I 
114TH CONGRESS 
1ST SESSION H. R. 4055 
To amend title IV of the Social Security 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, which prevents their parents 
and guardians from entering the workforce. 
IN THE HOUSE OF REPRESENTATIVES 
NOVEMBER 18, 2015 
Mr. ELLISON (for himself, Ms. DELAURO, Mr. GRIJALVA, Mr. PETERS, Mr. 
CA´RDENAS, Mr. CARSON of Indiana, Mr. MCGOVERN, Ms. MENG, Ms. 
CLARKE of New York, Ms. LEE, Mr. POCAN, Ms. KAPTUR, Ms. NORTON, 
Mr. NADLER, Mr. HASTINGS, Mr. CONYERS, Ms. MICHELLE LUJAN 
GRISHAM of New Mexico, Ms. JUDY CHU of California, Ms. EDWARDS, 
and Mr. VAN HOLLEN) introduced the following bill; which was referred 
to the Committee on Ways and Means 
A BILL 
To amend title IV of the Social Security 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, 
which prevents their parents and guardians from enter-
ing the workforce. 
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Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Hygiene Assistance 
for Families of Infants and Toddlers Act of 2015’’. 
SEC. 2. FINDINGS. 
Congress finds the following: 
(1) Access to a reliable supply of clean diapers 
is a medical necessity for the health and welfare of 
infants and toddlers, their families, and child care 
and health care providers, yet in a representative 
survey of mothers in the United States, 1 in 3 moth-
ers reported having to cut back on essentials in 
order to afford enough diapers for a child. 
(2) In the United States, most children begin 
toilet training between 2 and 3 years of age, and 
after toilet training is complete, the child will not 
need diapers. Families with infants and toddlers are 
more likely to be economically disadvantaged than 
other families. Infants and toddlers are more likely 
to live with low-income and poor families than older 
children, 25 percent of infants and toddlers live with 
families earning less than the Federal poverty level, 
and 47 percent of infants and toddlers live with fam-
ilies earning less than twice the Federal poverty 
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level. There are over 980,000 infants and toddlers 
who are recipients of assistance under the program 
of block grants to States for temporary assistance 
for needy families (TANF), over one-third of all 
families enrolled in such a State program include an 
infant or toddler, and the average monthly diaper 
bill of $70 to $80 represents at least 8 percent and 
up to 40 percent of the average amount of cash as-
sistance provided to a family through such a State 
program. 
(3) The average monthly diaper bill of $70 to 
$80 represents 6 percent of the pretax income of a 
parent working full time for Federal minimum wage. 
Approximately 46 percent of low-income children 
and 26 percent of poor infants and toddlers live with 
at least 1 parent who is employed full time and year 
round, and only 47 percent of low-income children 
and 35 percent of poor infants and toddlers live with 
married parents. 
(4) Without child care, parents and guardians 
of infants and toddlers cannot participate in the 
workforce, but most child care providers require par-
ents to provide a supply of clean disposable diapers 
for their children. In a 2014 survey of 1,129 clients 
of 8 large diaper banks conducted by the National 
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Diaper Bank Network, 12.4 percent of respondents 
indicated that the respondent was unable to leave a 
child at a child care provider at least 1 day a month 
because the respondent’s child lacked diapers, and 
47.5 percent of respondents said that the diapers re-
ceived from the diaper bank enabled the respondent 
to go to work. Therefore, increasing availability of 
clean diapers for needy infants and toddlers furthers 
the national goal of enabling parents to participate 
in the workforce to increase their economic self-suffi-
ciency, and enables better implementation of title I 
of the Personal Responsibility and Work Oppor-
tunity Reconciliation Act of 1996. 
(5) Increasing the availability of clean diapers 
for needy infants and toddlers furthers the national 
goal of increasing access to safe and quality child 
care for all families, and therefore enables better im-
plementation of the Child Care and Development 
Block Grant Act of 1990. 
(6) Insufficient diaper changes can lead to not 
only increased irritability and discomfort of a child, 
leading to increased parental stress, but also to dia-
per dermatitis, skin breakdown, open sores with a 
risk of infection, and urinary tract infections for the 
child, which require medical attention. In a survey 
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commissioned by Feeding America in 2011, 48 per-
cent of food bank clients surveyed said they would 
delay changing a diaper and 32 percent said they 
would reuse disposable diapers in order to make 
their diaper supply last longer. This increases the 
risk of negative health outcomes for children and 
their families. 
(7) A study from the Yale School of Medicine 
found a direct correlation between lacking enough 
clean diapers to change a child’s diapers as often as 
required—a condition called ‘‘diaper need’’—and 
maternal depression, which can adversely affect ma-
ternal-child bonding, a mother’s ability to care for 
her child, and a mother’s ability to work outside the 
home. 
(8) Diapers have proven to be valuable incen-
tives in smoking cessation programs, parenting 
training programs, and other programs promoting 
positive and healthy behaviors. 
