I 

118TH CONGRESS 

1ST SESSION H. R. 5644 

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 HOUSE OF REPRESENTATIVES 

SEPTEMBER 21, 2023 

Ms. LEE of California 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 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 2023’’. 

6 SEC. 2. GRANTS FOR DIAPER ASSISTANCE, INCLUDING DIA7 PERING SUPPLIES AND ADULT INCONTI8 NENCE MATERIALS AND SUPPLIES. 

9 (a) GRANTS.—The Secretary shall make grants to as10 sist eligible entities to help low-income families to address 

11 the diaper needs of infants and toddlers. 

12 (b) RESERVATION OF FUNDS.— 

13 (1) TECHNICAL ASSISTANCE AND TRAINING.— 

14 The Secretary shall reserve not more than 2 percent 

15 of the amount made available pursuant to subsection 

16 (a) for each of fiscal years 2024 through 2027 for 

17 purposes of entering into an agreement with a na18 tional entity described in subsection (c) to assist in 

19 providing technical assistance and training, to sup20 port effective policy, practice, research, and cross21 system collaboration among grantees and sub22 grantees, and to assist in the administration of the 

23 program described in this section; and 

24 (2) EVALUATION.—The Secretary shall reserve 

25 not more than $3,000,000 of the amount made 


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1 available pursuant to subsection (a) for fiscal year 

2 2024 for purposes of conducting an evaluation under 

3 subsection (f). 

4 (c) NATIONAL ENTITY DESCRIBED.—A national enti5 ty described in this subsection is a nonprofit organization 

6 described in section 501(c)(3) of the Internal Revenue 

7 Code of 1986 and exempt from taxation under section 

8 501(a) of such Code, that— 

9 (1) has experience in more than 1 State in the 

10 area of— 

11 (A) community distributions of basic need 

12 services, including experience collecting, 

13 warehousing, and distributing basic necessities 

14 such as diapers, food, or menstrual products; 

15 (B) child care; 

16 (C) child development activities in low-in17 come communities; or 

18 (D) motherhood, fatherhood, or parent 

19 education efforts serving low-income parents of 

20 young children; 

21 (2) demonstrates competency to implement a 

22 project, provide fiscal accountability, collect data, 

23 and prepare reports and other necessary documenta24 tion; and 


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1 (3) demonstrates a willingness to share infor2 mation with researchers, practitioners, and other in3 terested parties. 

4 (d) USE OF FUNDS.— 

5 (1) IN GENERAL.—An eligible entity to which a 

6 grant is made under this section shall use the grant 

7 in accordance with this subsection. 

8 (2) RULES GOVERNING USE OF FUNDS.— 

9 (A) IN GENERAL.—Funds are used in ac10 cordance with this subsection if— 

11 (i) the State, in consultation with rel12 evant stakeholders, including agencies, pro13 fessional associations, and nonprofit orga14 nizations, distributes the funds to eligible 

15 entities to— 

16 (I) decrease the need for diapers 

17 and diapering supplies and adult in18 continence materials and supplies in 

19 low-income families and meet such 

20 unmet needs of infants and toddlers, 

21 medically complex children, and low22 income adults and adults with disabil23 ities in such families through— 

24 (aa) the distribution of free 

25 diapers and diapering supplies, 


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1 medically necessary diapers, and 

2 adult incontinence materials and 

3 supplies; and 

4 (bb) improving access to dia5 pers and diapering supplies, 

6 medically necessary diapers, and 

7 adult incontinence materials and 

8 supplies; 

9 (II) carry out community out10 reach to assist in participation in dia11 per distribution programs or pro12 grams that distribute medically nec13 essary diapers or adult incontinence 

14 materials and supplies; and 

15 (III) increase the ability of com16 munities and low-income families in 

17 such communities to provide for the 

18 need for diapers and diapering sup19 plies, medically necessary diapers, and 

20 adult continence materials and sup21 plies, of infants and toddlers, medi22 cally complex children, and low-income 

23 adults and adults with disabilities; 


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1 (ii) the funds are used subject to the 

2 limitations in section 2005 of the Social 

3 Security Act (42 U.S.C. 1397d); and 

4 (iii) the funds are used to supplement, 

5 not supplant, State general revenue funds 

6 provided for the purposes described in 

7 clause (i). 

