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 avail-
able 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. 
VerDate Sep 11 2014 
00:30 Sep 26, 2023
Jkt 039200
PO 00000
Frm 00001
Fmt 6652
Sfmt 6652
E:\BILLS\H5644.IH
H5644
kjohnson on DSK7ZCZBW3PROD with $$_JOB
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘End Diaper Need Act 
of 2023’’. 
SEC. 2. GRANTS FOR DIAPER ASSISTANCE, INCLUDING DIA-
PERING 
SUPPLIES 
AND 
ADULT 
INCONTI-
NENCE MATERIALS AND SUPPLIES. 
(a) GRANTS.—The Secretary shall make grants to as-
sist eligible entities to help low-income families to address 
the diaper needs of infants and toddlers. 
(b) RESERVATION OF FUNDS.— 
(1) TECHNICAL ASSISTANCE AND TRAINING.— 
The Secretary shall reserve not more than 2 percent 
of the amount made available pursuant to subsection 
(a) for each of fiscal years 2024 through 2027 for 
purposes of entering into an agreement with a na-
tional entity described in subsection (c) to assist in 
providing technical assistance and training, to sup-
port effective policy, practice, research, and cross- 
system collaboration among grantees and sub-
grantees, and to assist in the administration of the 
program described in this section; and 
(2) EVALUATION.—The Secretary shall reserve 
not more than $3,000,000 of the amount made 
VerDate Sep 11 2014 
00:30 Sep 26, 2023
Jkt 039200
PO 00000
Frm 00002
Fmt 6652
Sfmt 6201
E:\BILLS\H5644.IH
H5644
kjohnson on DSK7ZCZBW3PROD with $$_JOB
available pursuant to subsection (a) for fiscal year 
2024 for purposes of conducting an evaluation under 
subsection (f). 
(c) NATIONAL ENTITY DESCRIBED.—A national enti-
ty described in this subsection is a nonprofit organization 
described in section 501(c)(3) of the Internal Revenue 
Code of 1986 and exempt from taxation under section 
501(a) of such Code, that— 
(1) has experience in more than 1 State in the 
area of— 
(A) community distributions of basic need 
services, 
including 
experience 
collecting, 
warehousing, and distributing basic necessities 
such as diapers, food, or menstrual products; 
(B) child care; 
(C) child development activities in low-in-
come communities; or 
(D) motherhood, fatherhood, or parent 
education efforts serving low-income parents of 
young children; 
(2) demonstrates competency to implement a 
project, provide fiscal accountability, collect data, 
and prepare reports and other necessary documenta-
tion; and 
VerDate Sep 11 2014 
00:30 Sep 26, 2023
Jkt 039200
PO 00000
Frm 00003
Fmt 6652
Sfmt 6201
E:\BILLS\H5644.IH
H5644
kjohnson on DSK7ZCZBW3PROD with $$_JOB
(3) demonstrates a willingness to share infor-
mation with researchers, practitioners, and other in-
terested parties. 
(d) USE OF FUNDS.— 
(1) IN GENERAL.—An eligible entity to which a 
grant is made under this section shall use the grant 
in accordance with this subsection. 
