PHOENIX – Arizona’s cash-strapped Medicaid program is considering charging patients $50 a year if they smoke, have diabetes or are overweight. A spokeswoman for the state Medicaid program, also known as the Arizona Health Care Cost Containment System, said Friday that the fee is intended to rein in health care costs by pushing patients to keep themselves healthy.

“It engages the consumer to start having a greater awareness of how they fit into the bigger health care puzzle,” said Monica Coury, spokeswoman for the program “We want to be able to provide health care to people. And we want to stretch our dollars as far as we can. Part of that is engaging people to take better care of themselves.”

Some private employers and state governments have instituted higher insurance premiums for workers who are overweight or smoke, but Arizona’s plan would mark the first time a state-federal health care program for low-income residents has charged people for unhealthy lifestyles. The fee would apply only to certain childless adults.

One part of the proposal affects people with diabetes. Coury says diabetics who fail to follow their doctor’s orders to lose weight would be subjected to the $50 charge.

Democratic state Sen. Kyrsten Sinema said that isn’t fair to diabetics.

“This would fine people with medical conditions beyond their own power and control,” Sinema said. “I just don’t think it’s fair to vilify someone with diabetes.”

People who are obese or chronically ill, and those who smoke, would need to work with a primary-care physician to develop a plan to help them lose weight and otherwise improve their health. Patients who don’t meet specified goals would be required to pay the $50 under the proposal.

The plan requires approval by the Republican-controlled Legislature, which has been considering $500 million of cuts to Arizona’s Medicaid program to help eliminate a state budget deficit of nearly $1.5 billion.

A fee for Medicaid patients also would need federal authorization, and federal rules could prevent Arizona from enforcing the fee.

Coury says the $50 fee is a way of showing the federal government Arizona is serious about getting people healthy while stretching and managing dollars better.

“Part of that requires that we engage the consumer in active, healthy behaviors,” she said.