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The recent approvals in both Delaware and Tennessee come as public health advocates say that families are increasingly struggling to afford enough diapers for their children — not only putting babies at risk of infection and rashes, but also forcing parents to miss work or school because they can't afford enough diapers required at many childcare centers.

On average, newborn babies can require eight to 10 diapers a day, or around 300 a month. Toddlers can use around 150 diapers a month.

“For infants and toddlers, a key benefit to adequate diaper supply is preventing diaper dermatitis, otherwise known as diaper rash, and urinary tract infections,” CMS wrote in their approval letter to Tennessee on May 17. “Diaper rash is one of the most common medical conditions for infants and toddlers, and changing diapers frequently is the mainstay of recommendations to prevent this condition.”

According to TennCare, Tennessee's Medicaid program, families will be able to receive up to 100 diapers per month for children under two starting in August — which will be available at TennCare pharmacies.

The request stemmed from an initiative backed by Republican Gov. Bill Lee in 2023 designed to support families, for which lawmakers approved allocating $30 million in TennCare funding for the free diapers.

“Strong families are central to strong communities, and Tennessee is leading the nation in prioritizing resources for families in need," Lee said in a statement on Wednesday. “We are the first state in the nation to cover the cost of diapers for mothers in the first two years of a child’s life, and we hope this is a model for others.”

In Delaware, individuals will be allowed to receive up to 80 diapers and up to one pack of baby wipes per week in the first twelve weeks postpartum. CMS agreed the state could use Medicaid funding to extend the program another five years.

“Access to sufficient diapers offers health benefits to the parent, as well, as diaper need is associated with maternal depression and stress,” said Martha Lodge, spokesperson for the Delaware Health and Social Services in an email.

Along with approving the diaper benefit, CMS approved increasing TennCare's income limit for parents to 100% of poverty. Previously, Tennessee's income eligibility was set at specific monthly amounts rather than being connected to the federal poverty level.

This has meant a parent in a household of three used to face an income limit of about $1,600 a month. Under the new changes, the income limit jumps to about $2,000 a month.

According to a report from the Sycamore Institute, a Tennessee think tank, Tennessee now has the highest income eligibility for parents and caretakers among the 10 states that have not expanded Medicaid eligibility broadly for adults under the Affordable Care Act.

Tennessee's new diaper benefit stands out as the state has gained attention over the years for becoming increasingly willing to reject federal funding that offer valuable resources to other families and struggling individuals.

Earlier this year, Tennessee confirmed that it would only participate in a federal program that gives low-income families $40 per child per month to pay for food while school is out for one year — choosing to opt out in 2025 because Lee's administration argued that other food programs existed.

Meanwhile, public health advocates say they were stunned when the state announced back in January that it was rebuffing roughly $9 million in .

Instead, health officials chose to fund the HIV-prevention program with state dollars. Doing so allowed Tennessee to bypass federal requirements and refuse to fund Planned Parenthood, long lambasted by Republicans for offering abortion and LGBTQ+ services.