316 
BENEFITS.—The provisions of this title relating to 
cost sharing for benefits (including sections 1916 
and 1916A) shall not apply with respect to benefits 
to which the annual deductible under paragraph 
(1)(A) 
applies. 
The 
provisions 
of 
section 
1902(a)(10)(B) (relating to comparability) shall not 
apply with respect to the provision of alternative 
benefits (as described in this subsection). 
‘‘(6) TREATMENT AS MEDICAL ASSISTANCE.— 
Subject to subparagraphs (D) and (E) of subsection 
(d)(2), payments for alternative benefits under this 
section (including contributions into a health oppor-
tunity account) shall be treated as medical assist-
ance for purposes of section 1903(a). 
‘‘(7) USE OF TIERED DEDUCTIBLE AND COST 
SHARING.— 
‘‘(A) IN GENERAL.—A State— 
‘‘(i) may vary the amount of the an-
nual deductible applied under paragraph 
(1)(A) based on the income of the family 
involved so long as it does not favor fami-
lies with higher income over those with 
lower income; and 
‘‘(ii) may vary the amount of the max-
imum out-of-pocket cost sharing (as de-
317 
fined in subparagraph (B)) based on the 
income of the family involved so long as it 
does not favor families with higher income 
over those with lower income. 
‘‘(B) 
MAXIMUM
OUT-OF-POCKET
COST 
SHARING.—For 
purposes 
of 
subparagraph 
(A)(ii), the term ‘maximum out-of-pocket cost 
sharing’ means, for an individual or family, the 
amount by which the annual deductible level ap-
plied under paragraph (1)(A) to the individual 
or family exceeds the balance in the health op-
portunity account for the individual or family. 
‘‘(8) CONTRIBUTIONS BY EMPLOYERS.—Noth-
ing in this section shall be construed as preventing 
an employer from providing health benefits coverage 
consisting of the coverage described in paragraph 
(1)(A) to individuals who are provided alternative 
benefits under this section. 
‘‘(d) HEALTH OPPORTUNITY ACCOUNT.— 
‘‘(1) IN GENERAL.—For purposes of this sec-
tion, the term ‘health opportunity account’ means an 
account that meets the requirements of this sub-
section. 
‘‘(2) CONTRIBUTIONS.—
318 
‘‘(A) IN GENERAL.—No contribution may 
be made into a health opportunity account ex-
cept— 
‘‘(i) contributions by the State under 
this title; and 
‘‘(ii) contributions by other persons 
and entities, such as charitable organiza-
tions. 
‘‘(B) STATE
CONTRIBUTION.—A State 
shall specify the contribution amount that shall 
be deposited under subparagraph (A)(i) into a 
health opportunity account. 
‘‘(C) LIMITATION ON ANNUAL STATE CON-
TRIBUTION PROVIDED AND PERMITTING IMPO-
SITION OF MAXIMUM ACCOUNT BALANCE.— 
‘‘(i) IN GENERAL.—A State— 
‘‘(I) may impose limitations on 
the maximum contributions that may 
be 
deposited 
under 
subparagraph 
(A)(i) into a health opportunity ac-
count in a year; 
‘‘(II) may limit contributions into 
such an account once the balance in 
the account reaches a level specified 
by the State; and
319 
‘‘(III) subject to clauses (ii) and 
(iii) and subparagraph (D)(i), may 
not provide contributions described in 
subparagraph (A)(i) to a health op-
portunity account on behalf of an in-
dividual or family to the extent the 
amount of such contributions (includ-
ing both State and Federal shares) 
exceeds, on an annual basis, $2,500 
for each individual (or family mem-
ber) who is an adult and $1,000 for 
each individual (or family member) 
who is a child. 
‘‘(ii) INDEXING
OF
DOLLAR
LIMITA-
TIONS.—For each year after 2006, the dol-
lar amounts specified in clause (i)(III) 
shall be annually increased by the Sec-
retary by a percentage that reflects the an-
nual percentage increase in the medical 
care component of the consumer price 
index for all urban consumers. 
‘‘(iii) BUDGET
NEUTRAL
ADJUST-
MENT.—A State may provide for dollar 
limitations in excess of those specified in 
clause (i)(III) (as increased under clause
320 
(ii)) for specified individuals if the State 
provides assurances satisfactory to the Sec-
retary that contributions otherwise made 
to other individuals will be reduced in a 
manner so as to provide for aggregate con-
tributions that do not exceed the aggregate 
contributions that would otherwise be per-
mitted under this subparagraph. 
‘‘(D) LIMITATIONS ON FEDERAL MATCH-
ING.— 
‘‘(i) STATE CONTRIBUTION.—A State 
may contribute under subparagraph (A)(i) 
amounts to a health opportunity account in 
excess of the limitations provided under 
subparagraph (C)(i)(III), but no Federal 
financial participation shall be provided 
under section 1903(a) with respect to con-
tributions in excess of such limitations. 
‘‘(ii) NO FFP FOR PRIVATE CONTRIBU-
TIONS.—No Federal financial participation 
shall be provided under section 1903(a) 
with respect to any contributions described 
in subparagraph (A)(ii) to a health oppor-
tunity account.