I 
107TH CONGRESS 
2D SESSION 
H. R. 5674
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 
OCTOBER 16, 2002
Mr. KENNEDY of Rhode Island 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.
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 ‘‘Healthy Early Edu-
cation Workforce Act’’.
SEC. 2. BLOCK GRANTS REGARDING AFFORDABLE HEALTH 
INSURANCE FOR CHILD CARE PROVIDERS. 
Title XIX of the Public Health Service Act is amend-
ed by adding at the end the following: 
‘‘PART D—BLOCK GRANTS REGARDING AFFORD-
ABLE HEALTH INSURANCE FOR CHILD CARE 
PROVIDERS 
‘‘SEC. 1981. FORMULA GRANTS TO STATES. 
‘‘For the purpose described in section 1982(a), the 
Secretary shall make an allotment each fiscal year for each 
State that submits an application in accordance with sec-
tion 1983 in an amount determined in accordance with 
section 1984. 
‘‘SEC. 1982. FUNDING AGREEMENTS. 
‘‘(a) PURPOSE.—A funding agreement for a grant 
under section 1981 is that the State involved will expend 
the grant only for the purpose of providing access to af-
fordable health benefits coverage for—
‘‘(1) eligible child care providers and the staff 
of center-based child care providers; and 
‘‘(2) at the discretion of the State involved, the 
spouses, domestic partners, and dependents (as 
those terms are defined by the State) of such pro-
viders and staff. 
‘‘(b) PERMISSIBLE ACTIVITIES.—A funding agree-
ment for a grant under section 1981 is that the State in-
volved, in carrying out the purpose described in subsection 
(a), may opt to use the grant for any of the following: 
‘‘(1) To reimburse an employer or individual 
described in subsection (a) for their share (or a por-
tion thereof) of the premiums or other costs for cov-
erage under group or individual health plans. 
‘‘(2) To offset the cost of enrolling individuals 
described in subsection (a) in public health benefits 
plans, such as the medicaid program under title XIX 
of the Social Security Act, the State Children’s 
Health Insurance Program under title XXI of such 
Act, or public employee health benefit plans. 
‘‘(3) To otherwise subsidize the cost of health 
benefits coverage for individuals described in sub-
section (a). 
‘‘(c) LIMITING CRITERIA.—A funding agreement for 
a grant under section 1981 is that the State involved may 
establish criteria to limit the providers and staff described 
in subsection (a)(1) who may receive assistance under the 
grant. 
‘‘(d) PRIORITY.—A funding agreement for a grant 
under section 1981 is that the State involved will give—
‘‘(1) highest priority to—
‘‘(A) providers and staff described in sub-
section (a)(1) that meet any applicable criteria
established in accordance with subsection (c) 
and received assistance under such a grant dur-
ing the previous fiscal year; and 
‘‘(B) at the State’s discretion, the spouses, 
domestic partners, and dependents of such pro-
viders and staff; and 
‘‘(2) second highest priority to—
‘‘(A) providers and staff described in sub-
section (a)(1) that meet any applicable criteria 
established in accordance with subsection (c) 
and are accredited by the National Association 
for the Education of Young Children or the Na-
tional Association for Family Child Care; and 
‘‘(B) at the State’s discretion, the spouses, 
domestic partners, and dependents of such pro-
viders and staff. 
‘‘(e) MATCHING FUNDS.—
‘‘(1) IN GENERAL.—With respect to the costs of 
carrying out the purpose described in subsection (a), 
a funding agreement for a grant under section 1981 
is that the State involved will make available (di-
rectly or through donations from public or private 
entities) non-Federal contributions toward such 
costs in an amount that is not less than 50 percent 
of such costs.
‘‘(2) DETERMINATION
OF
AMOUNT
CONTRIB-
UTED.—Non-Federal contributions under paragraph 
(1) may be in cash or in kind, fairly evaluated, in-
cluding plant, equipment, or services. Amounts pro-
vided by the Federal Government, or services as-
sisted or subsidized to any significant extent by the 
Federal Government, may not be included in deter-
mining the amount of such contributions. 
‘‘SEC. 1983. APPLICATION. 
‘‘For purposes of section 1981, an application for a 
grant for a fiscal year is in accordance with this section 
if—
‘‘(1) the application is submitted at such time, 
in such manner, and containing such information as 
the Secretary may require; 
‘‘(2) the application contains each funding 
agreement that is described in section 1982; and 
‘‘(3) with respect to each such funding agree-
ment, the application provides assurances of compli-
ance satisfactory to the Secretary. 
‘‘SEC. 1984. DETERMINATION OF AMOUNT OF ALLOTMENT. 
‘‘(a) AMOUNTS RESERVED.—
‘‘(1) TERRITORIES
AND
POSSESSIONS.—The 
Secretary shall reserve not to exceed one half of 1 
percent of the amount appropriated pursuant to sec-
tion 1986 in each fiscal year for payments to Guam, 
American Samoa, the Virgin Islands of the United 
States, and the Commonwealth of the Northern 
Mariana Islands to be allotted in accordance with 
their respective needs. 
‘‘(2) INDIAN TRIBES.—The Secretary shall re-
serve not less than 1 percent, and not more than 2 
percent, of the amount appropriated pursuant to 
section 1986 in each fiscal year for payments to In-
dian tribes and tribal organizations, to be allotted in 
accordance with their respective needs. 
