Caring for the Disabled Elderly: Who Will Pay?

By Alice M. Rivlin; Joshua M. Wiener et al. | Go to book overview

Chapter Twelve
Family Responsibility

A family responsibility policy would require adult children, spouses, and parents to contribute to the cost of nursing home care for relatives who are medicaid-eligible.* In essence, state-administered family responsibility programs would hold designated kin legally responsible for making cash payments, either to the state or directly to the nursing home, to offset the medicaid costs of their relative's nursing home care. Such a program could reduce net federal costs both by collecting money to be applied to the cost of care and by discouraging nursing home placement.

Precedent for family responsibility legislation dates back at least as far as the Elizabethan Poor Laws of 1601. 1 Under the old age assistance (OAA) program, which was replaced by the supplemental security income (SSI) program in 1974, most states required financially capable children to help support their parents. 2 Although rarely enforced, family responsibility laws remain on the books in about half the states. 3

Since 1965 federal law has not allowed states through their medicaid state plan to hold adult children financially responsible for their parents. 4 The prohibition was a congressional response to testimony on the harmful effects on family relationships of holding adult children financially responsible for parents receiving OAA support. Section 1902(a)(17)(D) of the Social Security Act prohibits a state medicaid plan from "taking into account the financial responsibility of any

____________________
*
The following discussion will focus on policies seeking contributions from spouses and offspring for their institutionalized aged kin on medicaid, but family responsibility policies may also require payments by parents of children receiving medicaid in institutional settings, mostly intermediate care facilities for the mentally retarded.

-170-

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