8 (B) ADMINISTRATIVE COSTS.—A State re9 ceiving funds made available under subsection 

10 (a) may use not more than 5 percent of the 

11 funds for State administrative costs, which may 

12 include costs of contracting, monitoring, and re13 porting. 

14 (C) ALLOWABLE USES BY ELIGIBLE ENTI15 TIES.—An eligible entity receiving funds made 

16 available under subsection (a) shall use the 

17 funds for any of the following: 

18 (i) To pay for the purchase and dis19 tribution of diapers and diapering supplies, 

20 medically necessary diapers, and funding 

21 diaper (including medically necessary dia22 pers) distribution that serves low-income 

23 families with— 

24 (I) 1 or more children 3 years of 

25 age or younger; or 


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1 (II) 1 or more medically complex 

2 children. 

3 (ii) To pay for the purchase and dis4 tribution of adult incontinence materials 

5 and supplies and funding distribution of 

6 the materials and supplies for low-income 

7 families with 1 or more low-income adults, 

8 adults with disabilities, or children with a 

9 disability who have attained 3 years of age 

10 and have not attained 19 years of age, who 

11 rely on adult incontinence materials and 

12 supplies. 

13 (iii) To integrate activities carried out 

14 under clause (i) with other basic needs as15 sistance programs serving eligible children 

16 and their families, including the following: 

17 (I) Programs funded by the tem18 porary assistance for needy families 

19 program under part A of title IV of 

20 the Social Security Act (42 U.S.C. 

21 601 et seq.), including the State 

22 maintenance of effort provisions of 

23 such program. 

24 (II) Programs designed to sup25 port the health of eligible children, 


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1 such as the Children’s Health Insur2 ance Program under title XXI of the 

3 Social Security Act, the Medicaid pro4 gram under title XIX of such Act, or 

5 State funded health care programs. 

6 (III) Programs funded through 

7 the special supplemental nutrition 

8 program for women, infants, and chil9 dren under section 17 of the Child 

10 Nutrition Act of 1966. 

11 (IV) Programs that offer early 

12 home visiting services, including the 

13 maternal, infant, and early childhood 

14 home visiting program (including the 

15 Tribal home visiting program) under 

16 section 511 of the Social Security Act 

17 (42 U.S.C. 711). 

18 (V) Programs to provide im19 proved and affordable access to child 

20 care, including programs funded 

21 through the Child Care and Develop22 ment Fund, the temporary assistance 

23 for needy families program under part 

24 A of title IV of the Social Security 


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1 Act (42 U.S.C. 601 et seq.), or a 

2 State-funded program. 

3 (VI) Programs funded under part 

4 C of the Individuals with Disabilities 

5 Education Act (20 U.S.C. 1431 et 

6 seq.). 

7 (D) AVAILABILITY OF FUNDS.— 

8 (i) FUNDS DISTRIBUTED TO ELIGIBLE

9 ENTITIES.—Funds made available under 

10 subsection (a) that are distributed to an el11 igible entity by a State for a fiscal year 

12 may be expended by the eligible entity only 

13 in such fiscal year or the succeeding fiscal 

14 year. 

15 (ii) EVALUATION.—Funds reserved 

16 under subsection (b)(2) to carry out the 

17 evaluation under subsection (f) shall be 

18 available for expenditure during the 3-year 

19 period that begins on the date of enact20 ment of this Act. 

21 (E) NO EFFECT ON OTHER PROGRAMS.— 

22 Any assistance or benefits received by a family 

23 through funds made available under subsection 

24 (a) shall be disregarded for purposes of deter25 mining the family’s eligibility for, or amount of, 


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1 benefits under any other Federal needs-based 

2 programs. 

