Filial responsibility is legal term for the duty owed by an adult child for his parents' necessities of life. It can come into play when a parent in need of long-term ​health care is unable to pay for it.

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.

Low- and many middle-class families rarely have to concern themselves with these laws if the parent has applied for and qualifies for Medicaid. But the picture 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.

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 (Pa. Super. Ct., No. 536 EDA 2011, May 7, 2012), holding an adult son liable for $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.

It should be noted that the woman had left the country—and 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 for 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 $93,000 bill. 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 of care required by their aging parents.

States With Filial Responsibility Laws

More than half of all states—26 plus Puerto Rico—hold adult children financially accountable in some way as of 2019.

They include Alaska, Arkansas, California, Connecticut, Delaware, Georgia, Indiana, Iowa, Kentucky, Louisiana, Massachusetts, Mississippi, Montana, Nevada, New Jersey, North Carolina, North Dakota, Ohio, Oregon, Pennsylvania, 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. Children without sufficient incomes to pay are not held liable for these debts.

Federal Law

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.

The federal Medicaid Estate Recovery Program additionally allows states to look to a patient's estate for reimbursement of benefits after the beneficiary has died.

Note: State laws can change frequently, and this information might not reflect the most recent changes. Please consult with an attorney for current legal advice. The information contained in this article is not legal advice and is not a substitute for legal advice.