II 

117TH CONGRESS 

1ST SESSION S. 304 

To provide targeted funding for States and other eligible entities through 

the Social Services Block Grant program to address the increased burden 

that maintaining the health and hygiene of infants and toddlers, medically complex children, and low-income adults or adults with disabilities 

who rely on adult incontinence materials and supplies place 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 diapering supplies, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

FEBRUARY 8, 2021 

Ms. DUCKWORTH (for herself, Mr. CRAMER, Mr. CASEY, Mr. DURBIN, Mrs. 

GILLIBRAND, and Ms. SMITH) introduced the following bill; which was 

read twice and referred to the Committee on Finance 

A BILL 

To provide targeted funding for States and other eligible 

entities through the Social Services Block Grant program 

to address the increased burden that maintaining the 

health and hygiene of infants and toddlers, medically 

complex children, and low-income adults or adults with 

disabilities who rely on adult incontinence materials and 

supplies place 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 diapering supplies, and for 

other purposes. 


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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 ‘‘End Diaper Need Act 

5 of 2021’’. 

6 SEC. 2. TARGETED FUNDING FOR DIAPER ASSISTANCE (IN7 CLUDING DIAPERING SUPPLIES AND ADULT 

8 INCONTINENCE MATERIALS AND SUPPLIES) 

9 THROUGH THE SOCIAL SERVICES BLOCK 

10 GRANT PROGRAM. 

11 (a) INCREASE IN FUNDING FOR SOCIAL SERVICES

12 BLOCK GRANT PROGRAM.— 

13 (1) IN GENERAL.—The amount specified in 

14 subsection (c) of section 2003 of the Social Security 

15 Act (42 U.S.C. 1397b) for purposes of subsections 

16 (a) and (b) of such section is deemed to be 

17 $1,900,000,000 for each of fiscal years 2022 

18 through 2025, of which, the amount equal to 

19 $200,000,000, reduced by the amounts reserved 

20 under paragraph (2)(B) for each such fiscal year, 

21 shall be obligated by States in accordance with sub22 section (b). 

23 (2) APPROPRIATION.— 

24 (A) IN GENERAL.—Out of any money in 

25 the Treasury of the United States not otherwise 


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1 appropriated, there is appropriated 

2 $200,000,000 for each of fiscal years 2022 

3 through 2025, to carry out this section. 

4 (B) RESERVATIONS.— 

5 (i) PURPOSES.—The Secretary shall 

6 reserve, from the amount appropriated 

7 under subparagraph (A) to carry out this 

8 section— 

9 (I) for each of fiscal years 2022 

10 through 2025, not more than 2 per11 cent of the amount appropriated for 

12 the fiscal year for purposes of enter13 ing into an agreement with a national 

14 entity described in subparagraph (C) 

15 to assist in providing technical assist16 ance and training, to support effective 

17 policy, practice, research, and cross18 system collaboration among grantees 

19 and subgrantees, and to assist in the 

20 administration of the program de21 scribed in this section; and 

22 (II) for fiscal year 2022, an 

23 amount, not to exceed $2,000,000, for 

24 purposes of conducting an evaluation 

25 under subsection (d). 


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1 (ii) NO STATE ENTITLEMENT TO RE2 SERVED FUNDS.—The State entitlement 

3 under section 2002(a) of the Social Secu4 rity Act (42 U.S.C. 1397a(a)) shall not 

5 apply to the amounts reserved under clause 

6 (i). 

7 (C) NATIONAL ENTITY DESCRIBED.—A na8 tional entity described in this subparagraph is 

9 a nonprofit organization described in section 

10 501(c)(3) of the Internal Revenue Code of 1986 

11 and exempt from taxation under section 501(a) 

12 of such Code, that— 

13 (i) has experience in more than 1 

14 State in the area of— 

15 (I) community distributions of 

16 basic need services, including experi17 ence collecting, warehousing, and dis18 tributing basic necessities such as dia19 pers, food, or menstrual products; 

20 (II) child care; 

21 (III) child development activities 

22 in low-income communities; or 

23 (IV) motherhood, fatherhood, or 

24 parent education efforts serving low25 income parents of young children; 


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1 (ii) demonstrates competency to im2 plement a project, provide fiscal account3 ability, collect data, and prepare reports 

4 and other necessary documentation; and 

5 (iii) demonstrates a willingness to 

6 share information with researchers, practi7 tioners, and other interested parties. 

