```

[Congressional Bills 114th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4055 Introduced in House (IH)]

<DOC>

114th CONGRESS
  1st Session
                                H. R. 4055

 To amend title IV of the Social Security Act to address the increased 
burden that maintaining the health and hygiene of infants and toddlers 
  places on families in need, the resultant adverse health effects on 
children and families, and the limited child care options available for 
infants and toddlers who lack sufficient diapers, which prevents their 
           parents and guardians from entering the workforce.

_______________________________________________________________________

                    IN THE HOUSE OF REPRESENTATIVES

                           November 18, 2015

 Mr. Ellison (for himself, Ms. DeLauro, Mr. Grijalva, Mr. Peters, Mr. 
Cardenas, Mr. Carson of Indiana, Mr. McGovern, Ms. Meng, Ms. Clarke of 
 New York, Ms. Lee, Mr. Pocan, Ms. Kaptur, Ms. Norton, Mr. Nadler, Mr. 
 Hastings, Mr. Conyers, Ms. Michelle Lujan Grisham of New Mexico, Ms. 
Judy Chu of California, Ms. Edwards, and Mr. Van Hollen) introduced the 
 following bill; which was referred to the Committee on Ways and Means

_______________________________________________________________________

                                 A BILL

 
 To amend title IV of the Social Security Act to address the increased 
burden that maintaining the health and hygiene of infants and toddlers 
  places on families in need, the resultant adverse health effects on 
children and families, and the limited child care options available for 
infants and toddlers who lack sufficient diapers, which prevents their 
           parents and guardians from entering the workforce.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Hygiene Assistance for Families of 
Infants and Toddlers Act of 2015''.

SEC. 2. FINDINGS.

    Congress finds the following:
            (1) Access to a reliable supply of clean diapers is a 
        medical necessity for the health and welfare of infants and 
        toddlers, their families, and child care and health care 
        providers, yet in a representative survey of mothers in the 
        United States, 1 in 3 mothers reported having to cut back on 
        essentials in order to afford enough diapers for a child.
            (2) In the United States, most children begin toilet 
        training between 2 and 3 years of age, and after toilet 
        training is complete, the child will not need diapers. Families 
        with infants and toddlers are more likely to be economically 
        disadvantaged than other families. Infants and toddlers are 
        more likely to live with low-income and poor families than 
        older children, 25 percent of infants and toddlers live with 
        families earning less than the Federal poverty level, and 47 
        percent of infants and toddlers live with families earning less 
        than twice the Federal poverty level. There are over 980,000 
        infants and toddlers who are recipients of assistance under the 
        program of block grants to States for temporary assistance for 
        needy families (TANF), over one-third of all families enrolled 
        in such a State program include an infant or toddler, and the 
        average monthly diaper bill of $70 to $80 represents at least 8 
        percent and up to 40 percent of the average amount of cash 
        assistance provided to a family through such a State program.
            (3) The average monthly diaper bill of $70 to $80 
        represents 6 percent of the pretax income of a parent working 
        full time for Federal minimum wage. Approximately 46 percent of 
        low-income children and 26 percent of poor infants and toddlers 
        live with at least 1 parent who is employed full time and year 
        round, and only 47 percent of low-income children and 35 
        percent of poor infants and toddlers live with married parents.
            (4) Without child care, parents and guardians of infants 
        and toddlers cannot participate in the workforce, but most 
        child care providers require parents to provide a supply of 
        clean disposable diapers for their children. In a 2014 survey 
        of 1,129 clients of 8 large diaper banks conducted by the 
        National Diaper Bank Network, 12.4 percent of respondents 
        indicated that the respondent was unable to leave a child at a 
        child care provider at least 1 day a month because the 
        respondent's child lacked diapers, and 47.5 percent of 
        respondents said that the diapers received from the diaper bank 
        enabled the respondent to go to work. Therefore, increasing 
        availability of clean diapers for needy infants and toddlers 
        furthers the national goal of enabling parents to participate 
        in the workforce to increase their economic self-sufficiency, 
        and enables better implementation of title I of the Personal 
        Responsibility and Work Opportunity Reconciliation Act of 1996.
            (5) Increasing the availability of clean diapers for needy 
        infants and toddlers furthers the national goal of increasing 
        access to safe and quality child care for all families, and 
        therefore enables better implementation of the Child Care and 
        Development Block Grant Act of 1990.
