Nursing Homes and the Filial Responsibility Trap: Undermining Medicaid Planning

For families planning to safeguard assets through Medicaid planning, a cornerstone strategy is the use of an irrevocable trust to shield resources from the five-year lookback period, ensuring eligibility for long-term care without depleting savings. Yet, a recent New Jersey case, Bartley Healthcare, Inc. v. Ott (No. A-3336-23, N.J. Super. App. Div. Aug. 15, 2025), highlights a troubling trend: nursing homes seeking to enforce filial responsibility (FR) obligations, despite federal law and most states’ reluctance to impose such duties for long-term care costs. This approach threatens to undo careful Medicaid plans, particularly in states like Ohio with nominal FR statutes, and underscores the need for vigilance in elder law.

The Case: A Nursing Home’s Bold MoveRobert Ott resided at Bartley Healthcare, Inc., until his 2022 death. His daughter, Laura Curcione, acting under a power of attorney (POA), signed letters of responsibility during his admission and readmission, agreeing to manage his funds and pursue Medicaid approval for his care costs. She also signed an agreement to pay a balance due. After Robert’s Medicaid application faced a penalty from unappealed nonqualified transfers, allegedly due to Laura’s inaction, Bartley sued her for $19,669.74, claiming she breached her duty to secure full Medicaid coverage.
The trial court dismissed Bartley’s claim, ruling Laura’s POA ended at Robert’s death, leaving no estate liability, and citing New Jersey’s law (N.J. Stat. Ann. § 30:13-3.1(a)(2)) that bars nursing homes from enforcing payment guarantees against family members. Bartley appealed, arguing Laura’s contractual breach, not FR, triggered her liability. The New Jersey Superior Court reversed and remanded, faulting the trial court for lacking specific factual findings under N.J. Ct. R. 1:7-4. The appellate court didn’t uphold or dismiss based on state/federal law but sent it back for clarity on Laura’s contractual obligations versus statutory protections.Filial Responsibility: A Clash with Federal Law and State TrendsFederal law (42 CFR § 483.12) prohibits nursing homes from conditioning admission or continued care on a family member’s financial guarantee, aiming to protect vulnerable seniors and their families from undue burden. Most states, including New Jersey, align with this, refusing to enforce FR for long-term care or Medicaid-related debts—except a handful like Pennsylvania, where FR laws have been controversially applied (e.g., Health Care & Retirement Corp. v. Pittas, 2012, holding a son liable for $93,000). Ohio, technically an FR state under Ohio Rev. Code § 2919.21, relegates it to a criminal statute, applicable only when someone voluntarily assumes care duties (e.g., co-signing a lease), not as a default for nursing home costs or Medicaid recovery. Missouri similarly limits FR to criminal neglect, not civil liability for care debts.
Yet, Bartley shows nursing homes sidestepping this by framing FR as a contractual issue (e.g., Laura’s letters of responsibility). This tactic threatens families who’ve transferred assets to irrevocable trusts, common in Medicaid planning to meet the five-year lookback (42 U.S.C. § 1396p(c)), rendering those assets unavailable for Medicaid eligibility or estate recovery. If successful, Bartley could force Laura to repay from personal funds, unraveling her father’s plan and exposing her own assets.Undoing Medicaid Planning: The Practical ThreatMedicaid planning often involves placing assets (e.g., a home, savings) into an irrevocable trust five years before care needs arise, shielding them from the lookback and ensuring funds for aging in place (e.g., home modifications, caregivers at $4,000–$6,000/month). Nursing homes, facing funding gaps (e.g., Ohio’s $527M Medicaid shortfall in 2024–2025), may target family members to offset unpaid bills, especially when Medicaid penalties arise from unappealed transfers.

• How It Undoes Planning: If Laura loses, her personal assets could cover Robert’s debt, bypassing the trust’s protection. This sets a precedent for nursing homes to pressure POA holders into guaranteeing care, risking families’ financial security.
• Legal Loophole: The remand suggests the court isn’t rubber-stamping lower rulings but also didn’t rule on federal/state law (e.g., 42 CFR § 483.12 or N.J. Stat. Ann. § 30:13-3.1). Bartley’s contract argument, unaddressed here, could exploit gaps if facts favor their narrative.