(2) RULES GOVERNING USE OF FUNDS.— 
(A) IN GENERAL.—Funds are used in ac-
cordance with this subsection if— 
(i) the State, in consultation with rel-
evant stakeholders, including agencies, pro-
fessional associations, and nonprofit orga-
nizations, distributes the funds to eligible 
entities to— 
(I) decrease the need for diapers 
and diapering supplies and adult in-
continence materials and supplies in 
low-income families and meet such 
unmet needs of infants and toddlers, 
medically complex children, and low- 
income adults and adults with disabil-
ities in such families through— 
(aa) the distribution of free 
diapers and diapering supplies, 
VerDate Sep 11 2014 
00:30 Sep 26, 2023
Jkt 039200
PO 00000
Frm 00004
Fmt 6652
Sfmt 6201
E:\BILLS\H5644.IH
H5644
kjohnson on DSK7ZCZBW3PROD with $$_JOB
medically necessary diapers, and 
adult incontinence materials and 
supplies; and 
(bb) improving access to dia-
pers 
and 
diapering 
supplies, 
medically necessary diapers, and 
adult incontinence materials and 
supplies; 
(II) carry out community out-
reach to assist in participation in dia-
per distribution programs or pro-
grams that distribute medically nec-
essary diapers or adult incontinence 
materials and supplies; and 
(III) increase the ability of com-
munities and low-income families in 
such communities to provide for the 
need for diapers and diapering sup-
plies, medically necessary diapers, and 
adult continence materials and sup-
plies, of infants and toddlers, medi-
cally complex children, and low-income 
adults and adults with disabilities; 
VerDate Sep 11 2014 
00:30 Sep 26, 2023
Jkt 039200
PO 00000
Frm 00005
Fmt 6652
Sfmt 6201
E:\BILLS\H5644.IH
H5644
kjohnson on DSK7ZCZBW3PROD with $$_JOB
(ii) the funds are used subject to the 
limitations in section 2005 of the Social 
Security Act (42 U.S.C. 1397d); and 
(iii) the funds are used to supplement, 
not supplant, State general revenue funds 
provided for the purposes described in 
clause (i). 
(B) ADMINISTRATIVE COSTS.—A State re-
ceiving funds made available under subsection 
(a) may use not more than 5 percent of the 
funds for State administrative costs, which may 
include costs of contracting, monitoring, and re-
porting. 
(C) ALLOWABLE USES BY ELIGIBLE ENTI-
TIES.—An eligible entity receiving funds made 
available under subsection (a) shall use the 
funds for any of the following: 
(i) To pay for the purchase and dis-
tribution of diapers and diapering supplies, 
medically necessary diapers, and funding 
diaper (including medically necessary dia-
pers) distribution that serves low-income 
families with— 
(I) 1 or more children 3 years of 
age or younger; or 
VerDate Sep 11 2014 
00:30 Sep 26, 2023
Jkt 039200
PO 00000
Frm 00006
Fmt 6652
Sfmt 6201
E:\BILLS\H5644.IH
H5644
kjohnson on DSK7ZCZBW3PROD with $$_JOB
(II) 1 or more medically complex 
children. 
(ii) To pay for the purchase and dis-
tribution of adult incontinence materials 
and supplies and funding distribution of 
the materials and supplies for low-income 
families with 1 or more low-income adults, 
adults with disabilities, or children with a 
disability who have attained 3 years of age 
and have not attained 19 years of age, who 
rely on adult incontinence materials and 
supplies. 
(iii) To integrate activities carried out 
under clause (i) with other basic needs as-
sistance programs serving eligible children 
and their families, including the following: 
(I) Programs funded by the tem-
porary assistance for needy families 
program under part A of title IV of 
the Social Security Act (42 U.S.C. 
601 et seq.), including the State 
maintenance of effort provisions of 
such program. 
(II) Programs designed to sup-
port the health of eligible children, 
VerDate Sep 11 2014 
00:30 Sep 26, 2023
Jkt 039200
PO 00000
Frm 00007
Fmt 6652
Sfmt 6201
E:\BILLS\H5644.IH
H5644
kjohnson on DSK7ZCZBW3PROD with $$_JOB
such as the Children’s Health Insur-
ance Program under title XXI of the 
Social Security Act, the Medicaid pro-
gram under title XIX of such Act, or 
State funded health care programs. 
(III) Programs funded through 
the special supplemental nutrition 
program for women, infants, and chil-
dren under section 17 of the Child 
Nutrition Act of 1966. 
(IV) Programs that offer early 
home visiting services, including the 
maternal, infant, and early childhood 
home visiting program (including the 
Tribal home visiting program) under 
section 511 of the Social Security Act 
(42 U.S.C. 711). 
