I 

109TH CONGRESS 

1ST SESSION H. R. 1613 

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 

APRIL 13, 2005 

Mr. KENNEDY of Rhode Island (for himself, Mr. FRANK of Massachusetts, 

Mr. HINCHEY, Ms. MILLENDER-MCDONALD, Ms. LEE, Ms. JACKSONLEE of Texas, Mr. GEORGE MILLER of California, Mr. MCDERMOTT, Mr. 

GRIJALVA, Ms. LINDA T. SA ́NCHEZ of California, Mr. OWENS, Ms. 

WOOLSEY, Mr. KUCINICH, Mr. PLATTS, Mr. ABERCROMBIE, Mr. 

WEXLER, Mrs. LOWEY, Mr. HIGGINS, Mr. HINOJOSA, and Mr. SERRANO) 

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’’. 
2 

•HR 1613 IH 

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 such 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-
3 

•HR 1613 IH 

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) eligible child care providers and the 

25 staff of such providers that meet any applicable 
4 

•HR 1613 IH 

1 criteria established in accordance with sub2 section (c) and received assistance under this 

3 part during 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) eligible child care providers that meet 

9 any applicable criteria established in accordance 

10 with subsection (c) and— 

11 ‘‘(i) as part of a statewide tiering sys12 tem, are designated by a State licensing 

13 authority (or an entity acting on the 

14 authority’s behalf) as a top-tier child care 

15 facility; or 

16 ‘‘(ii) have not less than 40 percent en17 rollment of children who receive govern18 mental financial assistance for the child 

19 care involved; 

20 ‘‘(B) the staff of such providers; and 

21 ‘‘(C) at the State’s discretion, the spouses, 

22 domestic partners, and dependents of such pro23 viders and staff. 

24 ‘‘(e) MATCHING FUNDS.— 
5 

•HR 1613 IH 

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

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

3 a funding agreement for a grant under section 1981 

4 is that the State involved will make available (di5 rectly or through donations from public or private 

6 entities) non-Federal contributions toward such 

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

8 of such costs. 

9 ‘‘(2) DETERMINATION OF AMOUNT CONTRIB10 UTED.—Non-Federal contributions under paragraph 

11 (1) may be in cash or in kind, fairly evaluated, in12 cluding plant, equipment, or services. Amounts pro13 vided by the Federal Government, or services as14 sisted or subsidized to any significant extent by the 

15 Federal Government, may not be included in deter16 mining the amount of such contributions. 

17 ‘‘(f) SUPPLEMENT NOT SUPPLANT.—Amounts pro18 vided to a State under this part shall be used to supple19 ment and not supplant other Federal, State, and local 

20 public funds provided for activities under this part. 

21 ‘‘SEC. 1983. APPLICATION. 

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

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

24 if— 
6 

•HR 1613 IH 

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

2 in such manner, and containing such information as 

3 the Secretary may require; 

4 ‘‘(2) the application contains each funding 

5 agreement that is described in section 1982; and 

6 ‘‘(3) with respect to each such funding agree7 ment, the application provides assurances of compli8 ance satisfactory to the Secretary. 

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

10 ‘‘(a) AMOUNTS RESERVED.— 

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

12 Secretary shall reserve not to exceed one half of 1 

13 percent of the amount appropriated pursuant to sec14 tion 1986 in each fiscal year for payments to Guam, 

15 American Samoa, the Virgin Islands of the United 

16 States, and the Commonwealth of the Northern 

17 Mariana Islands to be allotted in accordance with 

18 their respective needs. 

19 ‘‘(2) INDIAN TRIBES.—The Secretary shall re20 serve not less than 1 percent, and not more than 2 

21 percent, of the amount appropriated pursuant to 

22 section 1986 in each fiscal year for payments to In23 dian tribes and tribal organizations, to be allotted in 

24 accordance with their respective needs. 

25 ‘‘(b) STATE ALLOTMENT.— 
7 

•HR 1613 IH 

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

2 amounts appropriated pursuant to section 1986 for 

3 each fiscal year after reservations under subsection 

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

5 amount equal to the sum of— 

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

7 to 50 percent of such remainder as the product 

8 of the young child factor of the State and the 

9 allotment percentage of the State bears to the 

10 sum of the corresponding products for all 

11 States; and 

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

13 to 50 percent of such remainder as the product 

14 of the school lunch factor of the State and the 

15 allotment percentage of the State bears to the 

16 sum of the corresponding products for all 

17 States. 

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

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

20 the ratio of the number of children in the State 

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

22 in all States as provided by the most recent annual 

23 estimates of population in the States by the Census 

24 Bureau of the Department of Commerce. 
8 

•HR 1613 IH 

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

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

3 means the ratio of the number of children in the 

4 State who are receiving free or reduced price lunches 

5 under the school lunch program established under 

6 the Richard B. Russell National School Lunch Act 

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

8 determined annually by the Department of Agri9 culture. 