(9) Increasing the availability of clean diapers 
for needy families furthers public health by pro-
viding improved health outcomes for children, reduc-
ing visits to the emergency room, and reducing pa-
rental stress and depression. 
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SEC. 3. IMPROVING OPPORTUNITY DIAPER DEMONSTRA-
TION PROJECT. 
(a) IN GENERAL.—Section 403 of the Social Security 
Act (42 U.S.C. 603) is amended by adding at the end the 
following: 
‘‘(c) DIAPER BENEFIT DEMONSTRATION PROJECT.— 
‘‘(1) IN GENERAL.—The Secretary shall make 
grants to States to conduct demonstration projects 
to implement and evaluate strategies to help families 
with eligible children address the diapering supply 
needs of such children. 
‘‘(2) APPLICATION
REQUIREMENTS.—A State 
desiring a grant under this subsection shall submit 
to the Secretary an application that includes the fol-
lowing: 
‘‘(A) A description of how the State will 
use the grant funds to develop a diaper dis-
tribution program that will provide sufficient 
diapers and diapering supplies to each partici-
pating family so that each eligible child in the 
family receives, for each month in which the 
child participates in the program, not less than 
the lesser of— 
‘‘(i) 50 percent of the diaper changes 
required for a month for a healthy child of 
similar age and size; or 
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‘‘(ii) 100 percent of the actual diaper 
changes required for the child for the 
month. 
‘‘(B) A description of how the State will 
coordinate with other State and Federal assist-
ance programs and agencies (particularly other 
programs and agencies targeted at assisting in-
fants, toddlers, or the parents or guardians of 
infants or toddlers) that provide benefits and 
services to families participating in the diaper 
distribution program, to integrate the distribu-
tion of diapers and diapering supplies with the 
delivery of such other benefits and services, for 
the purpose of— 
‘‘(i) helping participating families to 
use effectively the benefits they receive 
under the diaper distribution program; and 
‘‘(ii) removing barriers to the partici-
pation of such families in activities such as 
child care, training, and work activities. 
‘‘(C) A description of how the State will 
evaluate the extent to which the diaper distribu-
tion program increases the efficacy, and affects 
the participation rates, of other State and Fed-
eral assistance programs in the State. 
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‘‘(D) A description of how the State will 
provide for the delivery of benefits under the di-
aper distribution program, which may include— 
‘‘(i) cash assistance to be used to pur-
chase diapers and diapering supplies; 
‘‘(ii) vouchers, coupons, electronic 
benefit transfer systems, or any other non- 
cash method to be used to purchase dia-
pers and diapering supplies, except that 
the State may not require a store to cover 
the cost of any equipment, system, or proc-
essing required for any such method as a 
condition of participation in the program; 
‘‘(iii) assistance in distributing dia-
pers and diapering supplies from any pro-
gram or agency the State considers appro-
priate, which may include— 
‘‘(I) State or Federal child care 
programs; 
‘‘(II) work programs or father-
hood initiative programs, if the State 
explains the method it intends to use 
to ensure that diapers and diapering 
supplies distributed through these 
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programs are used by the eligible 
child who is the intended recipient; 
‘‘(III) home visiting programs; 
‘‘(IV) family resource centers; 
‘‘(V) Federal and State health 
clinics; and 
‘‘(VI) community service centers; 
‘‘(iv) the distribution of diapers and 
diapering supplies at diaper banks or 
through other nonprofit organizations de-
scribed in section 501(c)(3) of the Internal 
Revenue Code of 1986 and exempt from 
taxation under section 501(a) of such 
Code, including through the assistance of 
other State or Federal agencies that part-
ner with such organizations to assist with 
diaper and diapering supply distribution; 
and 
‘‘(v) the distribution of diapers and 
diapering supplies at any other location or 
through any other means that will allow 
the State to deliver diapers and diapering 
supplies to participating families without 
undue inconvenience. 
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‘‘(E) A description of whether the State 
will provide a cloth diapering system, a dispos-
able diapering system, or both, and in cases in 
which the State provides a cloth diapering sys-
tem, an explanation of how the State will pro-
vide for diaper cleaning services if requested by 
the parent or guardian. 
‘‘(F) A description of how the State will 
ensure that the diapering system or systems 
provided meet the requirements of licensed child 
care facilities in the State, such that the type 
of diapers and diapering supplies provided do 
not prevent participating families from enrolling 
eligible children in such a facility. 
‘‘(3) USE OF FUNDS.—A State to which a grant 
is made under this subsection shall use the grant 
funds to carry out a diaper distribution program in 
accordance with the State grant application ap-
proved by the Secretary, as provided in paragraph 
(2). 
‘‘(4) PROGRAM ADMINISTRATION.— 
‘‘(A) STATE
TANF
AGENCY
AS
PRIMARY 
ADMINISTRATOR.—Subject 
to 
subparagraph 
(B), a State diaper distribution program carried 
out pursuant to this subsection shall be carried 
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out by the State agency responsible for admin-
istering the State program funded under this 
part. 