            (6) Insufficient diaper changes can lead to not only 
        increased irritability and discomfort of a child, leading to 
        increased parental stress, but also to diaper dermatitis, skin 
        breakdown, open sores with a risk of infection, and urinary 
        tract infections for the child, which require medical 
        attention. In a survey commissioned by Feeding America in 2011, 
        48 percent of food bank clients surveyed said they would delay 
        changing a diaper and 32 percent said they would reuse 
        disposable diapers in order to make their diaper supply last 
        longer. This increases the risk of negative health outcomes for 
        children and their families.
            (7) A study from the Yale School of Medicine found a direct 
        correlation between lacking enough clean diapers to change a 
        child's diapers as often as required--a condition called 
        ``diaper need''--and maternal depression, which can adversely 
        affect maternal-child bonding, a mother's ability to care for 
        her child, and a mother's ability to work outside the home.
            (8) Diapers have proven to be valuable incentives in 
        smoking cessation programs, parenting training programs, and 
        other programs promoting positive and healthy behaviors.
            (9) Increasing the availability of clean diapers for needy 
        families furthers public health by providing improved health 
        outcomes for children, reducing visits to the emergency room, 
        and reducing parental stress and depression.

SEC. 3. IMPROVING OPPORTUNITY DIAPER DEMONSTRATION PROJECT.

    (a) In General.--Section 403 of the Social Security Act (42 U.S.C. 
603) is amended by adding at the end the following:
    ``(c) Diaper Benefit Demonstration Project.--
            ``(1) In general.--The Secretary shall make grants to 
        States to conduct demonstration projects to implement and 
        evaluate strategies to help families with eligible children 
        address the diapering supply needs of such children.
            ``(2) Application requirements.--A State desiring a grant 
        under this subsection shall submit to the Secretary an 
        application that includes the following:
                    ``(A) A description of how the State will use the 
                grant funds to develop a diaper distribution program 
                that will provide sufficient diapers and diapering 
                supplies to each participating family so that each 
                eligible child in the family receives, for each month 
                in which the child participates in the program, not 
                less than the lesser of--
                            ``(i) 50 percent of the diaper changes 
                        required for a month for a healthy child of 
                        similar age and size; or
                            ``(ii) 100 percent of the actual diaper 
                        changes required for the child for the month.
                    ``(B) A description of how the State will 
                coordinate with other State and Federal assistance 
                programs and agencies (particularly other programs and 
                agencies targeted at assisting infants, toddlers, or 
                the parents or guardians of infants or toddlers) that 
                provide benefits and services to families participating 
                in the diaper distribution program, to integrate the 
                distribution of diapers and diapering supplies with the 
                delivery of such other benefits and services, for the 
                purpose of--
                            ``(i) helping participating families to use 
                        effectively the benefits they receive under the 
                        diaper distribution program; and
                            ``(ii) removing barriers to the 
                        participation of such families in activities 
                        such as child care, training, and work 
                        activities.
                    ``(C) A description of how the State will evaluate 
                the extent to which the diaper distribution program 
                increases the efficacy, and affects the participation 
                rates, of other State and Federal assistance programs 
                in the State.
                    ``(D) A description of how the State will provide 
                for the delivery of benefits under the diaper 
                distribution program, which may include--
                            ``(i) cash assistance to be used to 
                        purchase diapers and diapering supplies;
                            ``(ii) vouchers, coupons, electronic 
                        benefit transfer systems, or any other non-cash 
                        method to be used to purchase diapers and 
                        diapering supplies, except that the State may 
                        not require a store to cover the cost of any 
                        equipment, system, or processing required for 
                        any such method as a condition of participation 
                        in the program;
                            ``(iii) assistance in distributing diapers 
                        and diapering supplies from any program or 
                        agency the State considers appropriate, which 
                        may include--
                                    ``(I) State or Federal child care 
                                programs;
                                    ``(II) work programs or fatherhood 
                                initiative programs, if the State 
                                explains the method it intends to use 
                                to ensure that diapers and diapering 
                                supplies distributed through these 
                                programs are used by the eligible child 
                                who is the intended recipient;
                                    ``(III) home visiting programs;
                                    ``(IV) family resource centers;
                                    ``(V) Federal and State health 
                                clinics; and
                                    ``(VI) community service centers;
                            ``(iv) the distribution of diapers and 
                        diapering supplies at diaper banks or through 
                        other nonprofit organizations described in 
                        section 501(c)(3) of the Internal Revenue Code 
                        of 1986 and exempt from taxation under section 
                        501(a) of such Code, including through the 
                        assistance of other State or Federal agencies 
                        that partner with such organizations to assist 
                        with diaper and diapering supply distribution; 
                        and
                            ``(v) the distribution of diapers and 
                        diapering supplies at any other location or 
                        through any other means that will allow the 
                        State to deliver diapers and diapering supplies 
                        to participating families without undue 
                        inconvenience.