3 (e) ANNUAL REPORTS.—A State shall include in the 

4 annual report required under section 2006 of the Social 

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

6 years 2022 through 2025, information detailing how eligi7 ble entities, including subgrantees, used funds made avail8 able under subsection (a) to distribute diapers and dia9 pering supplies and adult incontinence materials and sup10 plies to families in need. Each such report shall include 

11 the following: 

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

13 medically complex children, and low-income adults 

14 and adults with disabilities who received assistance 

15 or benefits through such funds. 

16 (2) The number of families that have received 

17 assistance or benefits through such funds. 

18 (3) The number of diapers, medically necessary 

19 diapers, or adult incontinence materials and supplies 

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

21 pull-ons, pull-ups, liners, shields, guards, pads, un22 dergarments), and the number of each type of dia23 pering or adult incontinence supply, distributed 

24 through the use of such funds. 


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1 (4) The ZIP Code or ZIP Codes where the eli2 gible entity (or subgrantee) distributed diapers and 

3 diapering supplies and adult incontinence materials 

4 and supplies. 

5 (5) The method or methods the eligible entity 

6 (or subgrantee) uses to distribute diapers and dia7 pering supplies and, adult incontinence materials 

8 and supplies. 

9 (6) Such other information as the Secretary 

10 may specify. 

11 (f) EVALUATION.—The Secretary, in consultation 

12 with States, the national entity described in subsection (c), 

13 and eligible entities receiving funds made available under 

14 this section, shall— 

15 (1) not later than 2 years after the date of en16 actment of this Act— 

17 (A) complete an evaluation of the effective18 ness of the assistance program carried out pur19 suant to this section, such as the effect of ac20 tivities carried out under this Act on mitigating 

21 the health and developmental risks of unmet di22 aper need among infants, toddlers, medically 

23 complex children, and other family members in 

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1 per dermatitis, urinary tract infections, and pa2 rental and child depression and anxiety; 

3 (B) submit to the relevant congressional 

4 committees a report on the results of such eval5 uation; and 

6 (C) publish the results of the evaluation on 

7 the internet website of the Department of 

8 Health and Human Services; 

9 (2) not later than 3 years after the date of en10 actment of this Act, update the evaluation required 

11 by paragraph (1)(A); and 

12 (3) not later than 120 days after completion of 

13 the updated evaluation under paragraph (2)— 

14 (A) submit to the relevant congressional 

15 committees a report describing the results of 

16 such updated evaluation; and 

17 (B) publish the results of such evaluation 

18 on the internet website of the Department of 

19 Health and Human Services. 

20 (g) GUIDANCE.—Not later than 180 days after enact21 ment of this Act, the Secretary shall issue guidance re22 garding how the provisions of this section should be car23 ried out, including information regarding eligible entities, 

24 allowable use of funds, and reporting requirements. 

25 (h) DEFINITIONS.—In this section: 


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1 (1) ADULT INCONTINENCE MATERIALS AND

2 SUPPLIES.—The term ‘‘adult incontinence materials 

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

4 assist adults or adults with disabilities and includes 

5 adult diapers, briefs, protective underwear, pull-ons, 

6 pull-ups, liners, shields, guards, pads, undergar7 ments, disposable wipes, over-the-counter adult dia8 per rash cream products, intermittent catheteriza9 tion, indwelling catheters, condom catheters, urinary 

10 drainage bags, external collection devices, wearable 

11 urinals, and penile clamps. 

12 (2) ADULTS WITH DISABILITIES.—The term 

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

14 (A) have attained 18 years of age; and 

15 (B) have a disability (as such term is de16 fined, with respect to an individual, in section 

17 3 of the Americans with Disabilities Act of 

18 1990 (42 U.S.C. 12102)). 

19 (3) DIAPER.—The term ‘‘diaper’’ means an ab20 sorbent garment that— 

21 (A) is washable or disposable that may be 

22 worn by an infant or toddler who is not toilet23 trained; and 

24 (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 (42 U.S.C. 9902(2)) applicable to a family of 

7 the size involved. 

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

9 with respect to a family, means a family whose self10 certified income is not more than 200 percent of the 

11 Federal poverty line. 

12 (9) MEDICALLY COMPLEX CHILD.—The term 

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

14 has attained 3 years of age and for whom a licensed 

15 health care provider has provided a diagnosis of 1 or 

16 more significant chronic conditions. 

