Your Obligation to Pay a Parent's Nursing Home Bill

Many states have filial responsibility laws that make children responsible for their parents’ medical care. However, these laws are rarely enforced.

Filial Responsibility Laws

More than half of the states have “filial responsibility” laws that make adult children responsible for their parents’ medical care if their parents can’t pay. These rules do not apply when a patient qualifies for Medicare – in that case, the Medicare system pays. However, if a patient can’t pay for care received before qualifying for Medicare, filial responsibility laws could require the patient’s child or children to pay for this care. Most filial responsibility laws take an adult child’s ability to pay into account.

These laws are generally designed to minimize the parent’s burden on the state’s welfare system. Most allow any long-term care providers to sue family members for payment, but others make failing to care for a parent a criminal offense.

Generally Not Enforced

Most states that have filial responsibility laws don’t enforce them. Here’s why: Most elders who can’t pay for care receive federal assistance through Medicaid, and federal law specifically prohibits going after adult children. Also, most folks who need help paying for nursing home care qualify for Medicaid and it’s unusual for someone to rack up a large bill before qualifying. So, because there is so 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 caregiver chooses to sue the child.

A Rare Case

Although, in practice, these laws rarely cause children have to pay for their parents’ bills, a 2012 Pennsylvania appeals court ruled that an adult son of a nursing home resident would have to pay his mother’s $93,000 nursing home bill based on the Pennsylvania filial responsibility law. This is a rare case because 1) the mother made just enough money through a pension not to qualify for Medicaid, and 2) the court allowed a private institution to sue the son, whereas filial responsibility laws are generally designed to empower the state to recover payments to reduce the burden on welfare. While this is an unusual case, some practitioners wonder if rising care costs will cause more cases like this to surface.

Medicaid Estate Recovery

Although though filial responsibility laws are rarely enforced, adult children may still have to "pay" for nursing home care in another way: through the Medicaid estate recovery process. Medicaid can take the money that it paid for your parent's long-term care from your parent's estate through the Medicaid estate recovery process. This repayment 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 a lawyer if you're concerned about this possibility.

See a Lawyer If You’re Concerned

If you’re worried about becoming responsible for your parents’ long-term care bills (or if you’re worried that your child could become responsible for paying your bills), see 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. For help finding a lawyer, look to Nolo’s Lawyer Directory.

Read more about Working With a Lawyer on Nolo.com.

To learn about other issues that affect elders, go to Nolo’s section on Elder Care & Seniors.