Medicaid Reform: “Family Responsibility” Laws


One element of the Medicaid reform proposal recently passed by Congress (and vetoed by President Clinton) would, if adopted, have a dramatic effect on the way long term care is funded in the U.S. “Family Responsibility” laws, already on the books in some states, could become commonplace in the near future.

The Republican “MediGrant” proposal to replace Medicaid includes the following provision:

FAMILY RESPONSIBILITY.–A MediGrant plan may not require an adult child with a family income below the State median income (as determined by the State) applicable to a family of the size involved to contribute to the cost of covered nursing facility services and other long-term care services for the child’s parent under the plan.

What does this seemingly innocuous provision really mean? Under MediGrant, states would be free to adopt provisions requiring at least wealthy adult children to pay some or all of the costs of caring for their parents in nursing homes. The law would prohibit states from seeking contributions from children earning less than the median income for families of the same size; in Arizona, the median income for all families is just over $32,000.

While nothing in the MediGrant law requires states to adopt Family Responsibility laws, many already have such provisions on the books. Since current Medicaid rules prohibit Family Responsibility recovery, those laws have been unenforced for decades.

Little attention has been paid to the Family Responsibility (sometimes also called “Filial Responsibility”) provisions of the Republican proposal. Critics, however, note that the concept of charging adult children for the costs of their parents’ care is inconsistent with public notions of individual liability.

In addition, there are other concerns about the proposal. Since states would be free to adopt or ignore Family Responsibility laws, the costs of care would be treated differently in each state. Since states would have both legal and practical and practical problems pursuing out-of-state children, the effect of such laws would be to penalize only those children staying in their parents’ state. Furthermore, such laws would encourage children to leave the state and abandon parents.

Supporters of Family Responsibility laws point out that, as proposed, they would affect only wealthier children. As costs of long term care rise and federal funding is cut back, states insist that they must have as many alternatives as possible to meet potentially huge budget shortfalls.

Observers anticipate that the Family Responsibility provision may be removed in budget negotiations. A recent article on the subject syndicated in newspapers across the country notes that many Republicans view the provision as “political suicide” and expect to give up the issue in talks with President Clinton.

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