17 (10) MEDICALLY NECESSARY DIAPER.—The 

18 term ‘‘medically necessary diaper’’ means an absorb19 ent garment that is— 

20 (A) washable or disposable; 

21 (B) worn by a medically complex child who 

22 has been diagnosed with bowel or bladder incon23 tinence, a bowel or bladder condition that 

24 causes excess urine or stool (such as short gut 

25 syndrome or diabetes insipidus), or a severe 


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1 skin condition that causes skin erosions (such 

2 as epidermolysis bullosa) and needs such gar3 ment to correct or ameliorate such condition; 

4 and 

5 (C) if disposable— 

6 (i) does not use any latex or common 

7 allergens; and 

8 (ii) meets or exceeds the quality 

9 standards for diapers commercially avail10 able through retail sale in the following 

11 categories: 

12 (I) Absorbency (with acceptable 

13 rates for first and second wetting). 

14 (II) Waterproof outer cover. 

15 (III) Flexible leg openings. 

16 (IV) Refastening closures. 

17 (11) STATE.—The term ‘‘State’’ means the 50 

18 States, the District of Columbia, the Commonwealth 

19 of Puerto Rico the United States Virgin Islands, 

20 Guam, the Commonwealth of the Northern Mariana 

21 Islands, American Samoa, the Republic of the Mar22 shall Islands, the Federated States of Micronesia, 

23 and the Republic of Palau. 

24 (i) LIMITATIONS ON AUTHORIZATION OF APPROPRIA25 TIONS.—To carry out this section, there is authorized to 


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1 be appropriated $200,000,000 for each of fiscal years 

2 2024 through 2027. 

3 (j) EXEMPTION OF PROGRAM FROM SEQUESTRA4 TION.— 

5 (1) IN GENERAL.—Section 255(h) of the Bal6 anced Budget and Emergency Deficit Control Act of 

7 1985 (2 U.S.C. 905(h)) is amended by inserting 

8 after ‘‘Supplemental Security Income Program (28– 

9 0406–0–1–609).’’ the following: 

10 ‘‘Targeted funding for States for diaper assist11 ance, including diapering supplies and adult inconti12 nence materials and supplies.’’. 

13 (2) APPLICABILITY.—The amendment made by 

14 this subsection shall apply to any sequestration 

15 order issued under the Balanced Budget and Emer16 gency Deficit Control Act of 1985 (2 U.S.C. 900 et 

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

18 SEC. 3. IMPROVING ACCESS TO DIAPERS FOR MEDICALLY 

19 COMPLEX CHILDREN. 

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

21 1396n(c)) is amended by adding at the end the following 

22 new paragraph: 

23 ‘‘(11)(A) In the case of any waiver under this sub24 section that provides medical assistance to a medically 

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1 der incontinence, a bowel or bladder condition that causes 

2 excess urine or stool (such as short gut syndrome or diabe3 tes insipidus), or a severe skin condition that causes skin 

4 erosions (such as epidermolysis bullosa), such medical as5 sistance shall include, for the duration of the waiver, the 

6 provision of 200 medically necessary diapers per month 

7 and diapering supplies. Such medical assistance may in8 clude the provision of medically necessary diapers in 

9 amounts greater than 200 if a licensed health care pro10 vider (such as a physician, nurse practitioner, or physician 

11 assistant) specifies that such greater amounts are nec12 essary for such medically complex child. 

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

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

15 an individual who has attained age 3 and for whom 

16 a licensed health care provider has provided a diag17 nosis of 1 or more significant chronic conditions. 

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

19 means an absorbent garment that is— 

20 ‘‘(I) washable or disposable; 

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

22 who has been diagnosed with a condition de23 scribed in subparagraph (A) and needs such 

24 garment to correct or ameliorate such condition; 

25 and 


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1 ‘‘(III) if disposable— 

2 ‘‘(aa) does not use any latex or com3 mon allergens; and 

4 ‘‘(bb) meets or exceeds the quality 

5 standards for diapers commercially avail6 able through retail sale in the following 

7 categories: 

8 ‘‘(AA) Absorbency (with accept9 able rates for first and second wet10 ting). 

