I 

108TH CONGRESS 

1ST SESSION H. R. 1929

To amend the Public Health Service Act to authorize formula grants to 

States to provide access to affordable health insurance for certain child 

care providers and staff, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

MAY 1, 2003

Mr. KENNEDY of Rhode Island (for himself, Mr. PLATTS, Mr. GEORGE MILLER of California, Mr. MCDERMOTT, Mr. GRIJALVA, Mr. FROST, Mr. 

FRANK of Massachusetts, Mr. OWENS, and Ms. KAPTUR) introduced the 

following bill; which was referred to the Committee on Energy and Commerce 

A BILL

To amend the Public Health Service Act to authorize formula 

grants to States to provide access to affordable health 

insurance for certain child care providers and staff, and 

for other purposes.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Healthy Early Edu5 cation Workforce Act’’. 
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1 SEC. 2. BLOCK GRANTS REGARDING AFFORDABLE HEALTH 

2 INSURANCE FOR CHILD CARE PROVIDERS. 

3 Title XIX of the Public Health Service Act is amend4 ed by adding at the end the following: 

5 ‘‘PART D—BLOCK GRANTS REGARDING AFFORD6 ABLE HEALTH INSURANCE FOR CHILD CARE 

7 PROVIDERS 

8 ‘‘SEC. 1981. FORMULA GRANTS TO STATES. 

9 ‘‘For the purpose described in section 1982(a), the 

10 Secretary shall make an allotment each fiscal year for each 

11 State that submits an application in accordance with sec12 tion 1983 in an amount determined in accordance with 

13 section 1984. 

14 ‘‘SEC. 1982. FUNDING AGREEMENTS. 

15 ‘‘(a) PURPOSE.—A funding agreement for a grant 

16 under section 1981 is that the State involved will expend 

17 the grant only for the purpose of providing access to af18 fordable health benefits coverage for—

19 ‘‘(1) eligible child care providers and the staff 

20 of center-based child care providers; and 

21 ‘‘(2) at the discretion of the State involved, the 

22 spouses, domestic partners, and dependents (as 

23 those terms are defined by the State) of such pro24 viders and staff. 

25 ‘‘(b) PERMISSIBLE ACTIVITIES.—A funding agree26 ment for a grant under section 1981 is that the State in-
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1 volved, in carrying out the purpose described in subsection 

2 (a), may opt to use the grant for any of the following: 

3 ‘‘(1) To reimburse an employer or individual 

4 described in subsection (a) for their share (or a por5 tion thereof) of the premiums or other costs for cov6 erage under group or individual health plans. 

7 ‘‘(2) To offset the cost of enrolling individuals 

8 described in subsection (a) in public health benefits 

9 plans, such as the medicaid program under title XIX 

10 of the Social Security Act, the State Children’s 

11 Health Insurance Program under title XXI of such 

12 Act, or public employee health benefit plans. 

13 ‘‘(3) To otherwise subsidize the cost of health 

14 benefits coverage for individuals described in sub15 section (a). 

16 ‘‘(c) LIMITING CRITERIA.—A funding agreement for 

17 a grant under section 1981 is that the State involved may 

18 establish criteria to limit the providers and staff described 

19 in subsection (a)(1) who may receive assistance under the 

20 grant. 

21 ‘‘(d) PRIORITY.—A funding agreement for a grant 

22 under section 1981 is that the State involved will give—

23 ‘‘(1) highest priority to—

24 ‘‘(A) providers and staff described in sub25 section (a)(1) that meet any applicable criteria 
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1 established in accordance with subsection (c) 

2 and received assistance under such a grant dur3 ing the previous fiscal year; and 

4 ‘‘(B) at the State’s discretion, the spouses, 

5 domestic partners, and dependents of such pro6 viders and staff; and 

7 ‘‘(2) second highest priority to—

8 ‘‘(A) providers and staff described in sub9 section (a)(1) that meet any applicable criteria 

10 established in accordance with subsection (c) 

11 and are accredited by the National Association 

12 for the Education of Young Children or the Na13 tional Association for Family Child Care; and 

14 ‘‘(B) at the State’s discretion, the spouses, 

15 domestic partners, and dependents of such pro16 viders and staff. 

