees from third parties as a condition of admittance, and patients cannot be "evicted" for the lack of such a guarantee.
A Montana court rejected a nursing home's claim in 2013 based on this federal law.
However, the federal Medicaid Estate Recovery Program allows states to look to a patient's estate for reimbursement of benefits after the beneficiary has died.
How COVID-19 May Affect Filial Responsibilities
Given that filial responsibility laws may require adult children to pay for their elderly parents’ medical expenses, it’s plausible that the COVID-19 pandemic could bring these laws to the forefront. The disease disproportionately affects the elderly, and people between ages 65 and 74 are five times more likely to be hospitalized than those between 18 and 29, according to the CDC. For people aged 75 to 84, that multiple is eight times.
A simple doctor’s visit likely isn’t enough to call filial responsibility into play. “At least as far as the elderly are concerned, most have Medicare and supplements that cover their medical bills,” says John Ross, an elder law attorney at Ross & Shoalmire and co-host of the Aging Insight radio and TV shows.
However, Ross sees a greater potential for filial responsibility issues when it comes to long-term care during the pandemic. “We have seen a number of people racking up nursing home bills because of a combination of the patient being isolated, and the family not having access to info to apply for Medicaid.” That creates a tough situation in which the patients' bills are coming in, but their family members may not have adequate resources to pay them—and the debt continues to grow.
“It’s unreimbursed medical expenses like that where filial responsibilities typically pop up,” concludes Ross.