8 (b) RULES GOVERNING USE OF ADDITIONAL

9 FUNDS.— 

10 (1) IN GENERAL.—Funds are used in accord11 ance with this subsection if— 

12 (A) the State, in consultation with relevant 

13 stakeholders, including agencies, professional 

14 associations, and nonprofit organizations, dis15 tributes the funds to eligible entities to— 

16 (i) decrease the need for diapers and 

17 diapering supplies and adult incontinence 

18 materials and supplies in low-income fami19 lies and meet such unmet needs of infants 

20 and toddlers, medically complex children, 

21 and low-income adults and adults with dis22 abilities in such families through— 

23 (I) the distribution of free dia24 pers and diapering supplies, medically 


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1 necessary diapers, and adult inconti2 nence materials and supplies; 

3 (II) community outreach to assist 

4 in participation in existing diaper dis5 tribution programs or programs that 

6 distribute medically necessary diapers 

7 or adult incontinence materials and 

8 supplies; or 

9 (III) improving access to diapers 

10 and diapering supplies, medically nec11 essary diapers, and adult incontinence 

12 materials and supplies; and 

13 (ii) increase the ability of communities 

14 and low-income families in such commu15 nities to provide for the need for diapers 

16 and diapering supplies, medically necessary 

17 diapers, and adult continence materials 

18 and supplies, of infants and toddlers, medi19 cally complex children, and low-income 

20 adults and adults with disabilities; 

21 (B) the funds are used subject to the limi22 tations in section 2005 of the Social Security 

23 Act (42 U.S.C. 1397d); 

24 (C) the funds are used to supplement, not 

25 supplant, State general revenue funds provided 


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1 for the purposes described in subparagraph (A); 

2 and 

3 (D) the funds are not used for costs that 

4 are reimbursable by the Federal Emergency 

5 Management Agency, under a contract for in6 surance, or by self-insurance. 

7 (2) ALLOWABLE USES BY ELIGIBLE ENTI8 TIES.—An eligible entity receiving funds made avail9 able under subsection (a) shall use the funds for any 

10 of the following: 

11 (A) To pay for the purchase and distribu12 tion of diapers and diapering supplies, medically 

13 necessary diapers, and funding diaper (includ14 ing medically necessary diapers) distribution 

15 that serves low-income families with— 

16 (i) 1 or more children 3 years of age 

17 or younger; or 

18 (ii) 1 or more medically complex chil19 dren. 

20 (B) To pay for the purchase and distribu21 tion of adult incontinence materials and sup22 plies and funding distribution of such materials 

23 and supplies that serves low-income families 

24 with 1 or more low-income adults or adults with 


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1 disabilities who rely on adult incontinence mate2 rials and supplies. 

3 (C) To integrate activities carried out 

4 under subparagraph (A) with other basic needs 

5 assistance programs serving eligible children 

6 and their families, including the following: 

7 (i) Programs funded by the temporary 

8 assistance for needy families program 

9 under part A of title IV of the Social Secu10 rity Act (42 U.S.C. 601 et seq.), including 

11 the State maintenance of effort provisions 

12 of such program. 

13 (ii) Programs designed to support the 

14 health of eligible children, such as the Chil15 dren’s Health Insurance Program under 

16 title XXI of the Social Security Act, the 

17 Medicaid program under title XIX of such 

18 Act, or State funded health care programs. 

19 (iii) Programs funded through the 

20 special supplemental nutrition program for 

21 women, infants, and children under section 

22 17 of the Child Nutrition Act of 1966. 

