I 
109TH CONGRESS 
1ST SESSION H. R. 3757 
To amend title XIX of the Social Security Act to provide for health 
opportunity accounts under the Medicaid Program. 
IN THE HOUSE OF REPRESENTATIVES 
SEPTEMBER 13, 2005 
Mr. ROGERS of Michigan (for himself, Mr. BURGESS, Mr. BLUNT, and Mr. 
SHIMKUS) introduced the following bill; which was referred to the Com-
mittee on Energy and Commerce 
A BILL 
To amend title XIX of the Social Security Act to provide 
for health opportunity accounts under the Medicaid Program. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Medicaid Health Op-
portunity Account Act of 2005’’. 
SEC. 2. HEALTH OPPORTUNITY ACCOUNTS UNDER THE 
MEDICAID PROGRAM. 
Title XIX of the Social Security Act is amended— 
(1) by redesignating section 1936 as section 
1937; and
(2) by inserting after section 1935 the following 
new section: 
‘‘HEALTH OPPORTUNITY ACCOUNTS 
‘‘SEC. 1936. (a) AUTHORITY.— 
‘‘(1) IN GENERAL.—Notwithstanding any other 
provision of this title, the Secretary shall establish a 
demonstration program under which States may pro-
vide under their State plans under this title (includ-
ing such a plan operating under a statewide waiver 
under section 1115) in accordance with this section 
for the provision of alternative benefits consistent 
with subsection (c) for eligible population groups in 
one or more geographic areas of the State specified 
by the State. An amendment under the previous sen-
tence is referred to in this section as a ‘State dem-
onstration program’. 
‘‘(2) INITIAL
DEMONSTRATION.—The dem-
onstration program under this section shall begin on 
January 1, 2006. During the first 5 years of such 
program, the Secretary shall not approve more than 
10 State demonstration programs, with each State 
demonstration program covering one or more geo-
graphic areas specified by the State. After such 5- 
year period— 
‘‘(A) unless the Secretary finds, taking 
into account cost-effectiveness, quality of care,
and other criteria that the Secretary specifies, 
that a State demonstration program previously 
implemented has been unsuccessful, such a 
demonstration program may be extended or 
made permanent in the State; and 
‘‘(B) unless the Secretary finds, taking 
into account cost-effectiveness, quality of care, 
and other criteria that the Secretary specifies, 
that all State demonstration program previously 
implemented were unsuccessful, other States 
may implement State demonstration programs. 
‘‘(3) APPROVAL.—The Secretary shall not ap-
prove a State demonstration program under para-
graph (1) unless the program incorporates the fol-
lowing: 
‘‘(A) Creating patient awareness of the 
high cost of medical care. 
‘‘(B) Providing incentives to patients to 
seek preventive care services. 
‘‘(C) Reducing inappropriate use of health 
care services. 
‘‘(D) Enabling patients to take responsi-
bility for health outcomes. 
‘‘(E) Providing enrollment counselors and 
ongoing education activities.
‘‘(F) 
Providing 
transactions 
involving 
health opportunity accounts to be conducted 
electronically and without cash. 
‘‘(G) Providing access to negotiated pro-
vider payment rates consistent with this section. 
Nothing in this section shall be construed as pre-
venting a State demonstration program from pro-
viding incentives for patients obtaining appropriate 
preventive care (as defined for purposes of section 
223(c)(2)(C) of the Internal Revenue Code of 1986), 
such as additional account contributions for an indi-
vidual demonstrating healthy prevention practices. 
‘‘(4) 
NO
REQUIREMENT
FOR 
STATEWIDENESS.—Nothing in this section or any 
other provision of law shall be construed to require 
that a State must provide for the implement of a 
State demonstration program on a Statewide basis. 
‘‘(5) REPORTS.—The Secretary shall periodi-
cally submit to Congress reports regarding the suc-
cess of State demonstration programs. 
‘‘(b) ELIGIBLE POPULATION GROUPS.— 
‘‘(1) IN GENERAL.—A State demonstration pro-
gram under this section shall specify the eligible 
population groups consistent with paragraph (2).