‘‘(B) AUTHORITY TO SUBGRANT AND COL-
LABORATE.—In carrying out such diaper dis-
tribution program, the State agency described 
in subparagraph (A) may collaborate with, and 
the State may make a subgrant to, such public 
and nonprofit entities as the State considers ap-
propriate, including State agencies, local gov-
ernments, 
community-based 
organizations, 
Community Action Agencies, child care agen-
cies, food assistance agencies, and other non-
profit 
organizations 
described 
in 
section 
501(c)(3) of the Internal Revenue Code of 1986 
and exempt from taxation under section 501(a) 
of such Code. 
‘‘(5) 
CERTIFICATION
OF
BENEFIT
ELIGI-
BILITY.—A State to which a grant is made under 
this subsection may require, as a condition of receiv-
ing benefits under a State diaper distribution pro-
gram, that participating families provide to the 
State such information at such times as the State 
considers necessary to determine whether a child in 
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‘‘(II) update the website de-
scribed in clause (i)(II) to include the 
results of the final evaluation. 
‘‘(8) 
APPLICABILITY
OF
CERTAIN
PROVI-
SIONS.— 
‘‘(A) DIAPER BENEFITS NOT COUNTED AS 
ASSISTANCE.—Benefits provided under a State 
diaper distribution program conducted pursuant 
to this subsection shall not be counted as assist-
ance under a State program funded under this 
part (or any other State program funded with 
qualified State expenditures (as defined in sec-
tion 409(a)(7)(B)(i))). 
‘‘(B) RULES CONCERNING GRANTS INAP-
PLICABLE.—Sections 404 and 409(a)(4) shall 
not apply with respect to a grant made under 
this subsection. 
‘‘(9) REGULATIONS.—The Secretary of Health 
and Human Services may prescribe such regulations 
as may be necessary to implement this subsection. 
‘‘(10) DEFINITIONS.—In this subsection: 
‘‘(A) The term ‘diaper’ means an absorb-
ent garment that is washable or disposable that 
is worn by a child who cannot control bladder 
or bowel movements. 
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‘‘(B) The term ‘diapering supplies’ means 
items, including diaper wipes and diaper cream, 
necessary to ensure that a child using a diaper 
is properly cleaned and protected from diaper 
rash, and that the surrounding population is 
protected from harmful bacteria originating 
from dirty diapers. 
‘‘(C) The term ‘diapering system’ means a 
method of providing an adequate supply of 
clean, properly sized diapers and diapering sup-
plies. In the case of washable cloth diapers, this 
method includes the laundering of diapers to 
ensure a sufficient supply of clean diapers and 
waterproof covers. 
‘‘(D) The term ‘eligible child’ means a 
child who— 
‘‘(i) is not toilet-trained; 
‘‘(ii) has not attained 3 years of age, 
unless the State determines that the child 
has a substantial physical or mental im-
pairment that requires the child to wear 
diapers; and 
‘‘(iii) is— 
‘‘(I) a recipient of, or is eligible 
to receive, assistance under a State 
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program funded under this part (or 
any other State program funded with 
qualified State expenditures (as de-
fined in section 409(a)(7)(B)(i))), or 
is a member of a family that meets 
the income eligibility requirements of 
such State program; or 
‘‘(II) a member of a family whose 
income is not more than 130 percent 
of the poverty line (as defined by the 
Office of Management and Budget, 
and revised annually in accordance 
with section 673(2) of the Omnibus 
Budget Reconciliation Act of 1981) 
applicable to a family of the size in-
volved. 
‘‘(E) The term ‘infant’ means a child who 
has not attained 1 year of age. 
‘‘(F) 
The 
term 
‘participating 
family’ 
means a family that includes an eligible child 
participating in a State diaper distribution pro-
gram carried out pursuant to this subsection. 
‘‘(G) The term ‘State’ means each of the 
50 States, the District of Columbia, Puerto 
Rico, Guam, the United States Virgin Islands, 
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the 
Northern 
Mariana 
Islands, 
American 
Samoa, and Indian tribes and tribal organiza-
tions. 
‘‘(H) The term ‘toddler’ means a child who 
has attained 1 year of age but has not attained 
3 years of age. 
‘‘(I) The term ‘toilet-trained’ means able 
and willing to use a toilet consistently such that 
diapers are not necessary on a daily basis. 
‘‘(11) APPROPRIATION.—Out of any funds in 
the Treasury of the United States not otherwise ap-
propriated, there are appropriated for each of fiscal 
years 2017 through 2021 $75,000,000 to carry out 
this subsection. 
‘‘(12) AVAILABILITY OF FUNDS.—Funds pro-
vided to a State under this subsection for a fiscal 
year may be expended only in the fiscal year or the 
succeeding fiscal year.’’. 
(b) DIAPER BENEFITS EXEMPTED FROM TERRI-
TORIAL PAYMENT CEILING.—Section 1108(a)(2) of such 
Act (42 U.S.C. 1308(a)(2)) is amended by inserting 
‘‘403(c),’’ after ‘‘403(a)(5),’’. 
Æ 
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