23 (iv) Programs that offer early home 

24 visiting services, including the maternal, 

25 infant, and early childhood home visiting 


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1 program (including the Tribal home vis2 iting program) under section 511 of the 

3 Social Security Act (42 U.S.C. 711). 

4 (v) Programs to provide improved and 

5 affordable access to child care, including 

6 programs funded through the Child Care 

7 and Development Fund, the temporary as8 sistance for needy families program under 

9 part A of title IV of the Social Security 

10 Act (42 U.S.C. 601 et seq.), or a State11 funded program. 

12 (3) AVAILABILITY OF FUNDS.— 

13 (A) FUNDS DISTRIBUTED TO ELIGIBLE

14 ENTITIES.—Funds made available under sub15 section (a) that are distributed to an eligible en16 tity by a State for a fiscal year may be ex17 pended by the eligible entity only in such fiscal 

18 year or the succeeding fiscal year. 

19 (B) EVALUATION.—Funds reserved under 

20 subsection (a)(2)(B)(i)(II) to carry out the eval21 uation under subsection (d) shall be available 

22 for expenditure during the 3-year period that 

23 begins on the date of enactment of this Act. 

24 (4) NO EFFECT ON OTHER PROGRAMS.—Any 

25 assistance or benefits received by a family through 


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1 funds made available under subsection (a) shall be 

2 disregarded for purposes of determining the family’s 

3 eligibility for, or amount of, benefits under any other 

4 Federal needs-based programs. 

5 (c) ANNUAL REPORTS.—A State shall include in the 

6 annual report required under section 2006 of the Social 

7 Security Act (42 U.S.C. 1397e) covering each of fiscal 

8 years 2022 through 2025, information detailing how eligi9 ble entities, including subgrantees, used funds made avail10 able under subsection (a) to distribute diapers and dia11 pering supplies and adult incontinence materials and sup12 plies to families in need. Each such report shall include 

13 the following: 

14 (1) The number and age of infants, toddlers, 

15 medically complex children, and low-income adults 

16 and adults with disabilities who received assistance 

17 or benefits through such funds. 

18 (2) The number of families that have received 

19 assistance or benefits through such funds. 

20 (3) The number of diapers, medically necessary 

21 diapers, or adult incontinence materials and supplies 

22 (such as adult diapers, briefs, protective underwear, 

23 pull-ons, pull-ups, liners, shields, guards, pads, un24 dergarments), and the number of each type of diaVerDate Sep 11 2014 19:06 Feb 27, 2021 Jkt 019200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S304.IS S304

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1 pering or adult incontinence supply, distributed 

2 through the use of such funds. 

3 (4) The ZIP Code or ZIP Codes where the eli4 gible entity (or subgrantee) distributed diapers and 

5 diapering supplies and adult incontinence materials 

6 and supplies. 

7 (5) The method or methods the eligible entity 

8 (or subgrantee) uses to distribute diapers and dia9 pering supplies and, adult incontinence materials 

10 and supplies. 

11 (6) Such other information as the Secretary 

12 may specify. 

13 (d) EVALUATION.—The Secretary, in consultation 

14 with States, the national entity described in subsection 

15 (a)(2)(C), and eligible entities receiving funds made avail16 able under this section, shall— 

17 (1) not later than 2 years after the date of en18 actment of this Act— 

19 (A) complete an evaluation of the effective20 ness of the assistance program carried out pur21 suant to this section, such as the effect of ac22 tivities carried out under this Act on mitigating 

23 the health and developmental risks of unmet di24 aper need among infants, toddlers, medically 

25 complex children, and other family members in 


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1 low-income families, including the risks of dia2 per dermatitis, urinary tract infections, and pa3 rental and child depression and anxiety; 

4 (B) submit to the relevant congressional 

5 committees a report on the results of such eval6 uation; and 

7 (C) publish the results of the evaluation on 

8 the internet website of the Department of 

9 Health and Human Services; 

10 (2) not later than 3 years after the date of en11 actment of this Act, update the evaluation required 

12 by paragraph (1)(A); and 

13 (3) not later than 90 days after completion of 

14 the updated evaluation under paragraph (2)— 

15 (A) submit to the relevant congressional 

16 committees a report describing the results of 

17 such updated evaluation; and 

18 (B) publish the results of such evaluation 

19 on the internet website of the Department of 

20 Health and Human Services. 

21 (e) GUIDANCE.—Not later than 180 days after enact22 ment of this Act, the Secretary shall issue guidance re23 garding how the provisions of this section should be car24 ried out, including information regarding eligible entities, 

25 allowable use of funds, and reporting requirements. 


