The Healthy Drinking Water Affordability Act, or the Healthy H2O Act, amends the Consolidated Farm and Rural Development Act to establish a new grant program. This program, called the Healthy Drinking Water Affordability Assistance Program , aims to improve drinking water quality for eligible end users in rural areas by providing financial assistance. Grants are available to eligible end users, including homeowners, individual lessees or renters, property owners of multi-unit residential buildings with 25 or fewer units, and licensed child-care facilities. Eligibility requires a finding of need , typically demonstrated through a qualified water quality test showing the presence of one or more health contaminants like lead, arsenic, or PFAS. Nonprofit organizations are also eligible grant recipients, using funds to assist end users. The grants can be used for several purposes, including the purchase of eligible drinking water quality improvement products or replacement certified filter components. They also cover the approved installation of these products by qualified third-party installers and their approved maintenance by certified service technicians. Additionally, grants can fund qualified water quality tests necessary to support these purchases and services. Nonprofit organizations receiving grants are tasked with offering voluntary water quality tests, facilitating the analysis of results, assisting end users in selecting appropriate response options, and coordinating approved installations. Grant amounts are limited to reasonable costs, and eligible end users must have a household income no more than 150 percent of the median nonmetropolitan household income for their State or territory. The Secretary of Agriculture is responsible for establishing and administering the program, allocating funds to respond to various water quality challenges, prioritizing private well users, and improving local capacity to address contamination. The bill mandates annual reports to Congress, detailing ongoing barriers to safe drinking water, contamination sources, available technologies, and recommendations to increase access to the program and its services. To fund this initiative, the bill authorizes an appropriation of $10,000,000 for each of fiscal years 2025 through 2029 .