Pennsylvania Filial Support Law

Pennsylvania is one of approximately 30 states with a filial support law (23 Pa.C.S. § 4603) — but it's one of the very few where the law has actual teeth. Under this statute, adult children can be held financially responsible for the care of their indigent parents. Most people have never heard of this law. The ones who have usually learned about it the hard way.

The Statute — 23 Pa.C.S. § 4603

The Domestic Relations Code provides that adult children have a duty to care for and maintain their parents if the parent is "unable to support himself." This is not a theoretical obligation — it creates a private right of action that allows a care provider (including a nursing home) to sue the children directly for unpaid bills. It also allows the parent, or a person or institution caring for the parent, to petition the court for support.

The Pittas Case: When Theory Became Reality

In 2012, the Superior Court decided Health Care & Retirement Corp. of America v. Pittas (155 A.3d 397), and filial support went from an obscure statute to front-page news in the elder law community.

The facts: Maryann Pittas, an elderly woman, was admitted to a skilled nursing facility. Her care cost roughly $2,000 per day. A Medicaid application was pending but had not been approved. After Maryann left the facility and moved to Greece, the nursing home was left with approximately $93,000 in unpaid charges. Rather than pursue Maryann (who was out of the country) or wait for Medicaid to adjudicate the claim, the nursing home sued her adult son, John Pittas, under § 4603.

John argued that the claim should be directed at Medicaid, or at his mother, or at his siblings — not solely at him. The Superior Court disagreed on every point:

• A pending Medicaid application does not bar a filial support claim. The nursing home was not required to wait for Medicaid to process the claim before pursuing the children.
• The nursing home could choose which child to sue. It was not required to pursue all siblings equally. John was the child with assets — so the nursing home pursued John.
• The obligation is joint and several among siblings — meaning any one child can be held liable for the full amount, regardless of what other siblings could pay.

John Pittas was ordered to pay the full $93,000. The Supreme Court declined to hear the appeal.

What Triggers a Filial Support Claim?

In practice, filial support claims most commonly arise when:

• A parent enters a nursing facility without Medicaid eligibility
• The Medicaid application is delayed, denied, or subject to a transfer penalty period
• The parent has no assets to cover the gap between private-pay costs and Medicaid approval
• The parent dies with unpaid nursing home bills and an insufficient estate
• The nursing home's collection department decides to pursue the children rather than write off the debt

The risk is highest during the Medicaid gap period — the months between nursing home admission and Medicaid approval (or during a penalty period caused by improper asset transfers). At $400–$500+ per day for skilled nursing care, even a few months creates a five- or six-figure liability.

Defenses and Limitations

Section 4603 includes a defense if the parent abandoned the child or failed to support the child during minority. But this is a narrow exception — and the burden is on the child to prove it. Other potential arguments:

• Inability to pay: The court must consider the child's own financial circumstances. If you genuinely cannot pay, the court shouldn't order you to. But "I have a mortgage and college tuition" is not the same as "I have no assets."
• Medicaid eligibility: Once Medicaid is approved and paying, there's no ongoing gap — the claim is limited to the pre-Medicaid period.
• Federal preemption: Some commentators have argued that Medicaid's "anti-lien" provisions preempt state filial support laws. This argument was raised but not resolved in Pittas, and the legal landscape remains unsettled.

How to Prevent a Filial Support Claim

The best defense is making sure the gap never exists:

• Plan early. If a parent is likely to need long-term care, begin Medicaid planning at least 5 years in advance to avoid the lookback penalty entirely.
• Apply for Medicaid immediately upon nursing home admission if the parent may qualify. Every day of delay is a day of private-pay exposure.
• Avoid improper transfers that create penalty periods. A well-intentioned gift of assets to children can create a transfer penalty that leaves the parent (and the children) exposed to exactly the liability they were trying to avoid.
• Long-term care insurance eliminates the gap if coverage is adequate.
• Consider half-a-loaf and other crisis strategies that preserve some assets while ensuring enough remains to cover the penalty period privately.

Filial support adds urgency to every Medicaid planning conversation. The question is no longer just "Can Mom afford the nursing home?" It's "Can you afford the nursing home if Mom can't?"