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1 (f) DEFINITIONS.—In this section: 

2 (1) ADULT INCONTINENCE MATERIALS AND

3 SUPPLIES.—The term ‘‘adult incontinence materials 

4 and supplies’’ means those supplies that are used to 

5 assist low-income adults or adults with disabilities 

6 and includes adult diapers, briefs, protective under7 wear, pull-ons, pull-ups, liners, shields, guards, pads, 

8 undergarments, disposable wipes, over-the-counter 

9 adult diaper rash cream products, intermittent cath10 eterization, indwelling catheters, condom catheters, 

11 urinary drainage bags, external collection devices, 

12 wearable urinals, and penile clamps. 

13 (2) ADULTS WITH DISABILITIES.—The term 

14 ‘‘adults with disabilities’’ means individuals who— 

15 (A) have attained age 18; and 

16 (B) have a disability (as such term is de17 fined, with respect to an individual, in section 

18 3 of the Americans with Disabilities Act of 

19 1990 (42 U.S.C. 12102)). 

20 (3) 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 (4) DIAPERING SUPPLIES.—The term ‘‘dia13 pering supplies’’ means items, including diaper wipes 

14 and diaper cream, necessary to ensure that— 

15 (A) an eligible child using a diaper is prop16 erly cleaned and protected from diaper rash; or 

17 (B) a medically complex child who uses a 

18 medically necessary diaper is properly cleaned 

19 and protected from diaper rash. 

20 (5) ELIGIBLE CHILD.—The term ‘‘eligible 

21 child’’ means a child who— 

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

23 (B) is a member of a low-income family. 

24 (6) ELIGIBLE ENTITIES.—The term ‘‘eligible 

25 entity’’ means a State or local governmental entity, 


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1 an Indian tribe or tribal organization (as defined in 

2 section 4 of the Indian Self-Determination and Edu3 cation Assistance Act), or a nonprofit organization 

4 described in section 501(c)(3) of the Internal Rev5 enue Code of 1986 and exempt from taxation under 

6 section 501(a) of such Code that— 

7 (A) has experience in the area of— 

8 (i) community distributions of basic 

9 need services, including experience col10 lecting, warehousing, and distributing basic 

11 necessities such as diapers, food, or men12 strual products; 

13 (ii) child care; 

14 (iii) child development activities in 

15 low-income communities; or 

16 (iv) motherhood, fatherhood, or par17 ent education efforts serving low-income 

18 parents of young children; 

19 (B) demonstrates competency to implement 

20 a project, provide fiscal accountability, collect 

21 data, and prepare reports and other necessary 

22 documentation; and 

23 (C) demonstrates a willingness to share in24 formation with researchers, practitioners, and 

25 other interested parties. 


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1 (7) FEDERAL POVERTY LINE.—The term ‘‘Fed2 eral poverty line’’ means the Federal poverty line as 

3 defined by the Office of Management and Budget 

4 and revised annually in accordance with section 

5 673(2) of the Omnibus Budget Reconciliation Act of 

6 1981 applicable to a family of the size involved. 

7 (8) LOW-INCOME.—The term ‘‘low-income’’, 

8 with respect to a family, means a family whose self9 certified income is not more than 200 percent of the 

10 Federal poverty line. 

11 (9) MEDICALLY COMPLEX CHILD.—The term 

12 ‘‘medically complex child’’ means an individual who 

13 has attained age 3 and for whom a licensed health 

14 care provider has provided a diagnosis of bowel or 

15 bladder incontinence, a bowel or bladder condition 

16 that causes excess urine or stool (such as short gut 

17 syndrome or diabetes insipidus), or a severe skin 

18 condition that causes skin erosions (such as 

19 epidermolysis bullosa). 