(V) Programs to provide im-
proved and affordable access to child 
care, 
including 
programs 
funded 
through the Child Care and Develop-
ment Fund, the temporary assistance 
for needy families program under part 
A of title IV of the Social Security 
VerDate Sep 11 2014 
00:30 Sep 26, 2023
Jkt 039200
PO 00000
Frm 00008
Fmt 6652
Sfmt 6201
E:\BILLS\H5644.IH
H5644
kjohnson on DSK7ZCZBW3PROD with $$_JOB
Act (42 U.S.C. 601 et seq.), or a 
State-funded program. 
(VI) Programs funded under part 
C of the Individuals with Disabilities 
Education Act (20 U.S.C. 1431 et 
seq.). 
(D) AVAILABILITY OF FUNDS.— 
(i) FUNDS DISTRIBUTED TO ELIGIBLE 
ENTITIES.—Funds made available under 
subsection (a) that are distributed to an el-
igible entity by a State for a fiscal year 
may be expended by the eligible entity only 
in such fiscal year or the succeeding fiscal 
year. 
(ii) EVALUATION.—Funds reserved 
under subsection (b)(2) to carry out the 
evaluation under subsection (f) shall be 
available for expenditure during the 3-year 
period that begins on the date of enact-
ment of this Act. 
(E) NO EFFECT ON OTHER PROGRAMS.— 
Any assistance or benefits received by a family 
through funds made available under subsection 
(a) shall be disregarded for purposes of deter-
mining the family’s eligibility for, or amount of, 
VerDate Sep 11 2014 
00:30 Sep 26, 2023
Jkt 039200
PO 00000
Frm 00009
Fmt 6652
Sfmt 6201
E:\BILLS\H5644.IH
H5644
kjohnson on DSK7ZCZBW3PROD with $$_JOB
benefits under any other Federal needs-based 
programs. 
(e) ANNUAL REPORTS.—A State shall include in the 
annual report required under section 2006 of the Social 
Security Act (42 U.S.C. 1397e) covering each of fiscal 
years 2022 through 2025, information detailing how eligi-
ble entities, including subgrantees, used funds made avail-
able under subsection (a) to distribute diapers and dia-
pering supplies and adult incontinence materials and sup-
plies to families in need. Each such report shall include 
the following: 
(1) The number and age of infants, toddlers, 
medically complex children, and low-income adults 
and adults with disabilities who received assistance 
or benefits through such funds. 
(2) The number of families that have received 
assistance or benefits through such funds. 
(3) The number of diapers, medically necessary 
diapers, or adult incontinence materials and supplies 
(such as adult diapers, briefs, protective underwear, 
pull-ons, pull-ups, liners, shields, guards, pads, un-
dergarments), and the number of each type of dia-
pering or adult incontinence supply, distributed 
through the use of such funds. 
VerDate Sep 11 2014 
00:30 Sep 26, 2023
Jkt 039200
PO 00000
Frm 00010
Fmt 6652
Sfmt 6201
E:\BILLS\H5644.IH
H5644
kjohnson on DSK7ZCZBW3PROD with $$_JOB
(4) The ZIP Code or ZIP Codes where the eli-
gible entity (or subgrantee) distributed diapers and 
diapering supplies and adult incontinence materials 
and supplies. 
(5) The method or methods the eligible entity 
(or subgrantee) uses to distribute diapers and dia-
pering supplies and, adult incontinence materials 
and supplies. 
(6) Such other information as the Secretary 
may specify. 