What This Case DemonstratesThe remand signals judicial scrutiny, not blind approval, indicating the court seeks a robust factual basis to decide Laura’s liability. It’s not a dismissal based on federal preemption or New Jersey’s anti-FR stance, suggesting the outcome hinges on contract specifics (e.g., did Laura’s POA duty extend beyond death?). This ambiguity leaves families vulnerable, especially in FR-leaning states, and highlights nursing homes’ creative attempts to shift costs despite legal protections.Implications for Ohio and Missouri Families

• Ohio: Though FR is criminal (not civil), nursing homes might mimic Bartley’s strategy, targeting POA agents for “breach” of care agreements. Ensure trusts are ironclad and POA terms limit liability.
• Missouri: With no civil FR for care, the risk is lower, but contract pitfalls persist. Review admission agreements with an elder law attorney.
• Planning Tips: Use a Medicaid-compliant trust with a five-year lookback strategy. Register out-of-state POAs (e.g., Tennessee to Ohio) to avoid Norris-like disputes. Monitor Medicaid appeals to prevent penalties.

A Call to Action

Bartley warns of nursing homes undermining Medicaid plans with filial responsibility claims, even where prohibited. For aging in place, protect your legacy with a trust and legal counsel. For Medicaid planning, seek counsel that will provide ongoing representation to protect the plan- off-the-shelf trusts from online or seminar attorneys that only sell Medicaid trusts, leave you vulnerable.   

For more articles regarding filial responsibility and the efforts of states to circumvent state and federal protections, see the following: 

• Filial Responsibility Rule Means Son, Not Father, Must Pay Legal Bill for Negotiating Medicaid Penalty Reduction
• No Good Deed Goes Unpunished? Caregiver Exemption Does Not Apply When Medicaid Recipient Is Receiving Home Care
• Filial Support Laws Chaos: Pennsylvania and New Jersey Laws Clash
• Three Surprises to Watch Out for When Paying for Long-Term Care
• Maryland Repeals Filial Responsibility Law
• Filial Responsibility Laws Complicate Estate and Financial Planning
• Filial Responsibility In the News
• Filial Responsibility Laws Lead to Chaos
• Man Can't Challenge Discharge of Brother's Debt for Mom's Care under Filial Responsibility Law
• Use of Filial Responsibility to Collect a Nursing Home Debt Survives Federal Challenges
• Elderly Couple May Be Responsible for Adult Son's Unpaid Medical Bills
• California Heir Liable to Reimburse State for Mother's Medicaid Benefits
• Conveyance to Son Was Fraudulent, But His Siblings May Also Be Liable Under Filial Support Law
• Filial Responsibility- Complicating Estate, Retirement and Asset Protection Planning
• Pennsylvania's Filial Support Law Survives Federal Challenge (The Eades Case)
• Conveyance to Son Is Fraudulent, But Siblings May Also Be Liable Under Filial Support Law
• Adult Children Could Be Responsible for Parents' Nursing Home Bills
• Son Liable for Mother's Nursing Home Bill Under Filial Responsibility Law (The Pittas Case)

The following are links to articles describing legal mechanisms by which nursing homes attempt to create filial responsibility even in the absence of filial responsibility statutes: 

• Promissory Note Executed by Nursing Home Resident’s Daughter Is Not Illegal Third-Party Guarantee
• Filial Responsibility- Resident’s Son Not Liable for Breach of Contract Because He Did Not Cause His Mother to Be Ineligible for Medicaid;
• Judge Can Not Impose an ‘Unusual’ Condition on a Reversal of a Default Judgment in a Nursing Home Breach of Contract Lawsuit;
• Tortious Interference With Contractual Relationship Claim Most Recent Possible Remedy Nursing Homes can Employ Against Children of Nursing Home Residents;
• Conservator Owes Duty to Nursing Home to Timely Apply for Medicaid;
• Agent Under Power of Attorney Liable for Damages to Nursing Home for Breach of Contract;
• Conveyance to Son Was Fraudulent, But His Siblings May Also Be Liable Under Filial Support Law;
• Nursing Home May Sue Resident's Daughter for Breach of Contract.

Additional Resources: 

• Losing Loved Ones and Your Livelihood: Re-Evaluating Filial Responsibility Laws
• Filial Support Laws: “A Sleeping Giant”
• Filial Responsibility: Can the Legal Duty to Support Our Parents Be Effectively Enforced?
• A Rational Role for Filial Responsibility Laws in Modern Society?

A Beacon of Hope for Seniors’ Families: Federal Court Protects Ohio Homeowners from Aggressive Medicaid Debt Collection

For families with loved ones in nursing homes receiving Medicaid benefits, the fear of losing a family home to aggressive debt collection can feel overwhelming. Many seniors and their families already face financial hardship; Medicaid eligibility requires having less than $2,000 in assets. When a loved one passes away, families often expect to inherit little, but they shouldn’t have to worry about losing their home to the state’s improper efforts to recover Medicaid costs. 

