In 2008, John Pittas received a $93,000 bill for his mother's six-month stay at a Pennsylvania nursing home after a car accident. His mother had already left the facility and the country, and had filed a Medicaid application. Pittas, then 47 and expecting his second child, had never signed any agreement to pay her bills and was unaware of the law that held him liable. State filial responsibility laws, dating back to colonial times, are rarely invoked but remain on the books in 2026. Generally, these laws state that adult children can be held financially responsible for their parents' unpaid bills, especially nursing home or long-term care costs, when parents cannot pay.
How Filial Responsibility Laws Work
As of now, fewer than 20 states have filial support statutes, according to Katherine Pearson, a professor at Penn State Dickinson Law School. Some sources claim 26 to 28 states, but Pearson argues those numbers include states that only make children liable for burial costs. Very few states actually permit or pursue these claims. "Most of the time, the parent does not want to sue their children, and they're the party who could make the claim under most of the laws," Pearson told HuffPost. However, some states—like Pennsylvania—give nursing homes "standing to sue" to recover care costs from adult children.
Parents may be unable to pay due to indigence, illness, or age. "The claims tend to be made because the parents have gone into some type of care facility, usually a nursing home, and the bills aren't being paid by the parents," Pearson said. "So if there is a gap in private payment by the resident, and public payment by Medicaid law, then somebody is going to say, 'Well, let's see if the adult children are obligated to pay.'"
John Pittas's Case: A Precedent
In Pittas's case, his mother's Medicaid application was not approved in time, and the nursing home claimed she was "indigent." Despite having multiple siblings and a stepfather, Pittas qualified as the statutory family member responsible. His joint annual income with his wife was around $85,000. In May 2012, the Pennsylvania Supreme Court affirmed Pittas was liable for his mother's nursing home debt under the state's filial responsibility law. The court noted that splitting costs with other family members was up to Pittas, not the court or nursing home.
Adult children do not need to sign any legal documents or physically be present to check parents into nursing homes. "You are related to them; you are their children," Pearson said. There is no common-law obligation for children to pay parents' bills—only a statute or contract can require it. Filial support laws provide that statute.
Defenses and Complications
One major defense is if the parent abandoned the child for at least 10 years while the child was a minor. Courts are sensitive to abuse or estrangement, but such cases are rare. "The courts have the power of equity, which is to say, 'OK, those parents did not deserve this child's financial support,'" Pearson said. "That's pretty rare, to be honest, but it can happen."
When parent and child live in different states, there is no federal system for enforcing filial laws across state lines. A child in a state without filial laws may have some protection, but Pearson says it's not a complete guarantee.
States with Filial Responsibility Laws
The states with some form of filial responsibility laws are: Arkansas, California, Delaware, Georgia, Indiana, Kentucky, Louisiana, Mississippi, New Hampshire, New Jersey, North Carolina, North Dakota, Ohio, Oregon, Pennsylvania, South Dakota, Tennessee, Vermont, Virginia, and West Virginia. In Massachusetts and Rhode Island, children over 18 who refuse to support a parent when they reasonably can may be fined up to $200 and face up to one year in prison. In Alaska, the law applies only to adult mental care; in Connecticut, only if parents are younger than 65; and in Nevada, only if there is a written, signed agreement.
Why These Laws Persist
Pearson calls these "scarecrow laws" with moral qualities that states leave on the books without enforcing. Financial costs of repeal also play a role. "They're rarely used, so it's really not a big deal," she said. "The biggest reason [they're not repealed] is that they're just such small potatoes."
In 2022, both houses of the Virginia legislature voted to repeal the law following controversial cases, including one where a brother who ran his mother's finances into the ground sued his sister for support. Gov. Glenn Youngkin (R) vetoed the repeal, arguing filial laws protect elderly people during bankruptcy proceedings and that repeal would cause "grave risk of unforeseeable and unintended consequences." Pearson noted conservative states tend to keep laws with moral qualities.
Impact of Medicaid Cuts
With the Trump administration's pending Medicaid cuts, filial laws could become more relevant. However, Pearson believes it's unlikely they will be more commonly enforced. Instead, middle to low-income nursing homes may lose funding, fewer beds will be covered, and more families may care for parents at home. For those affected, Pearson recommends consulting elder law attorneys for crisis planning and advance payment strategies.
