Fox Business News had a good article on who is responsible for paying the nursing home bill when the resident is indigent.  Typically, Medicaid pays for the services.  However, 29 states have parental support laws, also known as "filial support," which could force the resident’s children to pay for unpaid bills. These laws allow long-term care providers to pursue payment from a parent’s children.  Parental support laws are archaic dating back to colonial times to make sure family members relied on one another rather than turning to public resources for help.  They were rarely enforced after Medicaid’s enactment.

The article mentions a recent study published by Katherine Pearson, a professor of law at the Dickinson School of Law at Penn State University, found that long-term care providers are taking advantage of such laws in at least two states: Pennsylvania and South Dakota.

After one case involving a $93,000 bill wound its way through the court system, in May 2012, the superior court found against the resident’s children, based on the son’s ability to pay. 

"By holding the son liable for a lump sum of close to $93,000 in the Pittas case, the superior court appears to confirm a significant tool for certain creditors of individuals who are unable to pay their debts personally, permitting the filial support statute to be applied retroactively to substantial accrued debt, without requiring evidence of fault on the part of the targeted family member," according to Pearson’s study.

"At the same time, new restrictions have been placed on Medicaid, which traditionally has paid a large percentage of long-term care costs in the United States. For example, the Deficit Reduction Act of 2005 increases penalties on people who transfer assets for less than market value prior to applying for Medicaid."  Medicare may cover nursing home care if certain conditions are met, but only for a maximum of 100 days.


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