I 

117TH CONGRESS 

1ST SESSION H. R. 259 

To amend the Public Health Service 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, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

JANUARY 11, 2021 

Ms. LEE of California (for herself, Mrs. CAROLYN B. MALONEY of New York, 

Mrs. WATSON COLEMAN, Mr. POCAN, Ms. MENG, Mr. RUSH, Ms. SCHAKOWSKY, Mr. GRIJALVA, Mr. COHEN, Mr. PETERS, Mrs. HAYES, Mr. 

SIRES, Ms. NORTON, and Ms. CHU) introduced the following bill; which 

was referred to the Committee on Energy and Commerce, and in addition 

to the Committee on Ways and Means, for a period to be subsequently 

determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned 

A BILL 

To amend the Public Health Service 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, 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, 


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1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘End Diaper Need Act 

3 of 2021’’. 

4 SEC. 2. DIAPER DISTRIBUTION DEMONSTRATION PROJECT. 

5 Part P of title III of the Public Health Service Act 

6 (42 U.S.C. 280g et seq.) is amended by adding at the end 

7 the following: 

8 ‘‘SEC. 399V–7. DIAPER DISTRIBUTION DEMONSTRATION 

9 PROGRAM. 

10 ‘‘(a) ESTABLISHMENT.—The Secretary shall make 

11 grants to assist eligible entities to conduct demonstration 

12 projects that implement and evaluate strategies to help 

13 low-income families to address the diaper needs of infants 

14 and toddlers. 

15 ‘‘(b) DESIGN OF PROGRAM.—In carrying out the 

16 grant program under subsection (a), the Secretary shall— 

17 ‘‘(1) consult with relevant stakeholders, includ18 ing agencies, professional associations, and nonprofit 

19 organizations, on the design of the program; and 

20 ‘‘(2) design the program in such a way that the 

21 program— 

22 ‘‘(A) decreases diaper need in low-income 

23 families and meets the unmet diaper needs of 

24 infants and toddlers in such families through— 

25 ‘‘(i) the distribution of free diapers 

26 and diapering supplies; 


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1 ‘‘(ii) community outreach to assist in 

2 participation in existing diaper distribution 

3 programs; or 

4 ‘‘(iii) improving access to diapers and 

5 diapering supplies as part of a comprehen6 sive service; and 

7 ‘‘(B) increases the abilities of communities 

8 and low-income families in those communities 

9 to provide for the diaper needs of infants and 

10 toddlers in those communities. 

11 ‘‘(c) ELIGIBLE ENTITIES.—To be eligible for a grant 

12 under this section, an entity shall— 

13 ‘‘(1) be a State or local governmental entity, an 

14 Indian Tribe or tribal organization (as defined in 

15 section 4 of the Indian Self-Determination and Edu16 cation Assistance Act), or a nonprofit organization 

17 described in section 501(c)(3) of the Internal Rev18 enue Code of 1986 and exempt from taxation under 

19 section 501(a) of such Code; 

20 ‘‘(2) have experience in the area of— 

21 ‘‘(A) community distributions of basic need 

22 services, including experience collecting, 

23 warehousing, and distributing basic necessities 

24 such as diapers, food, or menstrual products; 

25 ‘‘(B) child care; 


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1 ‘‘(C) child development activities in low-in2 come communities; or 

3 ‘‘(D) motherhood, fatherhood, or parent4 education efforts serving low-income parents of 

5 young children; 

6 ‘‘(3) demonstrate competency to implement a 

7 project, provide fiscal accountability, collect data, 

8 and prepare reports and other necessary documenta9 tion; 

10 ‘‘(4) demonstrate a willingness to share infor11 mation with researchers, practitioners, and other in12 terested parties; and 

13 ‘‘(5) submit to the Secretary a description of 

14 the design of the evaluation to be carried out under 

15 subsection (d)(2) and receive the Secretary’s ap16 proval of such design based on a determination that 

17 such design is rigorous and is likely to yield informa18 tion that is credible and will be useful to other 

19 States. 

20 ‘‘(d) USE OF FUNDS.—Amounts provided through a 

21 grant under this section shall be used to conduct a dem22 onstration project to implement and evaluate strategies to 

23 help low-income families to address the diaper needs of 

24 infants and toddlers, which use may include any of the 

25 following: 


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1 ‘‘(1) To pay for the purchase of diapers and 

2 diapering supplies and fund diaper distribution dem3 onstration projects that serve low-income families 

4 with one or more children 3 years of age or younger. 

