I 

116TH CONGRESS 

1ST SESSION H. R. 1846 

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 

MARCH 21, 2019 

Ms. LEE of California (for herself, Ms. MOORE, Mr. KHANNA, Ms. OMAR, Mr. 

HASTINGS, Ms. NORTON, Ms. JACKSON LEE, Mr. MCNERNEY, Mr. NADLER, Mr. RUSH, Mr. COHEN, Mrs. CAROLYN B. MALONEY of New York, 

Ms. PRESSLEY, Mrs. KIRKPATRICK, Mr. GRIJALVA, Mr. TAKANO, Ms. 

WILD, Mr. POCAN, Ms. OCASIO-CORTEZ, Ms. JAYAPAL, Ms. MCCOLLUM, 

Ms. SCHAKOWSKY, Mr. PETERS, Ms. SEWELL of Alabama, and Ms. 

DELAURO) 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. 


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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 2019’’. 

6 SEC. 2. DIAPER DISTRIBUTION DEMONSTRATION PROJECT. 

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

8 (42 U.S.C. 280g et seq.) is amended by adding at the end 

9 the following: 

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

11 PROGRAM. 

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

13 grants to assist eligible entities to conduct demonstration 

14 projects that implement and evaluate strategies to help 

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

16 and toddlers. 

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

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

19 ‘‘(1) consult with relevant stakeholders, includ20 ing agencies, professional associations, and nonprofit 

21 organizations, on the design of the program; and 

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

23 program— 


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

2 families and meets the unmet diaper needs of 

3 infants and toddlers in such families through— 

4 ‘‘(i) the distribution of free diapers 

5 and diapering supplies; 

6 ‘‘(ii) community outreach to assist in 

7 participation in existing diaper distribution 

8 programs; or 

9 ‘‘(iii) improving access to diapers and 

10 diapering supplies as part of a comprehen11 sive service; and 

12 ‘‘(B) increases the abilities of communities 

13 and low-income families in those communities 

14 to provide for the diaper needs of infants and 

15 toddlers in those communities. 

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

17 under this section, an entity shall— 

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

19 Indian Tribe or tribal organization (as defined in 

20 section 4 of the Indian Self-Determination and Edu21 cation Assistance Act), or a nonprofit organization 

22 described in section 501(c)(3) of the Internal Rev23 enue Code of 1986 and exempt from taxation under 

24 section 501(a) of such Code; 

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


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1 ‘‘(A) community distributions of basic need 

2 services, including experience collecting, 

3 warehousing, and distributing basic necessities 

4 such as diapers, food, or menstrual products; 

5 ‘‘(B) child care; 

6 ‘‘(C) child development activities in low-in7 come communities; or 

8 ‘‘(D) motherhood, fatherhood, or parent9 education efforts serving low-income parents of 

10 young children; 

11 ‘‘(3) demonstrate competency to implement a 

12 project, provide fiscal accountability, collect data, 

13 and prepare reports and other necessary documenta14 tion; 

15 ‘‘(4) demonstrate a willingness to share infor16 mation with researchers, practitioners, and other in17 terested parties; and 

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

19 the design of the evaluation to be carried out under 

20 subsection (d)(2) and receive the Secretary’s ap21 proval of such design based on a determination that 

22 such design is rigorous and is likely to yield informa23 tion that is credible and will be useful to other 

24 States. 


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

2 grant under this section shall be used to conduct a dem3 onstration project to implement and evaluate strategies to 

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

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

6 following: 

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

8 diapering supplies and fund diaper distribution dem9 onstration projects that serve low-income families 

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

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

12 funds received by the grantee under this section, to 

13 evaluate the effect of activities under paragraph (1) 

14 on mitigating the health and developmental risks of 

15 unmet diaper need among infants, toddlers, and 

16 other family members in low-income families, includ17 ing the risks of diaper dermatitis, urinary tract in18 fections, and parental and child depression and anx19 iety. 

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

21 with other basic needs assistance programs serving 

22 eligible children and their families, including the fol23 lowing: 


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1 ‘‘(A) Programs funded by the Temporary 

2 Assistance for Needy Families program, includ3 ing its State maintenance of effort provisions. 

4 ‘‘(B) Programs designed to support the 

5 health of eligible children, such as the Chil6 dren’s Health Insurance Program under title 

7 XXI of the Social Security Act, the Medicaid 

8 program under title XIX of such Act, or State9 funded health care programs. 

