Delaware and Tennessee Become First States to Cover Diapers for Young Children in Medicaid through Section 1115 Demonstrations

Last week, CMS announced the approval of section 1115 demonstration project requests from Delaware and Tennessee to provide diapers to young children covered by Medicaid. These approvals mark the first time a state has been authorized to cover diapers for infants in Medicaid regardless of medical necessity due to incontinence issues. Under federal statute, section 1115 demonstrations may be used to experiment or test new policies that are likely to assist in promoting the objectives of Medicaid. CMS’s recent action comes as other states are increasingly pursuing policies to address the health-related social needs (HRSNs) of certain Medicaid enrollees, including prioritizing addressing HRSNs for pregnant/postpartum individuals and their infants.

Tennessee received CMS’s first approval to cover diapers for infants from households with low-incomes, acting on the state’s proposed amendment to its “TennCare III” demonstration project from November 2023. (The amendment also sought to set the eligibility for parents and caretaker relatives at 100 percent FPL, which was included in the state’s May 17th approval as well). The state is now authorized to provide 100 diapers per month for all children under age two enrolled in Medicaid or CHIP. Parents and legal guardians will receive the monthly supply of diapers through pharmacies in the state’s Medicaid pharmacy benefit manager (PBM) network.

In Delaware, the diaper benefit is targeted to new postpartum mothers. Through the state’s “Diamond State Health Plan” 1115 demonstration, Delaware will be allowed to provide up to 80 diapers and up to one pack of baby wipes per week (approximately 345 diapers per month) to individuals in the first twelve weeks postpartum. The diaper and diaper supplies are part of a “Postpartum Nutrition Supports initiative” pilot, which also includes up to two meals per day, through home-delivered meals or food boxes. The approval extends an existing state-funded pilot program that provided the same nutrition and diaper benefits, but only up to eight weeks postpartum.

Both the Delaware and Tennessee demonstrations are designed to address the medical needs of infants and the HRSNs of their parents associated with diapers. Diapers are a necessity and unavoidable expense for families with very young children, regardless of income. Newborns need an average of 8 to 10 diaper changes per day to help prevent diaper-related medical conditions like diaper dermatitis (i.e., diaper rash). Although the number of diaper changes decreases after the newborn period young children continue to require numerous diaper changes throughout the day. According to the National Diaper Bank, almost half of families in 2023 reported not having an adequate supply of diapers, also known as “diaper need”. With an inadequate number of diapers, children may go longer than recommended between diaper changes, which can cause diaper dermatitis and urinary tract infections, among other conditions, that require medical treatment. As part of the evaluation of its demonstration (a required part of a section 1115 demonstration), Tennessee will examine how the new diaper benefit affected infant health outcomes, specifically the rates of UTIs and diaper rash among eligible children.

“Diaper need” has also been associated with maternal depression and parental stress. Providing a fixed supply of diapers to parents with low-incomes can help reduce stress linked to having an insufficient supply of diapers for their babies. The new diaper benefit may also provide other positive ripple effects. Child care facilities often require families to provide enough diapers for the child’s time in care; with a greater ability to have enough diapers for childcare, parents will likely have to miss less work and their children will be able to spend more time in early education programs that can promote their development.

The approved demonstration projects in Tennessee and Delaware are an important chance to test whether covering diapers can reduce preventable diaper-related illnesses and is a great example of using Medicaid flexibilities to find innovative ways to improve how Medicaid serves infants and toddlers. Additional CCF analysis of state efforts to address HRSNs for pregnant/postpartum individuals and young children is coming soon!