                    ``(E) A description of whether the State will 
                provide a cloth diapering system, a disposable 
                diapering system, or both, and in cases in which the 
                State provides a cloth diapering system, an explanation 
                of how the State will provide for diaper cleaning 
                services if requested by the parent or guardian.
                    ``(F) A description of how the State will ensure 
                that the diapering system or systems provided meet the 
                requirements of licensed child care facilities in the 
                State, such that the type of diapers and diapering 
                supplies provided do not prevent participating families 
                from enrolling eligible children in such a facility.
            ``(3) Use of funds.--A State to which a grant is made under 
        this subsection shall use the grant funds to carry out a diaper 
        distribution program in accordance with the State grant 
        application approved by the Secretary, as provided in paragraph 
        (2).
            ``(4) Program administration.--
                    ``(A) State tanf agency as primary administrator.--
                Subject to subparagraph (B), a State diaper 
                distribution program carried out pursuant to this 
                subsection shall be carried out by the State agency 
                responsible for administering the State program funded 
                under this part.
                    ``(B) Authority to subgrant and collaborate.--In 
                carrying out such diaper distribution program, the 
                State agency described in subparagraph (A) may 
                collaborate with, and the State may make a subgrant to, 
                such public and nonprofit entities as the State 
                considers appropriate, including State agencies, local 
                governments, community-based organizations, Community 
                Action Agencies, child care agencies, food assistance 
                agencies, and other nonprofit organizations described 
                in section 501(c)(3) of the Internal Revenue Code of 
                1986 and exempt from taxation under section 501(a) of 
                such Code.
            ``(5) Certification of benefit eligibility.--A State to 
        which a grant is made under this subsection may require, as a 
        condition of receiving benefits under a State diaper 
        distribution program, that participating families provide to 
        the State such information at such times as the State considers 
        necessary to determine whether a child in the family is (or 
        continues to be) an eligible child, as such term is defined in 
        paragraph (7)(D).
            ``(6) Reports.--As a condition of receiving a grant under 
        this subsection for a fiscal year, the State shall submit to 
        the Secretary, not later than 6 months after the end of the 
        fiscal year, a report that--
                    ``(A) specifies the number of children and the 
                number of families receiving assistance under the State 
                diaper assistance program for each month of the fiscal 
                year;
                    ``(B) specifies the number of cloth diapers, the 
                number of disposable diapers, and the number of each 
                type of diapering supply distributed under the diaper 
                distribution program for each month of the fiscal year;
                    ``(C) specifies the method or methods the State 
                uses to distribute diapers and diapering supplies; and
                    ``(D) specifies the number of children and the 
                number of families receiving benefits under the diaper 
                distribution program who also receive assistance during 
                the fiscal year under other relevant public assistance 
                programs, as determined by the Secretary.
            ``(7) Evaluation.--
                    ``(A) In general.--Not later than September 30, 
                2018, the Secretary, in consultation with each State 
                that receives a grant under this subsection, shall 
                conduct a high quality evaluation of the effectiveness 
                of the State diaper distribution programs carried out 
                pursuant to this subsection and of varying approaches 
                for distributing diapers and diapering supplies used in 
                such State programs.
                    ``(B) Areas of evaluation.--The evaluation 
                described in subparagraph (A) shall include a study of 
                the populations served in such State programs, the 
                different methods used by States to distribute diapers 
                and diapering supplies, and the effectiveness of each 
                such method.
                    ``(C) Evaluator qualifications.--The Secretary may 
                not enter into a contract with an evaluator to conduct 
                an evaluation under this paragraph unless the evaluator 
                has demonstrated experience in conducting rigorous, 
                descriptive evaluations of program effectiveness.
                    ``(D) Final evaluation.--Not later than September 
                30, 2022, the Secretary, in consultation with each 
                State that receives a grant under this subsection, 
                shall update the evaluation described in subparagraph 
                (A).