10 ‘‘(C) Programs funded through the Special 

11 Supplemental Nutrition Program for Women, 

12 Infants, and Children. 

13 ‘‘(D) Programs that offer early home vis14 iting services, including the Nurse-Family Part15 nership and the Maternal, Infant, and Early 

16 Childhood Home Visiting (MIECHV) Program 

17 (including the Tribal Home Visiting Program). 

18 ‘‘(E) Programs to provide improved and 

19 affordable access to child care, including pro20 grams funded through the Child Care and De21 velopment Fund, the Temporary Assistance for 

22 Needy Families program, or a State-funded 

23 program. 

24 ‘‘(e) NO EFFECT ON OTHER PROGRAMS.—Any as25 sistance or benefits received by a family as a result of a 


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1 project established pursuant to this section shall be dis2 regarded for purposes of determining the family’s eligi3 bility for, or amount of, benefits under any other Federal 

4 needs-based programs. 

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

6 under this section for a fiscal year, the grantee shall sub7 mit to the Secretary, not later than 6 months after the 

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

9 and fiscal year, the following: 

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

11 the age of the infant and toddlers who received as12 sistance from the grantee’s diaper distribution 

13 project. 

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

15 assistance from the grantee’s diaper distribution 

16 project. 

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

18 each type of diapering supply, distributed under the 

19 grantee’s diaper distribution project. 

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

21 grantee distributed diapers and diaper supplies. 

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

23 to distribute diapers and diapering supplies. 

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

25 may specify. 


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

2 with each grantee under this section, shall— 

3 ‘‘(1) not later than 2 years after the date of en4 actment of the End Diaper Need Act of 2019— 

5 ‘‘(A) complete an evaluation of the effec6 tiveness of the program carried out pursuant to 

7 this section; 

8 ‘‘(B) submit to the relevant congressional 

9 committees a report on the results of such eval10 uation; and 

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

12 on the internet website of the Department of 

13 Health and Human Services; and 

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

15 enactment of the End Diaper Need Act of 2019, up16 date the evaluation required by paragraph (1)(A); 

17 and 

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

19 the updated evaluation under subparagraph (A)— 

20 ‘‘(i) submit to the relevant congressional 

21 committees a report describing the results of 

22 such updated evaluation; and 

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

24 on the internet website of the Department of 

25 Health and Human Services. 


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

2 ‘‘(1) DIAPER.—The term ‘diaper’ means an ab3 sorbent garment that— 

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

5 worn by an infant or toddler who is not toilet6 trained; and 

7 ‘‘(B) if disposable— 

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

9 allergens; and 

10 ‘‘(ii) meets or exceeds the quality 

11 standards for diapers commercially avail12 able through retail sale in the following 

13 categories: 

14 ‘‘(I) Absorbency (with acceptable 

15 rates for first and second wetting). 

16 ‘‘(II) Waterproof outer cover. 

17 ‘‘(III) Flexible leg openings. 

18 ‘‘(IV) Refastening closures. 

19 ‘‘(2) DIAPERING SUPPLIES.—The term ‘dia20 pering supplies’ means items, including diaper wipes 

21 and diaper cream, necessary to ensure that a child 

22 using a diaper is properly cleaned and protected 

23 from diaper rash. 

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

25 child’ means a child who— 


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

2 ‘‘(B) is a member of a family whose self3 certified income is not more than 200 percent 

4 of the Federal poverty line. 

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

6 ‘Federal poverty line’ means the Federal poverty line 

7 as defined by the Office of Management and Budget 

8 and revised annually in accordance with section 

9 673(2) of the Omnibus Budget Reconciliation Act of 

10 1981 applicable to a family of the size involved. 

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

12 with respect to a family, means a family whose self13 certified income is not more than 200 percent of the 

14 Federal poverty line. 

15 ‘‘(i) AUTHORIZATION OF APPROPRIATIONS.— 

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

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

18 for each of fiscal years 2020 through 2023. 

19 ‘‘(2) AVAILABILITY OF FUNDS.—Funds pro20 vided to a grantee under this section for a fiscal 

21 year may be expended by the grantee only in such 

22 fiscal year or the succeeding fiscal year.’’. 


