Filial Responsibility: When Children Must Pay Their Parents Medical Debt

When a parent incurs medical debt—often through long-term care expenses such as nursing home costs—that they can't pay themselves, some states require that the parents' children are held responsible for the debt. Because the amount owed by the parent may represent a significant financial burden for the child, it's important to know what the laws of your state say about your "filial responsibility" to take on your parent's debt obligations and when you may be able to avoid enforcement.

What Are Filial Responsibility Laws?

Filial responsibility laws are statutes that impose a legal duty on adult children to support their parents when they can't pay for their basic needs, such as medical care. As of 2025, two dozen states have filial responsibility laws. Many parents who are owed a duty under these laws are very financially needy, meaning they're likely to qualify for Medicaid (which covers most medical expenses). But if the parent can't pay for the medical treatment they received before qualifying, filial responsibility laws could require the patient's child or children to pay for this care.

Filial Responsibility Laws by State

Most filial responsibility laws take an adult child's ability (or inability) to pay into account. These laws are generally designed to minimize the cost to the state's welfare system. The table below provides the statutory authority for filial responsibility laws in each state that has one.

How to Avoid Filial Responsibility

Few states with filial responsibility laws have a reason to enforce them. That's because most seniors who can't pay for health care receive assistance through Medicaid, and federal law limits when Medicaid can recover medical costs (42 USCS § 1396p). Also, many people who need help paying for nursing facilities are eligible for Medicaid, and it's uncommon for someone to rack up a large bill before qualifying. So, because there's little opportunity to apply filial responsibility laws, they very rarely affect families.

In most states, for a child to be held accountable for a parent's bill, all of these things would have to be true:

• The parent received care in a state that has a filial responsibility law.
• The parent did not qualify for Medicaid when receiving care.
• The parent does not have the money to pay the bill.
• The child has the money to pay the bill.
• The unpaid caregiver or facility chooses to sue the child.

Although filial responsibility laws are rarely enforced, after a parent's death, adult children may still have to "pay" for nursing home care through the Medicaid estate recovery process. In many states, Medicaid can take money that was paid for your parent's long-term care out of your parent's estate—which may come from the sale of your parent's home, money in a trust, or other property.

While you may not have to pay any bills directly, the recovery program reduces the amount of any inheritance you might have otherwise received. Some states may impose a lien on real property during your parent's lifetime if he or she is permanently institutionalized. There are some situations when Medicaid won't pursue estate recovery, so talk to an estate lawyer if you're concerned about this possibility.

When Are Filial Responsibility Laws Enforced?

As mentioned above, filial responsibility laws are rarely, but not never, enforced. One notable example is the 2012 case of Health Care & Retirement Corporation of America v. Pittas (46 A.3d 719), in which a Pennsylvania appeals court found that the adult son of a nursing home resident would have to pay his mother's $93,000 nursing home bill based on the state's filial responsibility law.

Pittas is an unusual case both because the appellant's mother made just enough money through a pension not to qualify for Medicaid, and the court allowed a private entity—in this case, the corporation that owned the nursing home—to sue the son. Generally, filial responsibility laws are designed to let state institutions recover payments to reduce the strain on public resources. Depending on your state, a private long-term health care provider may not be able to enforce filial responsibility laws to collect a debt.

See a Lawyer If You're Concerned

Making sure that an ailing parent is getting the medical care that they need without the extra stress of having to worry whether you'd be on the hook for any debt that they incur. Although the Centers for Medicare & Medicaid Services recently issued new guidance on restrictions against nursing homes using language that suggests third parties (such as children of residents) will "guarantee" that they'll pay medical costs, the terms can cause additional confusion during what can be an already difficult time.

If you're worried about becoming responsible for your parents' long-term care bills—or you're worried that your child could become responsible for paying your bills—consider seeing a lawyer for help. An experienced elder care lawyer will know whether your state has filial responsibility laws, and if so, whether it enforces them.