Opponents of Gov. Jan Brewer's plan to cut the state's health-care program for the poor say it's unconstitutional, cruel and costly in both human and economic terms.

They spoke out at a public hearing Monday in Phoenix, telling administrators with the state's Medicaid program that adding co-payments and fees, limiting hospital stays and respite care, and eventually eliminating health coverage for more than 136,000 people won't pass constitutional muster.

"These are the most vulnerable people. They are on the periphery of society. They have so many challenges," said Anthony Hernandez of Happy Kids Pediatrics. "Really, we can do better."

Many health-care advocates have gone above the Arizona Health Care Cost Containment System, urging the federal Centers for Medicare and Medicaid Services to deny Brewer's request to cut the program.

In a 32-page letter to the agency, attorneys for three public-interest law groups said the AHCCCS cuts would violate federal disability laws and the Arizona Constitution.

Voters in 2000 expanded Medicaid coverage for everyone at or below the federal poverty level, and an earlier constitutional amendment protects voter-approved laws from legislative tinkering.

Brewer and GOP lawmakers have said the AHCCCS cuts are necessary to maintain the program, which serves 1.3 million Arizonans, and to help bridge a $1.1 billion deficit.

Attorney Tami Johnson of the William E. Morris Institute for Justice said the enrollment freezes threaten to end care for many of Arizona's homeless, who are more likely to mislay paperwork, miss appointments and lack an address for AHCCCS correspondence.

"We're worried that this is going to result in the neediest populations being discontinued from having health insurance," Johnson said Monday.

AHCCCS announced the meeting last week, weeks after it asked federal officials to approve more than a dozen changes intended to save about $500 million next fiscal year.

The first cut is scheduled to take effect Sunday, freezing enrollment in a catastrophic-care program that has existed in one form or another since at least the 1970s.

The medical-expense-deduction program covers about 5,700 people, including nearly 1,000 children, who earn too much to qualify for AHCCCS but incur medical expenses that cause them to spend down to below 40 percent of the federal poverty level. Participants must re-enroll every six months.

Monica Coury, an assistant director for AHCCCS who led the meeting, said the program won't be eliminated unless the Centers for Medicare and Medicaid Services approves it. But Coury has said that she expects a decision from the feds before Sunday's deadline. If the centers approve, the program, which is not required under Medicaid, would end completely Oct. 1.

Typically, about 14 percent of people who qualify for the spend-down program because of a catastrophic health event become eligible for full AHCCCS coverage.

Brewer's proposal also includes co-payments, missed-appointment fees, penalties for smoking and being overweight, and it eliminates funding for certain ER visits and non-emergency transportation. Brewer on Monday signed a separate measure, Senate Bill 1357, that imposes a $25 fee on AHCCCS patients who miss their appointments.

Matt Jewett of the Children's Action Alliance said the notion that Arizona has been providing "Cadillac coverage" is wrong. Dozens of states offer spend-down programs and most have better coverage for parents, whose coverage would be capped at 75 percent of the poverty level if the AHCCCS cuts were approved.

"The waiver would take Arizona even further out of the mainstream," he said.

Brad Doyle, who has an autistic son, said he had to "basically go on a scavenger hunt" to find the meeting. He said state officials should have made a better effort to tell families about the meeting, which was almost exclusively attended by advocates and others who work in health care and social services.

Brewer's plan also would affect the developmentally disabled by reducing the maximum amount paid for their care and cutting respite for their caregivers, now limited to 720 hours a year.

Coury said she didn't know how much respite would be cut.

Health-care providers, including those who care for the disabled, also would be hit with a 5 percent cut in reimbursement rates, effective Oct. 1. That's on top of a 5 percent rate reduction that took effect April 1.

"I call it a selective tax," said Doyle, of Glendale.

AHCCCS also accepted written comments. One mother wrote that AHCCCS has kept her son alive for eight years. An Apache County non-profit director wrote, "You are putting the people of rural Arizona in great and serious danger."

The agency's typical response was that the cuts were necessary "to comply with legislative direction." It's unclear how much, if any, impact the comments will have on the proposal as state and federal negotiations continue.

The hearing was not required under federal rules, but the rules do require that the state submit a "phase-down" plan for the three programs it intends to cut.

"A lot of times, people just want to vent and make their opinions known," Coury said. "A lot of times, we can't do anything about it."