                    ``(E) Reports and public disclosure.--
                            ``(i) Initial report.--Not later than 
                        September 30, 2018, the Secretary shall--
                                    ``(I) submit to the relevant 
                                congressional committees a report on 
                                the results of the evaluation described 
                                in subparagraph (A); and
                                    ``(II) publish the results of the 
                                evaluation on the website of the 
                                Department of Health and Human Services 
                                in a location that is easily accessible 
                                to the public.
                            ``(ii) Final report.--Not later than 90 
                        days after completion of the final evaluation 
                        pursuant to subparagraph (D), the Secretary 
                        shall--
                                    ``(I) submit to the relevant 
                                congressional committees a report 
                                describing the results of the final 
                                evaluation; and
                                    ``(II) update the website described 
                                in clause (i)(II) to include the 
                                results of the final evaluation.
            ``(8) Applicability of certain provisions.--
                    ``(A) Diaper benefits not counted as assistance.--
                Benefits provided under a State diaper distribution 
                program conducted pursuant to this subsection shall not 
                be counted as assistance under a State program funded 
                under this part (or any other State program funded with 
                qualified State expenditures (as defined in section 
                409(a)(7)(B)(i))).
                    ``(B) Rules concerning grants inapplicable.--
                Sections 404 and 409(a)(4) shall not apply with respect 
                to a grant made under this subsection.
            ``(9) Regulations.--The Secretary of Health and Human 
        Services may prescribe such regulations as may be necessary to 
        implement this subsection.
            ``(10) Definitions.--In this subsection:
                    ``(A) The term `diaper' means an absorbent garment 
                that is washable or disposable that is worn by a child 
                who cannot control bladder or bowel movements.
                    ``(B) The term `diapering supplies' means items, 
                including diaper wipes and diaper cream, necessary to 
                ensure that a child using a diaper is properly cleaned 
                and protected from diaper rash, and that the 
                surrounding population is protected from harmful 
                bacteria originating from dirty diapers.
                    ``(C) The term `diapering system' means a method of 
                providing an adequate supply of clean, properly sized 
                diapers and diapering supplies. In the case of washable 
                cloth diapers, this method includes the laundering of 
                diapers to ensure a sufficient supply of clean diapers 
                and waterproof covers.
                    ``(D) The term `eligible child' means a child who--
                            ``(i) is not toilet-trained;
                            ``(ii) has not attained 3 years of age, 
                        unless the State determines that the child has 
                        a substantial physical or mental impairment 
                        that requires the child to wear diapers; and
                            ``(iii) is--
                                    ``(I) a recipient of, or is 
                                eligible to receive, assistance under a 
                                State program funded under this part 
                                (or any other State program funded with 
                                qualified State expenditures (as 
                                defined in section 409(a)(7)(B)(i))), 
                                or is a member of a family that meets 
                                the income eligibility requirements of 
                                such State program; or
                                    ``(II) a member of a family whose 
                                income is not more than 130 percent of 
                                the poverty line (as defined by the 
                                Office of Management and Budget, and 
                                revised annually in accordance with 
                                section 673(2) of the Omnibus Budget 
                                Reconciliation Act of 1981) applicable 
                                to a family of the size involved.
                    ``(E) The term `infant' means a child who has not 
                attained 1 year of age.
                    ``(F) The term `participating family' means a 
                family that includes an eligible child participating in 
                a State diaper distribution program carried out 
                pursuant to this subsection.
                    ``(G) The term `State' means each of the 50 States, 
                the District of Columbia, Puerto Rico, Guam, the United 
                States Virgin Islands, the Northern Mariana Islands, 
                American Samoa, and Indian tribes and tribal 
                organizations.
                    ``(H) The term `toddler' means a child who has 
                attained 1 year of age but has not attained 3 years of 
                age.
                    ``(I) The term `toilet-trained' means able and 
                willing to use a toilet consistently such that diapers 
                are not necessary on a daily basis.
            ``(11) Appropriation.--Out of any funds in the Treasury of 
        the United States not otherwise appropriated, there are 
        appropriated for each of fiscal years 2017 through 2021 
        $75,000,000 to carry out this subsection.
            ``(12) Availability of funds.--Funds provided to a State 
        under this subsection for a fiscal year may be expended only in 
        the fiscal year or the succeeding fiscal year.''.
    (b) Diaper Benefits Exempted From Territorial Payment Ceiling.--
Section 1108(a)(2) of such Act (42 U.S.C. 1308(a)(2)) is amended by 
inserting ``403(c),'' after ``403(a)(5),''.
                                 <all>
```