End Diaper Need Act of 2021
Bill: S.304 | Sponsor: Sen. Duckworth, Tammy (D-IL)
Policy area: Health

Summary:
End Diaper Need Act of 2021
This bill establishes and expands programs to provide low-income families and other vulnerable groups with access to diapers and related supplies.
Specifically, it provides additional funding for FY2022-FY2025 to meet the diapering needs of certain low-income families and adults through the Social Services Block Grant Program. This grant program provides a flexible funding stream to states and territories to support social services for vulnerable children, adults, and families. The bill exempts these funds from sequestration. Sequestration is a process of automatic, across-the-board reductions under which budgetary resources are permanently cancelled to enforce specific budget policy goals.
In particular, these funds must be used to meet the diapering needs of
Additionally, the bill permits states to use Medicaid funds to provide medically necessary diapers and supplies to low-income families with one or more medically complex children.
It also allows individuals to buy medically necessary diapers and supplies with funds from health savings accounts and other tax-advantaged accounts for health care expenses.

To provide targeted funding for States and other eligible entities 
    through the Social Services Block Grant program 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.

    Be it enacted by the Senate and House of Representatives 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 2021''.

SEC. 2. TARGETED FUNDING FOR DIAPER ASSISTANCE (INCLUDING DIAPERING 
              SUPPLIES AND ADULT INCONTINENCE MATERIALS AND SUPPLIES) 
              THROUGH THE SOCIAL SERVICES BLOCK GRANT PROGRAM.