10 ‘‘(4) ALLOTMENT PERCENTAGE.— 

11 ‘‘(A) IN GENERAL.—The allotment per12 centage for a State is determined by dividing 

13 the per capita income of all individuals in the 

14 United States, by the per capita income of all 

15 individuals in the State. 

16 ‘‘(B) LIMITATIONS.—If an allotment per17 centage determined under subparagraph (A)— 

18 ‘‘(i) exceeds 1.2 percent, then the al19 lotment percentage of that State shall be 

20 considered to be 1.2 percent; or 

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

22 allotment percentage of the State shall be 

23 considered to be 0.8 percent. 

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

25 of subparagraph (A), per capita income— 
9 

•HR 1613 IH 

1 ‘‘(i) shall be determined at 2-year in2 tervals; 

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

4 period beginning on October 1 of the first 

5 fiscal year beginning on the date such de6 termination is made; and 

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

8 the annual per capita incomes for the most 

9 recent period of 3 consecutive years for 

10 which satisfactory data are available from 

11 the Department of Commerce at the time 

12 such determination is made. 

13 ‘‘(c) ALLOCATION OF EXCESS FUNDS.—To the ex14 tent that all the funds appropriated under section 1986 

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

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

17 States have not submitted an application in accordance 

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

19 States have notified the Secretary that they do not intend 

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

21 be allotted among each of the remaining States in propor22 tion to the amount otherwise allotted to such States for 

23 the fiscal year without regard to this subsection. 

24 ‘‘SEC. 1985. DEFINITIONS. 

25 ‘‘In this part: 
10 

•HR 1613 IH 

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

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

3 child care provider (whether an entity or individual) 

4 that is licensed or otherwise regulated under State 

5 law and meets all applicable State and local health 

6 and safety requirements. 

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

8 means an individual who provides child care services 

9 for fewer than 24 hours per day, as the sole care10 giver, and in a private residence. 

11 ‘‘(3) The terms ‘Indian tribe’ and ‘tribal organi12 zation’ have the same meaning given such terms in 

13 section 4 of the Indian Self-Determination and Edu14 cation Assistance Act. 

15 ‘‘(4)(A) Except for purposes of determining al16 lotments under subsections (a) and (b) of section 

17 1984, the term ‘State’ means each of the several 

18 States, the District of Columbia, the Commonwealth 

19 of Puerto Rico, Guam, American Samoa, the Virgin 

20 Islands of the United States, the Commonwealth of 

21 the Northern Mariana Islands, and each Indian tribe 

22 or tribal organization. 

23 ‘‘(B) For purposes of determining allotments 

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

25 term ‘State’ means each of the several States, the 
11 

•HR 1613 IH 

1 District of Columbia, and the Commonwealth of 

2 Puerto Rico. 

3 ‘‘SEC. 1986. AUTHORIZATION OF APPROPRIATIONS. 

4 ‘‘There are authorized to be appropriated to the Sec5 retary to carry out this part $200,000,000 for fiscal year 

6 2006, $250,000,000 for fiscal year 2007, $300,000,000 

7 for fiscal year 2008, $400,000,000 for fiscal year 2009, 

8 and such sums as may be necessary for fiscal year 2010.’’. 

9 SEC. 3. EVALUATION OF BLOCK GRANT PROGRAM BY SEC10 RETARY. 

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

12 Human Services shall conduct an evaluation of several 

13 State programs carried out with grants under part D of 

14 title XIX of the Public Health Service Act, representing 

15 various approaches to raising the rate of child care work16 ers with health benefits coverage. 

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

18 programs under subsection (a), the Secretary may con19 sider any information appropriate to measure the success 

20 of the programs, and shall assess the impact of the pro21 grams on the following: 

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

23 benefits coverage. 

24 (2) The rate of child care workers with other 

25 benefits coverage, such as paid leave. 
12 

•HR 1613 IH 

1 (3) The take-up rate by eligible child care pro2 viders. 

3 (4) The turnover rate in the field. 

4 (5) The average wages paid. 

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

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

7 Human Services shall submit a report to the Congress on 

8 the results of the evaluation conducted under subsection 

9 (a), together with recommendations for strengthening pro10 grams carried out with grants under part D of title XIX 

11 of the Public Health Service Act. 

Æ