Filial Responsibility: When Children Must Pay Their Parents Medical Debt

Learn about how filial responsibility laws can make children responsible for their parents' medical costs.

By , Attorney University of Arkansas School of Law
Updated by Diana Chaikin, Attorney Seattle University School of Law
Updated 6/03/2025

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.

Alaska

Each child is bound to maintain the child's parents when the parents are poor and unable to maintain themselves. Alaska Stat. § 25.20.030 (2025)

Arkansas

Children may be legally liable for the cost of their parents' state-provided mental health services if the parent is unable to pay and the services aren't covered by insurance. Ark. Code § 20-47-106 (2025)

California

Except as otherwise provided by law (see CA Welf & Inst Code § 12350), an adult child "shall, to the extent of the adult child's ability, support a parent who is in need and unable to self-maintain by work." Cal. [Fam] Code § 4400 (2025)

Connecticut

Adult children must furnish "reasonably necessary support" to their parents younger than 65 unless the child is physically incapacitated or has other good cause. Conn. Gen. Stat. § 53-304 (2025)

Delaware

Children have a duty to support certain expenses for "a poor person" unable to support themselves if the person's spouse or own parents are unable. Del. Code tit. 13 § 503 (2025)

Georgia

Children of "paupers" have a duty to support them, if able. Ga. Code § 36-12-3 (2025)

Indiana

Children whose parents provided them with food, shelter, clothing, education, and medical care through age 16 "shall contribute" to their parents if the parents are unable to provide themselves with food, shelter, and medical attention. Ind. Code § 31-16-17-1 (2025)

Kentucky

Adult children have a duty to support parents who are "destitute of means of subsistence" and unable to support themselves due to old age or illness. Ky. Rev. Stat. § 530.050 (2025)

Louisiana

Parents who are in "necessitous circumstances" may demand support from their children or grandchildren. La. Rev. Stat. § 13:4731 (2025)

Massachusetts

Adult children "possessed of sufficient means" who were reasonably supported by the parent as a minor may be fined or imprisoned for not supporting the destitute parent. Mass. Gen. Laws Ann. ch. 273 § 20 (2025)

Mississippi

Children of "paupers" who are unable to work may face fines if they don't support the impoverished parent. Miss. Code § 43-31-25 (2025)

Nevada

"Natural children" of certain indigent parents who maintain control of the parents' assets, have the ability to financially support the parent, and have promised (in writing) to support the parent may be required to reimburse the county for hospitalization expenses. Nev. Rev. Stat. § 428.070 (2025)

New Jersey

Children of parents who are eligible to receive public assistance may be required to make support payments. N.J. Stat. § 44:1-140 (2025)

North Carolina

Adult children with "sufficient income" to provide for their immediate family may be charged with a misdemeanor if they don't support a parent who isn't able to support themselves. N.C. Gen. Stat. § 14-326.1 (2025)

North Dakota

Adult children are subject to the "reciprocal duty of support for health services," meaning that they are obligated to support parents who are unable to support themselves. Creditors may be able to collect under this duty for debt incurred by medical and long-term care services. N.D. Cent. Code § 14-09-10 (2025)

Ohio

Children are obligated to provide adequate support to a parent who is unable to support themselves. Ohio Rev. Code § 2919.21 (2025)

Oregon

Children are bound to maintain their parents who are poor and unable to support themselves. Or. Rev. Stat. § 109.010 (2025)

Pennsylvania

Children of "indigent persons" have the responsibility to maintain them, regardless of whether they receive public assistance. 23 Pa. Cons.Stat. § 4603 (2025)

Rhode Island

Nursing homes are entitled to recover uncompensated costs from any "kindred," including children, of a "poor person" who receives care. R.I. Gen. Laws § 40-5-13 (2025)

South Dakota

Adult children who are financially able to do so shall provide necessary food, clothing, shelter, or medical attendance to a parent who is unable to provide for themselves. Claims against the child may be made if the child has written notice of the parent's inability to pay and the child refuses to support the parent. S.D. Codified Laws § 25-7-27 (2025)

Tennessee

The state may seek supplemental assistance or reimbursement from children for any public benefits their parents received. Tenn. Code § 71-5-115 (2025)

Vermont

Adult children who are "possessed of sufficient pecuniary or physical ability" to support their destitute parents may be fined or imprisoned for refusing to provide support. Vt. Stat. tit. 15 § 202 (2025)

Virginia

Adult children must assist in providing for their parents in "necessitous circumstances" after reasonably providing for their own immediate family. Va. Code § 20-88 (2025)

West Virginia

Children of an "indigent person" who are of sufficient ability are required to support the person. Courts have the authority to require that children contribute to past expenses incurred by the Department of Welfare for the indigent person. W.Va. Code § 9-5-9 (2025)

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.

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