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1 SEC. 3. IMPROVING ACCESS TO DIAPERS FOR MEDICALLY 

2 COMPLEX CHILDREN. 

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

4 1396n(c)) is amended by adding at the end the following 

5 new paragraph: 

6 ‘‘(11)(A) In the case of any waiver under this sub7 section that provides medical assistance to a medically 

8 complex child who has been diagnosed with bowel or blad9 der incontinence, a bowel or bladder condition that causes 

10 excess urine or stool (such as short gut syndrome or diabe11 tes insipidus), or a severe skin condition that causes skin 

12 erosions (such as epidermolysis bullosa), such medical as13 sistance shall include, for the duration of the waiver, the 

14 provision of 200 medically necessary diapers per month 

15 and diapering supplies. Such medical assistance may in16 clude the provision of medically necessary diapers in 

17 amounts greater than 200 if a licensed health care pro18 vider (such as a physician, nurse practitioner, or physician 

19 assistant) specifies that such greater amounts are nec20 essary for such medically complex child. 

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

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

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

24 for whom a licensed health care provider has pro25 vided a diagnosis of one or more significant chronic 

26 conditions; 


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

2 means an absorbent garment that is— 

3 ‘‘(I) washable or disposable; and 

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

5 who has been diagnosed with a condition de6 scribed in subparagraph (A) and needs such 

7 garment to correct or ameliorate such condition; 

8 and 

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

10 including diaper wipes and diaper creams, necessary 

11 to ensure that a medically complex child who has 

12 been diagnosed with a condition described in sub13 paragraph (A) and uses a medically necessary diaper 

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

15 SEC. 4. INCLUSION OF DIAPERS AND DIAPERING SUPPLIES 

16 AS QUALIFIED MEDICAL EXPENSES. 

17 (a) HEALTH SAVINGS ACCOUNTS.—Section 

18 223(d)(2) of the Internal Revenue Code of 1986 is amend19 ed— 

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

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

22 amounts paid for medically necessary diapers and 

23 diapering supplies shall be treated as paid for med24 ical care.’’; and 


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1 (2) by adding at the end the following new sub2 paragraph: 

3 ‘‘(D) MEDICALLY NECESSARY DIAPERS

4 AND DIAPERING SUPPLIES.—For purposes of 

5 this paragraph— 

6 ‘‘(i) MEDICALLY NECESSARY DIA7 PERS.—The term ‘medically necessary dia8 per’ means an absorbent garment that is 

9 washable or disposable worn by an indi10 vidual who has attained 3 years of age and 

11 needs diapers because they are medically 

12 necessary, serve a preventative medical 

13 purpose, or are needed to correct or ame14 liorate defects or physical or mental ill15 nesses or conditions which are diagnosed 

16 by a licenced health care provider. 

17 ‘‘(ii) DIAPERING SUPPLIES.—The 

18 term ‘diapering supplies’ means items, in19 cluding diaper wipes and diaper creams 

20 necessary to ensure that a child using a 

21 medically necessary diaper is properly 

22 cleaned and protected from diaper rash.’’. 

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

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

25 purposes of this subparagraph, amounts paid for medically 


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1 necessary diapers and diapering supplies (as defined in 

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

3 care.’’. 

4 (c) HEALTH FLEXIBLE SPENDING ARRANGEMENTS

5 AND HEALTH REIMBURSEMENT ARRANGEMENTS.—Sec6 tion 106 of such Code is amended by adding at the end 

7 the following new subsection: 

8 ‘‘(f) REIMBURSEMENTS FOR MEDICALLY NECESSARY

9 DIAPERS AND DIAPERING SUPPLIES.—For purposes of 

10 this section and section 105, expenses incurred for medi11 cally necessary diapers and diapering supplies (as defined 

12 in section 223(d)(2)(D)) shall be treated as incurred for 

13 medical care.’’. 

14 (d) EFFECTIVE DATES.— 

15 (1) DISTRIBUTIONS FROM HEALTH SAVINGS AC16 COUNTS.—The amendments made by subsections (a) 

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

18 31, 2020. 

19 (2) REIMBURSEMENTS.—The amendment made 

20 by subsection (c) shall apply to expenses incurred 

21 after December 31, 2020. 

Æ 


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