Starting this August, families enrolled in Tennessee’s Medicaid program will receive 100 free diapers a month for children under two — making Tennessee the first U.S. state to cover diapers as a health benefit. The Centers for Medicare and Medicaid Services approved the plan in 2025 C.E., and the state is now preparing to distribute what advocates estimate will be close to 100 million diapers annually.
At a glance
- Medicaid diaper coverage: Tennessee’s TennCare and CoverKids programs will provide 100 diapers per month to members with newborns, infants, and one-year-olds — at no cost to the family.
- Diaper insecurity: According to the National Diaper Bank Network, 92% of families receiving diapers in Tennessee are working and still cannot afford an adequate supply.
- TennCare expansion: Alongside the diaper benefit, federal regulators approved broader eligibility criteria, allowing more parents and caregivers to qualify for TennCare starting June 1 C.E.
Why diapers are a health issue
It might be easy to think of diapers as a convenience item. They are not.
When families run short, babies go longer between changes. That leads to diaper rash, urinary tract infections, and skin breakdown. For parents, the stress of not being able to meet a basic need for their child is linked to anxiety and depression. Doug Adair, president of the Nashville Diaper Connection, put it plainly: “It’s obviously important for the baby to be clean and dry. It helps them be more healthy.”
The Nashville Diaper Connection helped 4,600 babies every month in 2024 C.E. and gave away more than 3 million diapers in 2023 C.E. The majority went to TennCare families — the same families now set to benefit from this new coverage.
How the policy came together
The idea originated in Governor Bill Lee’s Strong Families Initiative, which the Tennessee General Assembly passed in 2023 C.E. It took roughly two years to move from legislation to federal approval.
Last spring, the Centers for Medicare and Medicaid Services signed off on Tennessee’s Section 1115 waiver amendment — the legal mechanism states use to expand Medicaid coverage beyond standard federal rules. That approval cleared the final hurdle. Tennessee now has the regulatory framework to begin distribution in August 2025 C.E.
No other state has done this. Nashville Diaper Connection and other local banks have been central to making the case, drawing on years of data about the families they serve. Their work helped show policymakers that diaper need is measurable, widespread, and solvable.
What this means in practice
The new benefit will reach families through TennCare’s existing distribution network. Adair described the state’s approach as focused on making it “a true and immediate and long-term and impactful benefit for their members.”
Diaper banks in Tennessee are not closing. As Adair noted, food banks have not gotten smaller since food stamps were introduced — demand for community support often rises alongside public programs as awareness grows and more families come forward. The National Diaper Bank Network has long argued that public coverage and nonprofit distribution work best together, not as substitutes for each other.
Tennessee’s five diaper banks served families across the state last year. Under the new Medicaid benefit, those organizations expect their capacity to shift toward families who fall outside TennCare eligibility — undocumented families, those just above the income threshold, and others the program does not reach.
A model other states may follow
Advocates have pushed for diaper coverage at the federal level for years. The Diaper Subsidy Act, introduced in the U.S. Senate, would make diapers a covered benefit under Medicaid nationwide, but it has not passed. Tennessee’s approval gives advocates a working example to point to.
The Section 1115 waiver pathway Tennessee used is available to every state. If the program runs smoothly — and early projections suggest strong uptake — other states could cite Tennessee’s data in their own waiver applications.
Still, there is an important gap to acknowledge. The benefit only covers children under two enrolled in TennCare or CoverKids. Toddlers over one, children in families above the income limit, and families in states without similar programs are not covered. One state’s milestone does not solve a national problem — it opens a door.
“They’re expensive, so this is going to be a huge, huge break,” Adair said. For the families who qualify, that break starts this August.
Read more
For more on this story, see: NewsChannel 5
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