17 ‘‘(e) MATCHING FUNDS.—

18 ‘‘(1) IN GENERAL.—With respect to the costs of 

19 carrying out the purpose described in subsection (a), 

20 a funding agreement for a grant under section 1981 

21 is that the State involved will make available (di22 rectly or through donations from public or private 

23 entities) non-Federal contributions toward such 

24 costs in an amount that is not less than 50 percent 

25 of such costs.
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1 ‘‘(2) DETERMINATION OF AMOUNT CONTRIB2 UTED.—Non-Federal contributions under paragraph 

3 (1) may be in cash or in kind, fairly evaluated, in4 cluding plant, equipment, or services. Amounts pro5 vided by the Federal Government, or services as6 sisted or subsidized to any significant extent by the 

7 Federal Government, may not be included in deter8 mining the amount of such contributions. 

9 ‘‘SEC. 1983. APPLICATION. 

10 ‘‘For purposes of section 1981, an application for a 

11 grant for a fiscal year is in accordance with this section 

12 if—

13 ‘‘(1) the application is submitted at such time, 

14 in such manner, and containing such information as 

15 the Secretary may require; 

16 ‘‘(2) the application contains each funding 

17 agreement that is described in section 1982; and 

18 ‘‘(3) with respect to each such funding agree19 ment, the application provides assurances of compli20 ance satisfactory to the Secretary. 

21 ‘‘SEC. 1984. DETERMINATION OF AMOUNT OF ALLOTMENT. 

22 ‘‘(a) AMOUNTS RESERVED.—

23 ‘‘(1) TERRITORIES AND POSSESSIONS.—The 

24 Secretary shall reserve not to exceed one half of 1 

25 percent of the amount appropriated pursuant to sec-
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1 tion 1986 in each fiscal year for payments to Guam, 

2 American Samoa, the Virgin Islands of the United 

3 States, and the Commonwealth of the Northern 

4 Mariana Islands to be allotted in accordance with 

5 their respective needs. 

6 ‘‘(2) INDIAN TRIBES.—The Secretary shall re7 serve not less than 1 percent, and not more than 2 

8 percent, of the amount appropriated pursuant to 

9 section 1986 in each fiscal year for payments to In10 dian tribes and tribal organizations, to be allotted in 

11 accordance with their respective needs. 

12 ‘‘(b) STATE ALLOTMENT.—

13 ‘‘(1) GENERAL RULE.—From the remainder of 

14 amounts appropriated pursuant to section 1986 for 

15 each fiscal year after reservations under subsection 

16 (a), the Secretary shall allot to each State an 

17 amount equal to the sum of—

18 ‘‘(A) an amount that bears the same ratio 

19 to 50 percent of such remainder as the product 

20 of the young child factor of the State and the 

21 allotment percentage of the State bears to the 

22 sum of the corresponding products for all 

23 States; and 

24 ‘‘(B) an amount that bears the same ratio 

25 to 50 percent of such remainder as the product 
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1 of the school lunch factor of the State and the 

2 allotment percentage of the State bears to the 

3 sum of the corresponding products for all 

4 States. 

5 ‘‘(2) YOUNG CHILD FACTOR.—For purposes of 

6 this subsection, the term ‘young child factor’ means 

7 the ratio of the number of children in the State 

8 under 5 years of age to the number of such children 

9 in all States as provided by the most recent annual 

10 estimates of population in the States by the Census 

11 Bureau of the Department of Commerce. 

12 ‘‘(3) SCHOOL LUNCH FACTOR.—For purposes 

13 of this subsection, the term ‘school lunch factor’ 

14 means the ratio of the number of children in the 

15 State who are receiving free or reduced price lunches 

16 under the school lunch program established under 

17 the Richard B. Russell National School Lunch Act 

18 to the number of such children in all the States as 

19 determined annually by the Department of Agri20 culture. 

21 ‘‘(4) ALLOTMENT PERCENTAGE.—

22 ‘‘(A) IN GENERAL.—The allotment per23 centage for a State is determined by dividing 

24 the per capita income of all individuals in the 
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1 United States, by the per capita income of all 

2 individuals in the State. 

3 ‘‘(B) LIMITATIONS.—If an allotment per4 centage determined under subparagraph (A)—

5 ‘‘(i) exceeds 1.2 percent, then the al6 lotment percentage of that State shall be 

7 considered to be 1.2 percent; or 

8 ‘‘(ii) is less than 0.8 percent, then the 

9 allotment percentage of the State shall be 

10 considered to be 0.8 percent. 