    (a) Increase in Funding for Social Services Block Grant Program.--
            (1) In general.--The amount specified in subsection (c) of 
        section 2003 of the Social Security Act (42 U.S.C. 1397b) for 
        purposes of subsections (a) and (b) of such section is deemed 
        to be $1,900,000,000 for each of fiscal years 2022 through 
        2025, of which, the amount equal to $200,000,000, reduced by 
        the amounts reserved under paragraph (2)(B) for each such 
        fiscal year, shall be obligated by States in accordance with 
        subsection (b).
            (2) Appropriation.--
                    (A) In general.--Out of any money in the Treasury 
                of the United States not otherwise appropriated, there 
                is appropriated $200,000,000 for each of fiscal years 
                2022 through 2025, to carry out this section.
                    (B) Reservations.--
                            (i) Purposes.--The Secretary shall reserve, 
                        from the amount appropriated under subparagraph 
                        (A) to carry out this section--
                                    (I) for each of fiscal years 2022 
                                through 2025, not more than 2 percent 
                                of the amount appropriated for the 
                                fiscal year for purposes of entering 
                                into an agreement with a national 
                                entity described in subparagraph (C) to 
                                assist in providing technical 
                                assistance and training, to support 
                                effective policy, practice, research, 
                                and cross-system collaboration among 
                                grantees and subgrantees, and to assist 
                                in the administration of the program 
                                described in this section; and
                                    (II) for fiscal year 2022, an 
                                amount, not to exceed $2,000,000, for 
                                purposes of conducting an evaluation 
                                under subsection (d).
                            (ii) No state entitlement to reserved 
                        funds.--The State entitlement under section 
                        2002(a) of the Social Security Act (42 U.S.C. 
                        1397a(a)) shall not apply to the amounts 
                        reserved under clause (i).
                    (C) National entity described.--A national entity 
                described in this subparagraph 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--
                            (i) has experience in more than 1 State in 
                        the area of--
                                    (I) community distributions of 
                                basic need services, including 
                                experience collecting, warehousing, and 
                                distributing basic necessities such as 
                                diapers, food, or menstrual products;
                                    (II) child care;
                                    (III) child development activities 
                                in low-income communities; or
                                    (IV) motherhood, fatherhood, or 
                                parent education efforts serving low-
                                income parents of young children;
                            (ii) demonstrates competency to implement a 
                        project, provide fiscal accountability, collect 
                        data, and prepare reports and other necessary 
                        documentation; and
                            (iii) demonstrates a willingness to share 
                        information with researchers, practitioners, 
                        and other interested parties.
    (b) Rules Governing Use of Additional Funds.--
            (1) In general.--Funds are used in accordance with this 
        subsection if--
                    (A) the State, in consultation with relevant 
                stakeholders, including agencies, professional 
                associations, and nonprofit organizations, distributes 
                the funds to eligible entities to--
                            (i) decrease the need for diapers and 
                        diapering supplies and adult incontinence 
                        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 disabilities in 
                        such families through--
                                    (I) the distribution of free 
                                diapers and diapering supplies, 
                                medically necessary diapers, and adult 
                                incontinence materials and supplies;
                                    (II) community outreach to assist 
                                in participation in existing diaper 
                                distribution programs or programs that 
                                distribute medically necessary diapers 
                                or adult incontinence materials and 
                                supplies; or
                                    (III) improving access to diapers 
                                and diapering supplies, medically 
                                necessary diapers, and adult 
                                incontinence materials and supplies; 
                                and
                            (ii) increase the ability of communities 
                        and low-income families in such communities to 
                        provide for the need for diapers and diapering 
                        supplies, medically necessary diapers, and 
                        adult continence materials and supplies, of 
                        infants and toddlers, medically complex 
                        children, and low-income adults and adults with 
                        disabilities;
                    (B) the funds are used subject to the limitations 
                in section 2005 of the Social Security Act (42 U.S.C. 
                1397d);
                    (C) the funds are used to supplement, not supplant, 
                State general revenue funds provided for the purposes 
                described in subparagraph (A); and
                    (D) the funds are not used for costs that are 
                reimbursable by the Federal Emergency Management 
                Agency, under a contract for insurance, or by self-
                insurance.
            (2) Allowable uses by eligible entities.--An eligible 
        entity receiving funds made available under subsection (a) 
        shall use the funds for any of the following:
                    (A) To pay for the purchase and distribution of 
                diapers and diapering supplies, medically necessary 
                diapers, and funding diaper (including medically 
                necessary diapers) distribution that serves low-income 
                families with--
                            (i) 1 or more children 3 years of age or 
                        younger; or
                            (ii) 1 or more medically complex children.
                    (B) To pay for the purchase and distribution of 
                adult incontinence materials and supplies and funding 
                distribution of such materials and supplies that serves 
                low-income families with 1 or more low-income adults or 
                adults with disabilities who rely on adult incontinence 
                materials and supplies.
                    (C) To integrate activities carried out under 
                subparagraph (A) with other basic needs assistance 
                programs serving eligible children and their families, 
                including the following:
                            (i) Programs funded by the temporary 
