119-s1815

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[S. 1815 Introduced in Senate

    (IS) ]

<DOC>

119th CONGRESS
 1st Session
 S. 1815

 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.

_______________________________________________________________________

 IN THE SENATE OF THE UNITED STATES

 May 20, 2025

 Ms. Duckworth (for herself, Mr. Cramer, and Mr. Kelly) introduced the 
 following bill; which was read twice and referred to the Committee on 
 Finance

_______________________________________________________________________

 A BILL

 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 2025''.

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 2026 through 
 2029. Each State shall use the increase in funding the State 
 receives as a result of this section in accordance with 
 subsection

    (b) of this section.

    (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 
 2026 through 2029, 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 2026 
 through 2029, 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 2026, an 
 amount, not to exceed $3,000,000, 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; 
 and
            (II) improving access to diapers 
 and diapering supplies, medically 
 necessary diapers, and adult 
 incontinence materials and supplies;
            (ii) carry out community outreach to assist 
 in participation in diaper distribution 
 programs or programs that distribute medically 
 necessary diapers or adult incontinence 
 materials and supplies; and
            (iii) 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); and
            (C) the funds are used to supplement, not supplant, 
 State general revenue funds provided for the purposes 
 described in subparagraph
        (A) .

    (2) Administrative costs.--A State receiving 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 reporting.

    (3) 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 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.
            (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.
            (vi) Programs funded under part C of the 
 Individuals with Disabilities Education Act (20 
 U.S.C. 1431 et seq.).

    (4) 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.

    (5) 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 2026 through 2029, 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 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.

    (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 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 18 years of age; 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) Diaper bank.--- The term ``diaper bank'' means a 
 nonprofit organization that--
        (A) is described in 

section 501
            (c) (3) of the 
 Internal Revenue Code of 1986 and exempt from taxation 
 under 

section 501

    (a) of such Code;
        (B) is established and operating primarily for the 
 purpose of collecting or purchasing diapers and 
 diapering supplies; and
            (C) distributes diapers and diapering supplies 
 either directly or through partnerships for eventual 
 distribution to individuals free of charge.

    (5) 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.

    (6) 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.

    (7) 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 diaper bank 
 or other 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 at least 1 year of demonstrated experience 
 in the area of--
            (i) community distributions of diapers and 
 diapering supplies and other basic need 
 services, such as 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.

    (8) 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 (42 U.S.C. 9902

    (2) ) applicable to a family of the size 
 involved.

    (9) 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.

    (10) 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.

    (11) 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.

    (12) 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 
 Marshall Islands, the Federated States of Micronesia, and the 
 Republic of Palau.

    (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. 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, 2025.

    (2) Reimbursements.--The amendment made by subsection
            (c) shall apply to expenses incurred after December 31, 2025.
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