A recent decision from the United States District Court for the Southern District of Ohio, Plaisted v. Harper, No. 1:24-cv-634 (May 13, 2025), offers hope by affirming that families can fight back against unfair debt collection practices by state-contracted attorneys under the Fair Debt Collection Practices Act (FDCPA), protecting vulnerable homeowners like surviving spouses or disabled children

. This ruling is a significant step toward protecting vulnerable homeowners—such as surviving spouses, disabled children, or other qualifying individuals from aggressive tactics by lawyers contracted by the State of Ohio to collect Medicaid debts.

The Heart of the Case: Protecting Family Homes

Imagine owning your home with a loved one—your mother or spouse—who relies on Medicaid for nursing home care. After their passing, you become the sole owner through joint ownership with rights of survivorship. Suddenly, you receive a threatening letter from an attorney from a law firm, agents of the State of Ohio Attorney General's office, claiming that the State of Ohio is owed hundreds of thousands of dollars for your loved one’s Medicaid benefits and demanding payment. Worse, the lawyers file a public document with the county recorder’s office, listing your home’s address and suggesting the state has a claim against it. You’re left terrified, believing you might lose your home and end up homeless. This is exactly what happened to Jacqueline Holden and Medardo Funez, two Ohio residents who fought back and won an important legal victory.

Jacqueline, a disabled retiree, owned her home jointly with her mother, who received Medicaid benefits before passing away in 2023. After her mother’s death, Jacqueline became the sole owner. Lawyers working for the State of Ohio sent her a letter demanding $372,435.73 for her mother’s Medicaid costs and filed an affidavit with the county, publicly stating that the state might have a claim against her home. Medardo, a disabled veteran, faced a similar situation after his wife, who also received Medicaid, passed away in 2024. The lawyers sent him a letter claiming $65,398.27 and filed a similar affidavit. Both Jacqueline and Medardo were distressed, fearing they would lose their homes. Jacqueline hired an attorney to clear her home’s title, and the lawyers released the affidavit, but Medardo’s affidavit remained, leaving his home under a cloud.

Fighting Back: The Legal Battle

Jacqueline and Medardo took their fight to federal court in Ohio, arguing that the actions violated the Fair Debt Collection Practices Act (FDCPA), a federal law that protects consumers from unfair debt collection tactics, and amounted to slander of title, a legal claim for damaging someone’s property rights by making false claims about their ownership. They also pointed to federal Medicaid laws (42 U.S.C. §§ 1396p(b)(2) and (a)(2)) and Ohio law, which prohibit the state from placing liens on a home during the lifetime of a surviving spouse or disabled child living in the property.

Importantly, federal Medicaid law also allows other exemptions that protect a home from recovery, such as when the home is transferred to a caregiver child who lived with the Medicaid recipient for at least two years before their nursing home admission and provided care that delayed the need for institutional care (42 U.S.C. § 1396p(b)(2)(B)). Debt collectors may ignore or misrepresent these exemptions, claiming such transfers are “improper” to pressure families into paying.

Jacqueline and Medardo claimed the lawyers’ actions violated these protections by targeting their homes, which they owned outright after their loved ones’ deaths. The lawyers tried to dismiss the case, arguing that Jacqueline and Medardo didn’t have Article III standing—a legal requirement to show they were harmed in a way a court can address. The lawyers claimed the affidavits they filed weren’t technically “liens” under Ohio law and thus couldn’t harm the plaintiffs’ property rights.

The Court’s Ruling: A Victory for Families

The federal court rejected the lawyers' argument, delivering a powerful win for Jacqueline, Medardo, and families like theirs. The court explained that Article III standing requires three things: a concrete and specific injury that is real or imminent, an injury caused by the defendant’s actions, and a way for the court to fix the harm through a ruling, such as awarding damages or ordering the defendant to stop.  

The court found that Jacqueline and Medardo met all three requirements:

    •Injury: The court agreed that the affidavits created a “cloud” on their home titles, making it harder to sell or borrow against their property. This was a real harm, even if the affidavits weren’t formal liens.

    •Cause: The harm came directly from the lawyers' actions—sending threatening letters and filing public affidavits suggesting the state could claim their homes.

    •Redress: The court could fix the harm by ordering the lawyers to remove the affidavits (injunctive relief) or awarding damages for distress and financial impact.

Ultimately, the court rejected the lawyers' claim that the affidavits weren’t liens under Ohio law and thus caused no harm. It clarified that federal law, not Ohio law, determines standing. Under federal law, any encumbrance—a burden or claim on property—can harm property rights, not just formal liens. The affidavits were encumbrances because they publicly suggested the state had a claim against the homes, causing fear and potential financial loss. By recognizing this harm, the court allowed Jacqueline and Medardo’s claims to move forward, denying the lawyers' attempt to dismiss the case.