                        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 support the 
                        health of eligible children, such as the 
                        Children's Health Insurance Program under title 
                        XXI of the Social Security Act, the Medicaid 
                        program 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 children 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 improved and 
                        affordable access to child care, including 
                        programs funded through the Child Care and 
                        Development Fund, the temporary assistance for 
                        needy families program under part A of title IV 
                        of the Social Security Act (42 U.S.C. 601 et 
                        seq.), or a State-funded program.
            (3) Availability of funds.--
                    (A) Funds distributed to eligible entities.--Funds 
                made available under subsection (a) that are 
                distributed to an eligible 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.
                    (B) Evaluation.--Funds reserved under subsection 
                (a)(2)(B)(i)(II) to carry out the evaluation under 
                subsection (d) shall be available for expenditure 
                during the 3-year period that begins on the date of 
                enactment of this Act.
            (4) 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 
        determining the family's eligibility for, or amount of, 
        benefits under any other Federal needs-based programs.
    (c) 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 eligible entities, including subgrantees, used funds made 
available under subsection (a) to distribute diapers and diapering 
supplies and adult incontinence materials and supplies 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, undergarments), and the number 
        of each type of diapering or adult incontinence supply, 
        distributed through the use of such funds.
            (4) The ZIP Code or ZIP Codes where the eligible 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 diapering supplies 
        and, adult incontinence materials and supplies.
            (6) Such other information as the Secretary may specify.
    (d) Evaluation.--The Secretary, in consultation with States, the 
national entity described in subsection (a)(2)(C), and eligible 
entities receiving funds made available under this section, shall--
            (1) not later than 2 years after the date of enactment of 
        this Act--
                    (A) complete an evaluation of the effectiveness of 
                the assistance program carried out pursuant to this 
                section, such as the effect of activities carried out 
                under this Act on mitigating the health and 
                developmental risks of unmet diaper need among infants, 
                toddlers, medically complex children, and other family 
                members in low-income families, including the risks of 
                diaper dermatitis, urinary tract infections, and 
                parental and child depression and anxiety;
                    (B) submit to the relevant congressional committees 
                a report on the results of such evaluation; 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 enactment of 
        this Act, update the evaluation required by paragraph (1)(A); 
        and
            (3) not later than 90 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.
    (e) Guidance.--Not later than 180 days after enactment of this Act, 
the Secretary shall issue guidance regarding how the provisions of this 
section should be carried out, including information regarding eligible 
entities, allowable use of funds, and reporting requirements.
    (f) Definitions.--In this section:
            (1) Adult incontinence materials and supplies.--The term 
        ``adult incontinence materials and supplies'' means those 
        supplies that are used to assist low-income adults or adults 
        with disabilities and includes adult diapers, briefs, 
        protective underwear, pull-ons, pull-ups, liners, shields, 
        guards, pads, undergarments, disposable wipes, over-the-counter 
        adult diaper rash cream products, intermittent catheterization, 
        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 age 18; and
                    (B) have a disability (as such term is defined, 
                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 absorbent 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--
                            (i) does not use any latex or common 
                        allergens; and
                            (ii) meets or exceeds the quality standards 
                        for diapers commercially available 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 ``diapering supplies'' 
        means items, including diaper wipes and diaper cream, necessary 
        to ensure that--
                    (A) an eligible child using a diaper is properly 
                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, an Indian tribe or tribal 
        organization (as defined in section 4 of the Indian Self-
        Determination and Education Assistance Act), or 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--
                    (A) has experience in the area of--
                            (i) community distributions of basic need 
                        services, including experience collecting, 
                        warehousing, and distributing basic necessities 
                        such as diapers, food, or menstrual products;
                            (ii) child care;
                            (iii) child development activities in low-
                        income communities; or
                            (iv) motherhood, fatherhood, or parent 
                        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 information 
                with researchers, practitioners, and other interested 
                parties.
            (7) Federal poverty line.--The term ``Federal 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 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 age 3 and for whom 
        a licensed health care provider has provided a diagnosis of 
        bowel or bladder incontinence, a bowel or bladder condition 
        that causes excess urine or stool (such as short gut syndrome 
        or diabetes insipidus), or a severe skin condition that causes 
        skin erosions (such as epidermolysis bullosa).
            (10) Medically necessary diaper.--The term ``medically 
        necessary diaper'' means an absorbent garment that is--
                    (A) washable or disposable;
                    (B) worn by a medically complex child who has been 
                diagnosed with bowel or bladder incontinence, a bowel 
                or bladder condition that causes excess urine or stool 
                (such as short gut syndrome or diabetes insipidus), or 
                a severe skin condition that causes skin erosions (such 
                as epidermolysis bullosa) and needs such garment 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 available 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.
    (g) Exemption of Program From Sequestration.--
            (1) In general.--Section 255(h) of the Balanced Budget and 
        Emergency Deficit Control Act of 1985 (2 U.S.C. 905(h)) is 
        amended by inserting after ``Supplemental Security Income 
        Program (28-0406-0-1-609).'' the following:
            ``Targeted funding for States for diaper assistance 
        (including diapering supplies and adult incontinence materials 
        and supplies) through the Social Services Block Grant 
        Program.''.
            (2) Applicability.--The amendment made by this subsection 
        shall apply to any sequestration order issued under the 
        Balanced Budget and Emergency Deficit Control Act of 1985 (2 
        U.S.C. 900 et seq.) on or after the date of enactment of this 
        Act.