11 ‘‘(BB) Waterproof outer cover. 

12 ‘‘(CC) Flexible leg openings. 

13 ‘‘(DD) Refastening closures. 

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

15 items, including diaper wipes and diaper creams, 

16 necessary to ensure that a medically complex child 

17 who has been diagnosed with a condition described 

18 in subparagraph (A) and uses a medically necessary 

19 diaper is properly cleaned and protected from diaper 

20 rash.’’. 

21 SEC. 4. INCLUSION OF DIAPERS AND DIAPERING SUPPLIES 

22 AS QUALIFIED MEDICAL EXPENSES. 

23 (a) HEALTH SAVINGS ACCOUNTS.—Section 

24 223(d)(2) of the Internal Revenue Code of 1986 is amend25 ed— 


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

2 and diapering supplies’’ after ‘‘menstrual care prod3 ucts’’ in the last sentence of subparagraph (A); and 

4 (2) by adding at the end the following new sub5 paragraph: 

6 ‘‘(E) MEDICALLY NECESSARY DIAPERS

7 AND DIAPERING SUPPLIES.—For purposes of 

8 this paragraph— 

9 ‘‘(i) MEDICALLY NECESSARY DIA10 PERS.—The term ‘medically necessary dia11 per’ means an absorbent garment which is 

12 washable or disposable and which is worn 

13 by an individual who has attained 3 years 

14 of age because of medical necessity, such 

15 as someone who has been diagnosed with 

16 bowel or bladder incontinence, a bowel or 

17 bladder condition that causes excess urine 

18 or stool (such as short gut syndrome or di19 abetes insipidus), or a severe skin condi20 tion that causes skin erosions (such as 

21 epidermolysis bullosa) and needs such gar22 ment to correct or ameliorate such condi23 tion, to serve a preventative medical pur24 pose, or to correct or ameliorate defects or 

25 physical or mental illnesses or conditions 


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1 diagnosed by a licensed health care pro2 vider, and, if disposable— 

3 ‘‘(I) does not use any latex or 

4 common allergens; and 

5 ‘‘(II) meets or exceeds the quality 

6 standards for diapers commercially 

7 available through retail sale in the fol8 lowing categories: 

9 ‘‘(aa) Absorbency (with ac10 ceptable rates for first and sec11 ond wetting). 

12 ‘‘(bb) Waterproof outer 

13 cover. 

14 ‘‘(cc) Flexible leg openings. 

15 ‘‘(dd) Refastening closures. 

16 ‘‘(ii) DIAPERING SUPPLIES.—The 

17 term ‘diapering supplies’ means items, in18 cluding diaper wipes and diaper creams, 

19 necessary to ensure that an individual 

20 wearing medically necessary diapers is 

21 properly cleaned and protected from diaper 

22 rash.’’. 

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

24 220(d)(2)(A) of such Code is amended by inserting ‘‘, 

25 medically necessary diapers (as defined in section 


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1 223(d)(2)(E)), and diapering supplies (as defined in sec2 tion 223(d)(2)(E))’’ after ‘‘menstrual care products (as 

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

4 (c) HEALTH FLEXIBLE SPENDING ARRANGEMENTS

5 AND HEALTH REIMBURSEMENT ARRANGEMENTS.—Sec6 tion 106(f) of such Code is amended— 

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

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

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

10 ‘‘menstrual care products (as defined in section 

11 223(d)(2)(D))’’; and 

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

13 NECESSARY DIAPERS, AND DIAPERING SUPPLIES’’ 

14 after ‘‘MENSTRUAL CARE PRODUCTS’’. 

15 (d) EFFECTIVE DATES.— 

16 (1) DISTRIBUTIONS FROM CERTAIN AC17 COUNTS.—The amendments made by subsections (a) 

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

19 31, 2024. 

20 (2) REIMBURSEMENTS.—The amendment made 

21 by subsection (c) shall apply to expenses incurred 

22 after December 31, 2024. 

Æ 


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