20 (10) MEDICALLY NECESSARY DIAPER.—The 

21 term ‘‘medically necessary diaper’’ means an absorb22 ent garment that is— 

23 (A) washable or disposable; 

24 (B) worn by a medically complex child who 

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1 tinence, a bowel or bladder condition that 

2 causes excess urine or stool (such as short gut 

3 syndrome or diabetes insipidus), or a severe 

4 skin condition that causes skin erosions (such 

5 as epidermolysis bullosa) and needs such gar6 ment to correct or ameliorate such condition; 

7 and 

8 (C) if disposable— 

9 (i) does not use any latex or common 

10 allergens; and 

11 (ii) meets or exceeds the quality 

12 standards for diapers commercially avail13 able through retail sale in the following 

14 categories: 

15 (I) Absorbency (with acceptable 

16 rates for first and second wetting). 

17 (II) Waterproof outer cover. 

18 (III) Flexible leg openings. 

19 (IV) Refastening closures. 

20 (g) EXEMPTION OF PROGRAM FROM SEQUESTRA21 TION.— 

22 (1) IN GENERAL.—Section 255(h) of the Bal23 anced Budget and Emergency Deficit Control Act of 

24 1985 (2 U.S.C. 905(h)) is amended by inserting 


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1 after ‘‘Supplemental Security Income Program (28– 

2 0406–0–1–609).’’ the following: 

3 ‘‘Targeted funding for States for diaper assist4 ance (including diapering supplies and adult inconti5 nence materials and supplies) through the Social 

6 Services Block Grant Program.’’. 

7 (2) APPLICABILITY.—The amendment made by 

8 this subsection shall apply to any sequestration 

9 order issued under the Balanced Budget and Emer10 gency Deficit Control Act of 1985 (2 U.S.C. 900 et 

11 seq.) on or after the date of enactment of this Act. 

12 SEC. 3. IMPROVING ACCESS TO DIAPERS FOR MEDICALLY 

13 COMPLEX CHILDREN. 

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

15 1396n(c)) is amended by adding at the end the following 

16 new paragraph: 

17 ‘‘(11)(A) In the case of any waiver under this sub18 section that provides medical assistance to a medically 

19 complex child who has been diagnosed with bowel or blad20 der incontinence, a bowel or bladder condition that causes 

21 excess urine or stool (such as short gut syndrome or diabe22 tes insipidus), or a severe skin condition that causes skin 

23 erosions (such as epidermolysis bullosa), such medical as24 sistance shall include, for the duration of the waiver, the 

25 provision of 200 medically necessary diapers per month 


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1 and diapering supplies. Such medical assistance may in2 clude the provision of medically necessary diapers in 

3 amounts greater than 200 if a licensed health care pro4 vider (such as a physician, nurse practitioner, or physician 

5 assistant) specifies that such greater amounts are nec6 essary for such medically complex child. 

7 ‘‘(B) For purposes of this paragraph: 

8 ‘‘(i) The term ‘medically complex child’ means 

9 an individual who has attained age 3 and for whom 

10 a licensed health care provider has provided a diag11 nosis of 1 or more significant chronic conditions. 

12 ‘‘(ii) The term ‘medically necessary diaper’ 

13 means an absorbent garment that is— 

14 ‘‘(I) washable or disposable; 

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

16 who has been diagnosed with a condition de17 scribed in subparagraph (A) and needs such 

18 garment to correct or ameliorate such condition; 

19 and 

20 ‘‘(III) if disposable— 

21 ‘‘(aa) does not use any latex or com22 mon allergens; and 

23 ‘‘(bb) meets or exceeds the quality 

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1 able through retail sale in the following 

2 categories: 

3 ‘‘(AA) Absorbency (with accept4 able rates for first and second wet5 ting). 

6 ‘‘(BB) Waterproof outer cover. 

7 ‘‘(CC) Flexible leg openings. 

8 ‘‘(DD) Refastening closures. 

9 ‘‘(iii) The term ‘diapering supplies’ means 

10 items, including diaper wipes and diaper creams, 

11 necessary to ensure that a medically complex child 

12 who has been diagnosed with a condition described 

13 in subparagraph (A) and uses a medically necessary 

14 diaper is properly cleaned and protected from diaper 

15 rash.’’. 