(f) EVALUATION.—The Secretary, in consultation 
with States, the national entity described in subsection (c), 
and eligible entities receiving funds made available under 
this section, shall— 
(1) not later than 2 years after the date of en-
actment of this Act— 
(A) complete an evaluation of the effective-
ness of the assistance program carried out pur-
suant to this section, such as the effect of ac-
tivities carried out under this Act on mitigating 
the health and developmental risks of unmet di-
aper need among infants, toddlers, medically 
complex children, and other family members in 
low-income families, including the risks of dia-
VerDate Sep 11 2014 
00:30 Sep 26, 2023
Jkt 039200
PO 00000
Frm 00011
Fmt 6652
Sfmt 6201
E:\BILLS\H5644.IH
H5644
kjohnson on DSK7ZCZBW3PROD with $$_JOB
per dermatitis, urinary tract infections, and pa-
rental and child depression and anxiety; 
(B) submit to the relevant congressional 
committees a report on the results of such eval-
uation; and 
(C) publish the results of the evaluation on 
the internet website of the Department of 
Health and Human Services; 
(2) not later than 3 years after the date of en-
actment of this Act, update the evaluation required 
by paragraph (1)(A); and 
(3) not later than 120 days after completion of 
the updated evaluation under paragraph (2)— 
(A) submit to the relevant congressional 
committees a report describing the results of 
such updated evaluation; and 
(B) publish the results of such evaluation 
on the internet website of the Department of 
Health and Human Services. 
(g) GUIDANCE.—Not later than 180 days after enact-
ment of this Act, the Secretary shall issue guidance re-
garding how the provisions of this section should be car-
ried out, including information regarding eligible entities, 
allowable use of funds, and reporting requirements. 
(h) DEFINITIONS.—In this section: 
VerDate Sep 11 2014 
00:30 Sep 26, 2023
Jkt 039200
PO 00000
Frm 00012
Fmt 6652
Sfmt 6201
E:\BILLS\H5644.IH
H5644
kjohnson on DSK7ZCZBW3PROD with $$_JOB
(1) ADULT
INCONTINENCE
MATERIALS
AND 
SUPPLIES.—The term ‘‘adult incontinence materials 
and supplies’’ means those supplies that are used to 
assist adults or adults with disabilities and includes 
adult diapers, briefs, protective underwear, pull-ons, 
pull-ups, liners, shields, guards, pads, undergar-
ments, disposable wipes, over-the-counter adult dia-
per rash cream products, intermittent catheteriza-
tion, indwelling catheters, condom catheters, urinary 
drainage bags, external collection devices, wearable 
urinals, and penile clamps. 
(2) ADULTS
WITH
DISABILITIES.—The term 
‘‘adults with disabilities’’ means individuals who— 
(A) have attained 18 years of age; and 
(B) have a disability (as such term is de-
fined, with respect to an individual, in section 
3 of the Americans with Disabilities Act of 
1990 (42 U.S.C. 12102)). 
(3) DIAPER.—The term ‘‘diaper’’ means an ab-
sorbent garment that— 
(A) is washable or disposable that may be 
worn by an infant or toddler who is not toilet- 
trained; and 
(B) if disposable— 
VerDate Sep 11 2014 
00:30 Sep 26, 2023
Jkt 039200
PO 00000
Frm 00013
Fmt 6652
Sfmt 6201
E:\BILLS\H5644.IH
H5644
kjohnson on DSK7ZCZBW3PROD with $$_JOB
(i) does not use any latex or common 
allergens; and 
(ii) meets or exceeds the quality 
standards for diapers commercially avail-
able through retail sale in the following 
categories: 
(I) Absorbency (with acceptable 
rates for first and second wetting). 
(II) Waterproof outer cover. 
(III) Flexible leg openings. 
(IV) Refastening closures. 
(4) DIAPERING
SUPPLIES.—The term ‘‘dia-
pering supplies’’ means items, including diaper wipes 
and diaper cream, necessary to ensure that— 
(A) an eligible child using a diaper is prop-
erly cleaned and protected from diaper rash; or 
(B) a medically complex child who uses a 
medically necessary diaper is properly cleaned 
and protected from diaper rash. 
(5) ELIGIBLE
CHILD.—The term ‘‘eligible 
child’’ means a child who— 
(A) has not attained 4 years of age; and 
(B) is a member of a low-income family. 