11 ‘‘(C) PER CAPITA INCOME.—For purposes 

12 of subparagraph (A), per capita income—

13 ‘‘(i) shall be determined at 2-year in14 tervals; 

15 ‘‘(ii) shall be applied for the 2-year 

16 period beginning on October 1 of the first 

17 fiscal year beginning on the date such de18 termination is made; and 

19 ‘‘(iii) shall be equal to the average of 

20 the annual per capita incomes for the most 

21 recent period of 3 consecutive years for 

22 which satisfactory data are available from 

23 the Department of Commerce at the time 

24 such determination is made.
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1 ‘‘(c) ALLOCATION OF EXCESS FUNDS.—To the ex2 tent that all the funds appropriated under section 1986 

3 for a fiscal year and available for allotment in such fiscal 

4 year are not otherwise allotted to States because 1 or more 

5 States have not submitted an application in accordance 

6 with section 1983 for the fiscal year, or because 1 or more 

7 States have notified the Secretary that they do not intend 

8 to use the full amount of their allotment, such excess shall 

9 be allotted among each of the remaining States in propor10 tion to the amount otherwise allotted to such States for 

11 the fiscal year without regard to this subsection. 

12 ‘‘SEC. 1985. DEFINITIONS. 

13 ‘‘In this part: 

14 ‘‘(1) The term ‘eligible child care provider’ 

15 means a family child care provider or a center-based 

16 child care provider (whether an entity or individual) 

17 that is licensed under State law and meets all appli18 cable State and local health and safety requirements. 

19 ‘‘(2) The term ‘family child care provider’ 

20 means an individual who provides child care services 

21 for fewer than 24 hours per day, as the sole care22 giver, and in a private residence. 

23 ‘‘(3) The terms ‘Indian tribe’ and ‘tribal organi24 zation’ have the same meaning given such terms in 
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1 section 4 of the Indian Self-Determination and Edu2 cation Assistance Act. 

3 ‘‘(4)(A) Except for purposes of determining al4 lotments under subsections (a) and (b) of section 

5 1984, the term ‘State’ means each of the several 

6 States, the District of Columbia, Guam, American 

7 Samoa, the Virgin Islands of the United States, the 

8 Commonwealth of the Northern Mariana Islands, 

9 and each Indian tribe or tribal organization. 

10 ‘‘(B) For purposes of determining allotments 

11 under subsections (a) and (b) of section 1984, the 

12 term ‘State’ means each of the several States and 

13 the District of Columbia. 

14 ‘‘SEC. 1986. AUTHORIZATION OF APPROPRIATIONS. 

15 ‘‘There are authorized to be appropriated to the Sec16 retary to carry out this part $200,000,000 for fiscal year 

17 2004, $250,000,000 for fiscal year 2005, $300,000,000 

18 for fiscal year 2006, $400,000,000 for fiscal year 2007, 

19 and such sums as may be necessary for fiscal year 2008.’’. 

20 SEC. 3. EVALUATION OF BLOCK GRANT PROGRAM BY SEC21 RETARY. 

22 (a) EVALUATION.—The Secretary of Health and 

23 Human Services shall conduct an evaluation of several 

24 State programs carried out with grants under part D of 

25 title XIX of the Public Health Service Act, representing 
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1 various approaches to raising the rate of child care work2 ers with health benefits coverage. 

3 (b) ASSESSMENT OF IMPACTS.—In evaluating State 

4 programs under subsection (a), the Secretary may con5 sider any information appropriate to measure the success 

6 of the programs, and shall assess the impact of the pro7 grams on the following: 

8 (1) The rate of child care workers with health 

9 benefits coverage. 

10 (2) The take-up rate by eligible child care pro11 viders. 

12 (3) The turnover rate in the field. 

13 (4) The average wages paid. 

14 (c) REPORT.—Not later than 3 years after the date 

15 of enactment of this Act, the Secretary of Health and 

16 Human Services shall submit a report to the Congress on 

17 the results of the evaluation conducted under subsection 

18 (a), together with recommendations for strengthening pro19 grams carried out with grants under part D of title XIX 

20 of the Public Health Service Act.

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