SEC. 3. IMPROVING ACCESS TO DIAPERS FOR MEDICALLY COMPLEX CHILDREN.

    Section 1915(c) of the Social Security Act (42 U.S.C. 1396n(c)) is 
amended by adding at the end the following new paragraph:
    ``(11)(A) In the case of any waiver under this subsection that 
provides medical assistance to a medically complex child who has been 
diagnosed with bowel or bladder incontinence, a bowel or bladder 
condition that causes excess urine or stool (such as short gut syndrome 
or diabetes insipidus), or a severe skin condition that causes skin 
erosions (such as epidermolysis bullosa), such medical assistance shall 
include, for the duration of the waiver, the provision of 200 medically 
necessary diapers per month and diapering supplies. Such medical 
assistance may include the provision of medically necessary diapers in 
amounts greater than 200 if a licensed health care provider (such as a 
physician, nurse practitioner, or physician assistant) specifies that 
such greater amounts are necessary for such medically complex child.
    ``(B) For purposes of this paragraph:
            ``(i) The term `medically complex child' means an 
        individual who has attained age 3 and for whom a licensed 
        health care provider has provided a diagnosis of 1 or more 
        significant chronic conditions.
            ``(ii) The term `medically necessary diaper' means an 
        absorbent garment that is--
                    ``(I) washable or disposable;
                    ``(II) worn by a medically complex child who has 
                been diagnosed with a condition described in 
                subparagraph (A) and needs such garment to correct or 
                ameliorate such condition; and
                    ``(III) if disposable--
                            ``(aa) does not use any latex or common 
                        allergens; and
                            ``(bb) meets or exceeds the quality 
                        standards for diapers commercially available 
                        through retail sale in the following 
                        categories:
                                    ``(AA) Absorbency (with acceptable 
                                rates for first and second wetting).
                                    ``(BB) Waterproof outer cover.
                                    ``(CC) Flexible leg openings.
                                    ``(DD) Refastening closures.
            ``(iii) The term `diapering supplies' means items, 
        including diaper wipes and diaper creams, necessary to ensure 
        that a medically complex child who has been diagnosed with a 
        condition described in subparagraph (A) and uses a medically 
        necessary diaper is properly cleaned and protected from diaper 
        rash.''.

SEC. 4. INCLUSION OF DIAPERS AND DIAPERING SUPPLIES AS QUALIFIED 
              MEDICAL EXPENSES.

    (a) Health Savings Accounts.--Section 223(d)(2) of the Internal 
Revenue Code of 1986 is amended--
            (1) by inserting ``, medically necessary diapers, and 
        diapering supplies'' after ``menstrual care products'' in the 
        last sentence of subparagraph (A); and
            (2) by adding at the end the following new subparagraph:
                    ``(E) Medically necessary diapers and diapering 
                supplies.--For purposes of this paragraph--
                            ``(i) Medically necessary diapers.--The 
                        term `medically necessary diaper' means an 
                        absorbent garment which is washable or 
                        disposable and which is worn by an individual 
                        who has attained 3 years of age because of 
                        medical necessity, such as someone who has been 
                        diagnosed with bowel or bladder incontinence, a 
                        bowel or bladder condition that causes excess 
                        urine or stool (such as short gut syndrome or 
                        diabetes insipidus), or a severe skin condition 
                        that causes skin erosions (such as 
                        epidermolysis bullosa) and needs such garment 
                        to correct or ameliorate such condition, to 
                        serve a preventative medical purpose, or to 
                        correct or ameliorate defects or physical or 
                        mental illnesses or conditions diagnosed by a 
                        licensed health care provider, and, if 
                        disposable--
                                    ``(I) does not use any latex or 
                                common allergens; and
                                    ``(II) meets or exceeds the quality 
                                standards for diapers commercially 
                                available through retail sale in the 
                                following categories:
                                            ``(aa) Absorbency (with 
                                        acceptable rates for first and 
                                        second wetting).
                                            ``(bb) Waterproof outer 
                                        cover.
                                            ``(cc) Flexible leg 
                                        openings.
                                            ``(dd) Refastening 
                                        closures.
                            ``(ii) Diapering supplies.--The term 
                        `diapering supplies' means items, including 
                        diaper wipes and diaper creams, necessary to 
                        ensure that an individual wearing medically 
                        necessary diapers is properly cleaned and 
                        protected from diaper rash.''.
    (b) Archer MSAs.--The last sentence of section 220(d)(2)(A) of such 
Code is amended by inserting ``, medically necessary diapers (as 
defined in section 223(d)(2)(E)), and diapering supplies (as defined in 
section 223(d)(2)(E))'' after ``menstrual care products (as defined in 
section 223(d)(2)(D))''.
    (c) Health Flexible Spending Arrangements and Health Reimbursement 
Arrangements.--Section 106(f) of such Code is amended--
            (1) by inserting ``, medically necessary diapers (as 
        defined in section 223(d)(2)(E)), and diapering supplies (as 
        defined in section 223(d)(2)(E))'' after ``menstrual care 
        products (as defined in section 223(d)(2)(D))''; and
            (2) in the heading, by inserting ``, Medically Necessary 
        Diapers, and Diapering Supplies'' after ``Menstrual Care 
        Products''.
    (d) Effective Dates.--
            (1) Distributions from certain accounts.--The amendments 
        made by subsections (a) and (b) shall apply to amounts paid 
        after December 31, 2022.
            (2) Reimbursements.--The amendment made by subsection (c) 
        shall apply to expenses incurred after December 31, 2022.
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