‘‘(b) STATE ALLOTMENT.—
‘‘(1) GENERAL RULE.—From the remainder of 
amounts appropriated pursuant to section 1986 for 
each fiscal year after reservations under subsection 
(a), the Secretary shall allot to each State an 
amount equal to the sum of—
‘‘(A) an amount that bears the same ratio 
to 50 percent of such remainder as the product 
of the young child factor of the State and the 
allotment percentage of the State bears to the 
sum of the corresponding products for all 
States; and 
‘‘(B) an amount that bears the same ratio 
to 50 percent of such remainder as the product
of the school lunch factor of the State and the 
allotment percentage of the State bears to the 
sum of the corresponding products for all 
States. 
‘‘(2) YOUNG CHILD FACTOR.—The term ‘young 
child factor’ means the ratio of the number of chil-
dren in the State under 5 years of age to the num-
ber of such children in all States as provided by the 
most recent annual estimates of population in the 
States by the Census Bureau of the Department of 
Commerce. 
‘‘(3) SCHOOL
LUNCH
FACTOR.—The term 
‘school lunch factor’ means the ratio of the number 
of children in the State who are receiving free or re-
duced price lunches under the school lunch program 
established under the Richard B. Russell National 
School Lunch Act to the number of such children in 
all the States as determined annually by the Depart-
ment of Agriculture. 
‘‘(4) ALLOTMENT PERCENTAGE.—
‘‘(A) IN
GENERAL.—The allotment per-
centage for a State is determined by dividing 
the per capita income of all individuals in the 
United States, by the per capita income of all 
individuals in the State.
‘‘(B) LIMITATIONS.—If an allotment per-
centage determined under subparagraph (A)—
‘‘(i) exceeds 1.2 percent, then the al-
lotment percentage of that State shall be 
considered to be 1.2 percent; or 
‘‘(ii) is less than 0.8 percent, then the 
allotment percentage of the State shall be 
considered to be 0.8 percent. 
‘‘(C) PER CAPITA INCOME.—For purposes 
of subparagraph (A), per capita income—
‘‘(i) shall be determined at 2-year in-
tervals; 
‘‘(ii) shall be applied for the 2-year 
period beginning on October 1 of the first 
fiscal year beginning on the date such de-
termination is made; and 
‘‘(iii) shall be equal to the average of 
the annual per capita incomes for the most 
recent period of 3 consecutive years for 
which satisfactory data are available from 
the Department of Commerce at the time 
such determination is made. 
‘‘(c) ALLOCATION OF EXCESS FUNDS.—To the ex-
tent that all the funds appropriated under section 1986 
for a fiscal year and available for allotment in such fiscal
year are not otherwise allotted to States because 1 or more 
States have not submitted an application in accordance 
with section 1983 for the fiscal year, or because 1 or more 
States have notified the Secretary that they do not intend 
to use the full amount of their allotment, such excess shall 
be allotted among each of the remaining States in propor-
tion to the amount otherwise allotted to such States for 
the fiscal year without regard to this subsection. 
‘‘SEC. 1985. DEFINITIONS. 
‘‘In this part: 
‘‘(1) The term ‘eligible child care provider’ 
means a family child care provider or a center-based 
child care provider (whether an entity or individual) 
that is licensed under State law and meets all appli-
cable State and local health and safety requirements. 
‘‘(2) The term ‘family child care provider’ 
means an individual who provides child care services 
for fewer than 24 hours per day, as the sole care-
giver, and in a private residence. 
‘‘(3) The terms ‘‘Indian tribe’’ and ‘‘tribal orga-
nization’’ have the same meaning given such terms 
in section 4 of the Indian Self-Determination and 
Education Assistance Act. 
‘‘(4)(A) Except for purposes of determining al-
lotments under subsections (a) and (b) of section
1984, the term ‘State’ means each of the several 
States, the District of Columbia, Guam, American 
Samoa, the Virgin Islands of the United States, the 
Commonwealth of the Northern Mariana Islands, 
and each Indian tribe or tribal organization. 
‘‘(B) For purposes of determining allotments 
under subsections (a) and (b) of section 1984, the 
term ‘State’ means each of the several States and 
the District of Columbia. 
‘‘SEC. 1986. AUTHORIZATION OF APPROPRIATIONS. 
‘‘There are authorized to be appropriated to the Sec-
retary to carry out this part $200,000,000 for fiscal year 
2004, $250,000,000 for fiscal year 2005, $300,000,000 
for fiscal year 2006, $400,000,000 for fiscal year 2007, 
and such sums as may be necessary for fiscal year 2008.’’. 
SEC. 3. EVALUATION OF BLOCK GRANT PROGRAM BY SEC-
RETARY. 
(a) EVALUATION.—The Secretary of Health and 
Human Services shall conduct an evaluation of several 
State programs carried out with grants under part D of 
title XIX of the Public Health Service Act, representing 
various approaches to raising the rate of child care work-
ers with health benefits coverage. 
(b) ASSESSMENT OF IMPACTS.—In evaluating State 
programs under subsection (a), the Secretary may con-
sider any information appropriate to measure the success 
of the programs, and shall assess the impact of the pro-
grams on the following: 
(1) The rate of child care workers with health 
benefits coverage. 
(2) The take-up rate by eligible child care pro-
viders. 
(3) The turnover rate in the field. 
(4) The average wages paid. 
(c) REPORT.—Not later than 3 years after the date 
of enactment of this Act, the Secretary of Health and 
Human Services shall submit a report to the Congress on 
the results of the evaluation conducted under subsection 
(a), together with recommendations for strengthening pro-
grams carried out with grants under part D of title XIX 
of the Public Health Service Act.
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