Why This Matters for Seniors’ Families

This ruling is a beacon of hope for families facing aggressive Medicaid debt collection. Here’s why it’s significant:

    •Protection Against Unfair Tactics: Families often feel powerless against debt collectors backed by the state’s authority. The Plaisted v. Harper decision shows that courts can hold these companies and lawyers accountable under the FDCPA for deceptive or harassing tactics, giving families a fighting chance.

    •Safeguarding Property Rights: Federal Medicaid laws (42 U.S.C. § 1396p) protect surviving spouses, disabled children, and other qualifying individuals—like a caregiver child who lived with and cared for a parent for two years before nursing home admission—from losing their homes to Medicaid recovery during their lifetimes. This ruling reinforces these protections, ensuring debt collectors can’t exploit loopholes by filing affidavits that scare families. 

    •Aging in Place: Seniors and Families can more confidently utilize Medicaid available exemptions protecting the home, encouraging and facilitating effective aging-in-place planning. 

    •Broader Exemptions: Beyond surviving spouses and disabled children, Medicaid law allows home transfers to others, such as a caregiver child, a sibling with an equity interest living in the home, or a minor child, without triggering recovery (42 U.S.C. § 1396p(b)(2)). Debt collectors may overlook or ignore these exemptions and claim they’re “improper” to pressure families.  As demonstrated in Plaisted v. Harper, lawyers will file public documents they later will claim are meaningless or harmless, for the sole purpose of pressuring family members to relenquish or settle their rights.  This decision empowers families to challenge such tactics. 

    •Hope for Justice: Hiring an attorney can be daunting for families with limited means, but Jacqueline’s success in clearing her title shows that legal action can work. The court’s openness to damages could help families recover costs or emotional distress. 

    •A Message to Debt Collectors: By denying the lawyers' motion to dismiss, the court signaled that debt collectors can’t dodge accountability with technical arguments. This decision may deter aggressive tactics and encourage respect for federal and Ohio laws protecting homeowners.

What Families Can Do

If you’re facing Medicaid debt collection efforts, here are steps to protect your home and rights: 

    •Know Your Rights: Federal law (42 U.S.C. § 1396p) prohibits Medicaid recovery from a home during the lifetime of a surviving spouse, disabled child, or other qualifying individuals, such as a caregiver child who lived with and cared for the Medicaid recipient for two years before nursing home admission.  Ohio law also limits estate recovery to protect these exemptions. After death, recovery is limited to the recipient’s estate, making it critical to challenge improper tactics.   

    •Plan ahead:  Consult a lawyer well in advance of need or crisis.  Even if you don't currently qualify for a Medicaid exemption, you or someone in your family might with planning and reorientation, qualify.   

    •Don’t Ignore Letters: If you receive a letter claiming a Medicaid debt or notice a filing with your county recorder, act quickly. These documents can create a “cloud” on your title, complicating sales or refinancing. 

    •Seek Legal Help: Consult an elder law or estate planning attorney familiar with Medicaid recovery and the FDCPA. They can challenge unfair collection efforts, clear your title, or negotiate with collectors. Jacqueline’s success shows legal action can make a difference. 

    •Explore Exemptions: If you’re a caregiver child, sibling with an equity interest, or another qualifying individual, you may be eligible for a home transfer exemption. An attorney can help verify your status and protect your rights. 

    •Document Everything: Keep all letters, affidavits, or communications from debt collectors to support your case in court. 

    •Consider Legal Action: If a debt collector violates the FDCPA or slanders your title, you may be able to sue for damages or injunctive relief, as Jacqueline and Medardo did.

A Path to Protection

For families caring for loved ones on Medicaid, the fear of losing a home to debt collectors adds an unfair burden to an already challenging situation. The Plaisted v. Harper decision offers hope that the law can protect you, whether you’re a surviving spouse, disabled child, caregiver child, or other exempt individual. It shows that courts are willing to stand up for vulnerable homeowners, ensuring debt collectors can’t exploit families with aggressive tactics. 

While the case continues, this early victory is a reminder that you have rights—potentially more than you realize—and the legal system can work to defend themIf you’re facing Medicaid debt collection, don’t lose hope. Reach out to an elder law attorney to explore your options, including exemptions that could protect your home. Decisions like Plaisted v. Harper are paving the way for fairer treatment of seniors’ families across Ohio.

In our next article, we’ll explore what damages families can recover under the FDCPA, including compensation for financial losses, emotional distress, and legal fees.