2 weeks Ago
The first time I saw the number, it didn’t seem real: $93,000. That’s what a Pennsylvania man named John Pittas was ordered to pay out of pocket for his mother’s nursing home care. He hadn’t signed anything; he wasn’t his mom’s power of attorney.
But his mom had a bill and t he nursing home sued him. The nursing home won because of Pennsylvania law. Pennsylvania is one of the only states still enforcing a Colonial-era statute called the “filial responsibility” law.
Under it, adult children can be held financially liable for their indigent parents’ unpaid medical bills, even if they weren’t involved in the care or even estranged from the parent. Not just children but spouses and parents of indigent adults can be targeted, too . Anyone in a nursing home on Medicaid is going to be considered indigent.
As the elected controller of Lehigh County, I sign nearly $170 million in Medicaid payments every year. I can tell you this: stories like John Pittas’ will become much more common if Medicaid gets cut or even squeezed. You could wake up to find yourself sued for tens of thousands of dollars, not because you did anything wrong, but because someone in your family couldn’t pay their bill, and Medicaid didn’t pick it up.
This isn’t theoretical. This is law. If Medicaid gets cut, we should expect it will be used more.
Our version of the law dates to 1771. Imported initially from English “Poor Laws,” it was designed to ensure the state didn’t have to pay for indigent relatives if the family could be forced to instead. Today, it’s been modernized in just one way: it’s now a tool for nursing homes and care providers to go after family members for payment if Medicaid doesn’t cover the bill.
Twenty-nine states still have filial laws, but almost none enforce them. In Maryland, it’s limited to state hospitals. California protects you if your relative is on public assistance.
Their law states that “ no demand shall be made upon any relative to support or contribute toward support ” of state aid recipients. If Medicaid is funded and functioning, most people never need to worry about this law. Medicaid covers long-term care for low-income seniors and adults with disabilities.
But that’s changing. In Washington, there is confusion over what they will do with Medicaid. The president has said he doesn’t want to reduce it, but he is also called for $1.
5 trillion to $2 trillion in spending cuts over the next decade in a budget blueprint that was approved by the House of Representatives in February. A new version calling for smaller cuts is also under consideration in the House. Since Medicaid and Medicare are two the largest annual federal government expenditures there is concern the cuts Trump wants will affect those programs.
Currently, the federal government pays about 55% of Pennsylvania’s base Medicaid program and 90% of the Medicaid expansion program. Let me give you one number that should haunt you: $12,700. That’s the approximate monthly cost of a nursing home bed in Lehigh County.
If Medicaid denies or reduces coverage, the law gives nursing homes and other providers one clear target: the family. At a recent town hall, I told constituents that the Pittas case might become the canary in the coal mine. That $93,000 bill could show up at their house, even if they didn’t cosign anything or have control over their parents’ decisions.
The law doesn’t require that. It just requires a blood or marital connection. There is hope.
In 2024, Pennsylvania House Bill 2094 was introduced to modernize our filial law. It passed the House unanimously but died in the Senate. In 2025, it returned as House Bill 65, championed by Rep.
Kristine Howard. This new version limits liability to two narrow cases: if you hide assets to cheat Medicaid or if you actively refuse to cooperate with the Medicaid process. But here’s the kicker: Rep.
Jeanne McNeill is the only Lehigh County state representative who has co-sponsored this bill. Why? You should ask the other representatives. They should explain why they are not working across the aisle and with the state Senate to ensure this new bill gets passed.
If you’re reading this and thinking, “This can’t be real,” I get it. That’s how most people react the first time they hear about filial responsibility. But it is real, active and dangerous, especially if Medicaid assistance is reduced.
We can fix this, bring our laws into the 21st century, and do so only if we act now — before that bill shows up in your mailbox. This is a contributed opinion column. Mark Pinsley is the Lehigh County controller.
The views expressed in this piece are those of its individual author, and should not be interpreted as reflecting the views of this publication. Do you have a perspective to share? Learn more about how we handle guest opinion submissions at themorningcall.com/opinions.
.