(6) ELIGIBLE
ENTITIES.—The term ‘‘eligible 
entity’’ means a State or local governmental entity, 
VerDate Sep 11 2014 
00:30 Sep 26, 2023
Jkt 039200
PO 00000
Frm 00014
Fmt 6652
Sfmt 6201
E:\BILLS\H5644.IH
H5644
kjohnson on DSK7ZCZBW3PROD with $$_JOB
an Indian tribe or tribal organization (as defined in 
section 4 of the Indian Self-Determination and Edu-
cation Assistance Act), or a nonprofit organization 
described in section 501(c)(3) of the Internal Rev-
enue Code of 1986 and exempt from taxation under 
section 501(a) of such Code that— 
(A) has experience in the area of— 
(i) community distributions of basic 
need services, including experience col-
lecting, warehousing, and distributing basic 
necessities such as diapers, food, or men-
strual products; 
(ii) child care; 
(iii) child development activities in 
low-income communities; or 
(iv) motherhood, fatherhood, or par-
ent education efforts serving low-income 
parents of young children; 
(B) demonstrates competency to implement 
a project, provide fiscal accountability, collect 
data, and prepare reports and other necessary 
documentation; and 
(C) demonstrates a willingness to share in-
formation with researchers, practitioners, and 
other interested parties. 
VerDate Sep 11 2014 
00:30 Sep 26, 2023
Jkt 039200
PO 00000
Frm 00015
Fmt 6652
Sfmt 6201
E:\BILLS\H5644.IH
H5644
kjohnson on DSK7ZCZBW3PROD with $$_JOB
(7) FEDERAL POVERTY LINE.—The term ‘‘Fed-
eral poverty line’’ means the Federal poverty line as 
defined by the Office of Management and Budget 
and revised annually in accordance with section 
673(2) of the Omnibus Budget Reconciliation Act of 
1981 (42 U.S.C. 9902(2)) applicable to a family of 
the size involved. 
(8) LOW-INCOME.—The term ‘‘low-income’’, 
with respect to a family, means a family whose self- 
certified income is not more than 200 percent of the 
Federal poverty line. 
(9) MEDICALLY
COMPLEX
CHILD.—The term 
‘‘medically complex child’’ means an individual who 
has attained 3 years of age and for whom a licensed 
health care provider has provided a diagnosis of 1 or 
more significant chronic conditions. 
(10) MEDICALLY
NECESSARY
DIAPER.—The 
term ‘‘medically necessary diaper’’ means an absorb-
ent garment that is— 
(A) washable or disposable; 
(B) worn by a medically complex child who 
has been diagnosed with bowel or bladder incon-
tinence, a bowel or bladder condition that 
causes excess urine or stool (such as short gut 
syndrome or diabetes insipidus), or a severe 
VerDate Sep 11 2014 
00:30 Sep 26, 2023
Jkt 039200
PO 00000
Frm 00016
Fmt 6652
Sfmt 6201
E:\BILLS\H5644.IH
H5644
kjohnson on DSK7ZCZBW3PROD with $$_JOB
skin condition that causes skin erosions (such 
as epidermolysis bullosa) and needs such gar-
ment to correct or ameliorate such condition; 
and 
(C) if disposable— 
(i) does not use any latex or common 
allergens; and 
(ii) meets or exceeds the quality 
standards for diapers commercially avail-
able through retail sale in the following 
categories: 
(I) Absorbency (with acceptable 
rates for first and second wetting). 
(II) Waterproof outer cover. 
(III) Flexible leg openings. 
(IV) Refastening closures. 
(11) STATE.—The term ‘‘State’’ means the 50 
States, the District of Columbia, the Commonwealth 
of Puerto Rico the United States Virgin Islands, 
Guam, the Commonwealth of the Northern Mariana 
Islands, American Samoa, the Republic of the Mar-
shall Islands, the Federated States of Micronesia, 
and the Republic of Palau. 
(i) LIMITATIONS ON AUTHORIZATION OF APPROPRIA-
TIONS.—To carry out this section, there is authorized to 
VerDate Sep 11 2014 
00:30 Sep 26, 2023
Jkt 039200
PO 00000
Frm 00017
Fmt 6652
Sfmt 6201
E:\BILLS\H5644.IH
H5644
kjohnson on DSK7ZCZBW3PROD with $$_JOB