Karen L. Sheng


The United States is caught in the crosshairs of skyrocketing health-care costs and a rapidly aging population. Families are buckling under the weight of supporting and caring for aging relatives, especially with the exorbitant costs of long-term care facilities, hospitalization, and chronic illness management. Although the government provides support through programs like Medicare and Medicaid, adult children, acting on an emotional impetus to support parents, often have to organize that support. They may even have a legal duty in over half of the states. These filial responsibility laws impose a duty on adult children to support their parents who cannot otherwise support themselves.

North Carolina is one of these states. State law holds that it is a misdemeanor, punishable by up to a year in jail, for an adult child to fail to support an ill or indigent parent. Much of the scholarship in this space has agreed that filial responsibility laws are inequitable and inefficient, but none have proposed solutions to achieve what these laws originally set out to do. Focusing on aging and poor people in North Carolina, this Note proposes three state-level, nonpartisan ideas to reform the landscape of elder care, providing families with more tools to support the ones they love and cherish. The North Carolina General Assembly should: (1) require employers that offer health insurance with dependent coverage to offer coverage of an employee’s uninsured parents; (2) establish a reciprocal beneficiary status that conveys certain rights and responsibilities to parent-child caretaking relationships; and (3) expand Medicaid eligibility under the Affordable Care Act.

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