5 ‘‘(2) Using not more than 25 percent of the 

6 funds received by the grantee under this section, to 

7 evaluate the effect of activities under paragraph (1) 

8 on mitigating the health and developmental risks of 

9 unmet diaper need among infants, toddlers, and 

10 other family members in low-income families, includ11 ing the risks of diaper dermatitis, urinary tract in12 fections, and parental and child depression and anx13 iety. 

14 ‘‘(3) To integrate activities under paragraph (1) 

15 with other basic needs assistance programs serving 

16 eligible children and their families, including the fol17 lowing: 

18 ‘‘(A) Programs funded by the Temporary 

19 Assistance for Needy Families program, includ20 ing its State maintenance of effort provisions. 

21 ‘‘(B) Programs designed to support the 

22 health of eligible children, such as the Chil23 dren’s Health Insurance Program under title 

24 XXI of the Social Security Act, the Medicaid 


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1 program under title XIX of such Act, or State2 funded health care programs. 

3 ‘‘(C) Programs funded through the Special 

4 Supplemental Nutrition Program for Women, 

5 Infants, and Children. 

6 ‘‘(D) Programs that offer early home vis7 iting services, including the Nurse-Family Part8 nership and the Maternal, Infant, and Early 

9 Childhood Home Visiting (MIECHV) Program 

10 (including the Tribal Home Visiting Program). 

11 ‘‘(E) Programs to provide improved and 

12 affordable access to child care, including pro13 grams funded through the Child Care and De14 velopment Fund, the Temporary Assistance for 

15 Needy Families program, or a State-funded 

16 program. 

17 ‘‘(e) NO EFFECT ON OTHER PROGRAMS.—Any as18 sistance or benefits received by a family as a result of a 

19 project established pursuant to this section shall be dis20 regarded for purposes of determining the family’s eligi21 bility for, or amount of, benefits under any other Federal 

22 needs-based programs. 

23 ‘‘(f) REPORTS.—As a condition of receiving a grant 

24 under this section for a fiscal year, the grantee shall sub25 mit to the Secretary, not later than 6 months after the 


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1 end of the fiscal year, a report that specifies, by month 

2 and fiscal year, the following: 

3 ‘‘(1) The number of infants and toddlers and 

4 the age of the infant and toddlers who received as5 sistance from the grantee’s diaper distribution 

6 project. 

7 ‘‘(2) The number of families that have received 

8 assistance from the grantee’s diaper distribution 

9 project. 

10 ‘‘(3) The number of diapers, and the number of 

11 each type of diapering supply, distributed under the 

12 grantee’s diaper distribution project. 

13 ‘‘(4) The ZIP Code or ZIP Codes where the 

14 grantee distributed diapers and diaper supplies. 

15 ‘‘(5) The method or methods the grantee uses 

16 to distribute diapers and diapering supplies. 

17 ‘‘(6) Such other information as the Secretary 

18 may specify. 

