PAYGO and Filial Responsibility Could Bankrupt Families of Disabled People.

Most laws have boring names that sound harmless—until you realize they can wreck your life. That’s the case with two policies every parent and caregiver of a disabled child needs to understand:

1. PAYGO (Pay-As-You-Go)
2. Filial Responsibility Laws

They may not trend on social media, but together, they’re quietly setting up families like ours for financial disaster.

PAYGO: Automatic Cuts You Can’t Stop

PAYGO is a federal budget rule that says if Congress passes a law that increases the deficit without offsets, automatic spending cuts kick in. And guess what usually gets cut? Medicare.

That’s exactly what happened with the recent “One Big Beautiful Bill.” No offsets, no new revenue, so PAYGO triggered $500 billion in automatic Medicare cuts over the next decade.

Here’s what that means in real life:

• Fewer doctors accepting Medicare patients.
• Longer wait times and fewer covered services.
• Out-of-pocket costs going up while coverage goes down.

For disabled people who already face barriers to care, these cuts will make access even harder.

Filial Responsibility: When Your Parent’s Bills Become Yours

Now let’s add insult to injury.

In 26 states, filial responsibility laws let nursing homes or the state come after adult children for a parent’s unpaid medical bills. Even if you never signed a thing. Even if you’re struggling financially yourself.

Here’s how it plays out:

• Medicaid gets tighter and denies coverage.
• Nursing homes send the bill directly to families.
• Facilities sue, garnish wages, or place liens on homes.

And for families raising disabled children, this is devastating. Many of us are already financially stretched thin with therapies, medical care, and lost income from caregiving. Adding your parent’s $93,000 nursing home bill on top? It’s a recipe for bankruptcy.

The Double Threat

PAYGO takes away care as you age.
Filial responsibility laws send the bill to your kids when you can’t pay.

Both policies punish families for needing healthcare, especially families already caring for disabled loved ones.

What You Can Do

• Check your state laws. Find out if you live in one of the 26 states with filial responsibility statutes.
• Ask about estate recovery. Call your state Medicaid office to see how they enforce cost recovery.
• Push lawmakers. Demand your federal reps fix PAYGO, and your state reps repeal filial responsibility laws.
• Plan if you can. Elder law attorneys can help families shield assets legally before crisis hits.
• Stay active. Join advocacy groups fighting for Medicaid, Medicare, and disability rights.

Healthcare shouldn’t bankrupt families. But unless we speak up, PAYGO and filial responsibility will keep doing exactly that, one household at a time.

States With Filial Responsibility Laws

At the time this article was published, these are the 26 states. Always double check your local laws.

According to recent data, these U.S. states (and Puerto Rico) currently have filial responsibility statutes:

• Alaska
• Arkansas*
• California
• Connecticut
• Delaware
• Georgia
• Indiana
• Kentucky
• Louisiana
• Massachusetts
• Mississippi
• Montana
• Nevada*
• New Hampshire
• New Jersey
• North Carolina
• North Dakota
• Ohio
• Oregon
• Pennsylvania
• Rhode Island
• South Dakota
• Tennessee
• Utah
• Vermont
• Virginia
• West Virginia

*Note: Some states limit these laws; for example, Arkansas applies only to certain mental health services; Nevada only if there’s a written agreement. Enforcement varies by state.