Offspring May Pay Medicaid Tab : Health: GOP plan to balance budget would let states require adult children of nursing home residents to contribute to costs of parents’ care.

Individual states could require the adult children of nursing home residents receiving Medicaid to contribute to the costs of their parents’ care under a provision in the Republican plan to balance the budget.

The provision is part of a vast overhaul of the Medicaid program, under which Congress would send $791 billion to the states over seven years to establish their own health insurance programs for the poor with fewer federal restrictions than in the past.

Medicare, the health care program for the elderly, does not cover long-term care. But Medicaid, the health care program for the poor, does pay such costs for those who meet income and asset requirements. Long-term care currently accounts for 37% of all federal Medicaid expenditures; the program pays for more than half of all nursing home bills in the country.

Under existing regulations, Medicaid is prohibited to go after the assets of the children of residents. But under the GOP budget legislation, states would have the option of requiring children to pay at least part of the bill.

Many experts think states won’t even try to collect. “It is just extremely politically unpopular,” said Korbin Liu, principal research associate at the Urban Institute. “It is very difficult to do administratively, prohibitively expensive, and the amount of recovery is likely to be extremely small.”

But others think states will seize the opportunity as they become hard-pressed for funds. “This is hitting families when they have their children’s education and their own retirement to save for,” said Patricia Nemore, staff attorney for the National Senior Citizens Law Center. “It would cause resentment among children and guilt among parents.”

The issue of the responsibility of adult children for their parents was little noted in a legislative year full of other intergenerational dramas. Much has been written about Congress’ efforts to protect Social Security benefits, which go to older Americans, while reducing welfare benefits, which go primarily to children. But the question of “family responsibility”--whether to make adult children bear more responsibility for their parents’ care--hits the generation in the middle.

Family responsibility was a stealth issue, late-blooming in the budget debate and presented as a matter of states rights.

House Commerce Committee Chairman Thomas E. Bliley Jr. (R-Va.), discussing his personal gratitude to his 96-year-old father, told reporters: “If my father required nursing home care and I’m able to pay, it should be my responsibility to look after him.”

Furthermore, as Bliley said last week of the protections for vulnerable populations in the entire Medicaid plan, “Compassion doesn’t end at the Beltway. If anything, these governors are closer to the people they serve, more sensitive to the needs of the poor and elderly in their communities and more vulnerable at the polls if they fail to do so.”

Congress, as part of its repeal of the existing Medicaid statute, eliminated the provision that prohibited states to make adult children liable for their parents’ bills. Instead, its new “Medigrant” plan says a state “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.”

The bill is silent about families with incomes above the median.

The average cost of nursing home care is $38,000 a year.

Nemore said that 29 states have “filial,” or adult responsibility, laws on their books that they enforce in connection with other medical services provided by the states.

Texas Gov. George W. Bush said last week that if the Republican proposal becomes law, his state should require people to pay a part of their parents’ nursing home bills now covered by Medicaid, according to the Dallas Morning News.

“Children ought to be responsible to the extent to which they can pay,” Bush said.

“Would Colorado attempt to collect from adult children?” asked Gov. Roy Romer rhetorically. “I don’t know. It is not just the issue of recovery of assets--it goes to the broader issue of do you reward those who thought ahead and were frugal, who didn’t just rely on somebody to take care of them?”

Even so, there already has been a fierce backlash against the “family responsibility” provision.

“I think this is a poisoned bill,” said Rep. Ron Klink (D-Pa.). “Any middle-income, middle-aged family understands they are at risk. It will explode like 100 sticks of dynamite when they are told that this is in the Medicaid bill.”