19 ‘‘(g) EVALUATION.—The Secretary, in consultation 

20 with each grantee under this section, shall— 

21 ‘‘(1) not later than 2 years after the date of en22 actment of the End Diaper Need Act of 2021— 

23 ‘‘(A) complete an evaluation of the effec24 tiveness of the program carried out pursuant to 

25 this section; 


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1 ‘‘(B) submit to the relevant congressional 

2 committees a report on the results of such eval3 uation; and 

4 ‘‘(C) publish the results of the evaluation 

5 on the internet website of the Department of 

6 Health and Human Services; and 

7 ‘‘(2)(A) not later than 3 years after the date of 

8 enactment of the End Diaper Need Act of 2021, up9 date the evaluation required by paragraph (1)(A); 

10 and 

11 ‘‘(B) not later than 90 days after completion of 

12 the updated evaluation under subparagraph (A)— 

13 ‘‘(i) submit to the relevant congressional 

14 committees a report describing the results of 

15 such updated evaluation; and 

16 ‘‘(ii) publish the results of such evaluation 

17 on the internet website of the Department of 

18 Health and Human Services. 

19 ‘‘(h) DEFINITIONS.—In this section: 

20 ‘‘(1) DIAPER.—The term ‘diaper’ means an ab21 sorbent garment that— 

22 ‘‘(A) is washable or disposable that may be 

23 worn by an infant or toddler who is not toilet24 trained; and 

25 ‘‘(B) if disposable— 


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1 ‘‘(i) does not use any latex or common 

2 allergens; and 

3 ‘‘(ii) meets or exceeds the quality 

4 standards for diapers commercially avail5 able through retail sale in the following 

6 categories: 

7 ‘‘(I) Absorbency (with acceptable 

8 rates for first and second wetting). 

9 ‘‘(II) Waterproof outer cover. 

10 ‘‘(III) Flexible leg openings. 

11 ‘‘(IV) Refastening closures. 

12 ‘‘(2) DIAPERING SUPPLIES.—The term ‘dia13 pering supplies’ means items, including diaper wipes 

14 and diaper cream, necessary to ensure that a child 

15 using a diaper is properly cleaned and protected 

16 from diaper rash. 

17 ‘‘(3) ELIGIBLE CHILD.—The term ‘eligible 

18 child’ means a child who— 

19 ‘‘(A) has not attained 4 years of age; and 

20 ‘‘(B) is a member of a family whose self21 certified income is not more than 200 percent 

22 of the Federal poverty line. 

23 ‘‘(4) FEDERAL POVERTY LINE.—The term 

24 ‘Federal poverty line’ means the Federal poverty line 

25 as defined by the Office of Management and Budget 


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1 and revised annually in accordance with section 

2 673(2) of the Omnibus Budget Reconciliation Act of 

3 1981 applicable to a family of the size involved. 

4 ‘‘(5) LOW-INCOME.—The term ‘low-income’, 

5 with respect to a family, means a family whose self6 certified income is not more than 200 percent of the 

7 Federal poverty line. 

8 ‘‘(i) AUTHORIZATION OF APPROPRIATIONS.— 

9 ‘‘(1) IN GENERAL.—To carry out this section, 

10 there is authorized to be appropriated $100,000,000 

11 for each of fiscal years 2022 through 2025. 

12 ‘‘(2) AVAILABILITY OF FUNDS.—Funds pro13 vided to a grantee under this section for a fiscal 

14 year may be expended by the grantee only in such 

15 fiscal year or the succeeding fiscal year.’’. 

16 SEC. 3. IMPROVING ACCESS TO DIAPERS FOR MEDICALLY 

17 COMPLEX CHILDREN. 

18 Section 1915(c) of the Social Security Act (42 U.S.C. 

19 1396n(c)) is amended by adding at the end the following 

20 new paragraph: 

21 ‘‘(11)(A) In the case of any waiver under this sub22 section that provides medical assistance to a medically 

23 complex child who has been diagnosed with bowel or blad24 der incontinence, a bowel or bladder condition that causes 

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1 tes insipidus), or a severe skin condition that causes skin 

2 erosions (such as epidermolysis bullosa), such medical as3 sistance shall include, for the duration of the waiver, the 

4 provision of 200 medically necessary diapers per month 

5 and diapering supplies. Such medical assistance may in6 clude the provision of medically necessary diapers in 

7 amounts greater than 200 if a licensed health care pro8 vider (such as a physician, nurse practitioner, or physician 

9 assistant) specifies that such greater amounts are nec10 essary for such medically complex child. 