16 SEC. 4. INCLUSION OF DIAPERS AND DIAPERING SUPPLIES 

17 AS QUALIFIED MEDICAL EXPENSES. 

18 (a) HEALTH SAVINGS ACCOUNTS.—Section 

19 223(d)(2) of the Internal Revenue Code of 1986 is amend20 ed— 

21 (1) by inserting ‘‘, medically necessary diapers, 

22 and diapering supplies’’ after ‘‘menstrual care prod23 ucts’’ in the last sentence of subparagraph (A); and 

24 (2) by adding at the end the following new sub25 paragraph: 


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1 ‘‘(E) MEDICALLY NECESSARY DIAPERS

2 AND DIAPERING SUPPLIES.—For purposes of 

3 this paragraph— 

4 ‘‘(i) MEDICALLY NECESSARY DIA5 PERS.—The term ‘medically necessary dia6 per’ means an absorbent garment which is 

7 washable or disposable and which is worn 

8 by an individual who has attained 3 years 

9 of age because of medical necessity, such 

10 as someone who has been diagnosed with 

11 bowel or bladder incontinence, a bowel or 

12 bladder condition that causes excess urine 

13 or stool (such as short gut syndrome or di14 abetes insipidus), or a severe skin condi15 tion that causes skin erosions (such as 

16 epidermolysis bullosa) and needs such gar17 ment to correct or ameliorate such condi18 tion, to serve a preventative medical pur19 pose, or to correct or ameliorate defects or 

20 physical or mental illnesses or conditions 

21 diagnosed by a licensed health care pro22 vider, and, if disposable— 

23 ‘‘(I) does not use any latex or 

24 common allergens; and 


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1 ‘‘(II) meets or exceeds the quality 

2 standards for diapers commercially 

3 available through retail sale in the fol4 lowing categories: 

5 ‘‘(aa) Absorbency (with ac6 ceptable rates for first and sec7 ond wetting). 

8 ‘‘(bb) Waterproof outer 

9 cover. 

10 ‘‘(cc) Flexible leg openings. 

11 ‘‘(dd) Refastening closures. 

12 ‘‘(ii) DIAPERING SUPPLIES.—The 

13 term ‘diapering supplies’ means items, in14 cluding diaper wipes and diaper creams, 

15 necessary to ensure that an individual 

16 wearing medically necessary diapers is 

17 properly cleaned and protected from diaper 

18 rash.’’. 

19 (b) ARCHER MSAS.—The last sentence of section 

20 220(d)(2)(A) of such Code is amended by inserting ‘‘, 

21 medically necessary diapers (as defined in section 

22 223(d)(2)(E)), and diapering supplies (as defined in sec23 tion 223(d)(2)(E))’’ after ‘‘menstrual care products (as 

24 defined in section 223(d)(2)(D))’’. 


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1 (c) HEALTH FLEXIBLE SPENDING ARRANGEMENTS

2 AND HEALTH REIMBURSEMENT ARRANGEMENTS.—Sec3 tion 106(f) of such Code is amended— 

4 (1) by inserting ‘‘, medically necessary diapers 

5 (as defined in section 223(d)(2)(E)), and diapering 

6 supplies (as defined in section 223(d)(2)(E))’’ after 

7 ‘‘menstrual care products (as defined in section 

8 223(d)(2)(D))’’; and 

9 (2) in the heading, by inserting ‘‘, MEDICALLY

10 NECESSARY DIAPERS, AND DIAPERING SUPPLIES’’ 

11 after ‘‘MENSTRUAL CARE PRODUCTS’’. 

12 (d) EFFECTIVE DATES.— 

13 (1) DISTRIBUTIONS FROM CERTAIN AC14 COUNTS.—The amendments made by subsections (a) 

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

16 31, 2022. 

17 (2) REIMBURSEMENTS.—The amendment made 

18 by subsection (c) shall apply to expenses incurred 

19 after December 31, 2022. 

Æ 


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