11 ‘‘(B) For purposes of this paragraph— 

12 ‘‘(i) the term ‘medically complex child’ means 

13 an individual who is at least three years of age and 

14 for whom a licensed health care provider has pro15 vided a diagnosis of one or more significant chronic 

16 conditions; 

17 ‘‘(ii) the term ‘medically necessary diaper’ 

18 means an absorbent garment that is— 

19 ‘‘(I) washable or disposable; and 

20 ‘‘(II) worn by a medically complex child 

21 who has been diagnosed with a condition de22 scribed in subparagraph (A) and needs such 

23 garment to correct or ameliorate such condition; 

24 and 


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1 ‘‘(iii) the term ‘diapering supplies’ means items, 

2 including diaper wipes and diaper creams, necessary 

3 to ensure that a medically complex child who has 

4 been diagnosed with a condition described in sub5 paragraph (A) and uses a medically necessary diaper 

6 is properly cleaned and protected from diaper rash.’’. 

7 SEC. 4. INCLUSION OF DIAPERS AND DIAPERING SUPPLIES 

8 AS QUALIFIED MEDICAL EXPENSES. 

9 (a) HEALTH SAVINGS ACCOUNTS.—Section 

10 223(d)(2) of the Internal Revenue Code of 1986 is amend11 ed— 

12 (1) by adding at the end of subparagraph (A) 

13 the following: ‘‘For purposes of this subparagraph, 

14 amounts paid for medically necessary diapers and 

15 diapering supplies shall be treated as paid for med16 ical care.’’; and 

17 (2) by adding at the end the following new sub18 paragraph: 

19 ‘‘(E) MEDICALLY NECESSARY DIAPERS

20 AND DIAPERING SUPPLIES.—For purposes of 

21 this paragraph— 

22 ‘‘(i) MEDICALLY NECESSARY DIA23 PERS.—The term ‘medically necessary dia24 per’ means an absorbent garment that is 

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1 vidual needs diapers because they are 

2 medically necessary, serve a preventative 

3 medical purpose, or are needed to correct 

4 or ameliorate defects or physical or mental 

5 illnesses or conditions which are diagnosed 

6 by a licenced health care provider. 

7 ‘‘(ii) DIAPERING SUPPLIES.—The 

8 term ‘diapering supplies’ means items, in9 cluding diaper wipes and diaper creams 

10 necessary to ensure that a child using a 

11 medically necessary diaper is properly 

12 cleaned and protected from diaper rash.’’. 

13 (b) ARCHER MSAS.—Section 220(d)(2)(A) of such 

14 Code is amended by adding at the end the following: ‘‘For 

15 purposes of this subparagraph, amounts paid for medically 

16 necessary diapers and diapering supplies (as defined in 

17 section 223(d)(2)(D)) shall be treated as paid for medical 

18 care.’’. 

19 (c) HEALTH FLEXIBLE SPENDING ARRANGEMENTS

20 AND HEALTH REIMBURSEMENT ARRANGEMENTS.—Sec21 tion 106 of such Code is amended by adding at the end 

22 the following new subsection: 

23 ‘‘(h) REIMBURSEMENTS FOR MEDICALLY NEC24 ESSARY DIAPERS AND DIAPERING SUPPLIES.—For pur25 poses of this section and section 105, expenses incurred 


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1 for medically necessary diapers and diapering supplies (as 

2 defined in section 223(d)(2)(D)) shall be treated as in3 curred for medical care.’’. 

4 (d) EFFECTIVE DATES.— 

5 (1) DISTRIBUTIONS FROM HEALTH SAVINGS AC6 COUNTS.—The amendments made by subsections (a) 

7 and (b) shall apply to amounts paid after December 

8 31, 2021. 

9 (2) REIMBURSEMENTS.—The amendment made 

10 by subsection (c) shall apply to expenses incurred 

11 after December 31, 2021. 

Æ 


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