Low-income individuals and families relying on Medicaid for basic care will have to dig deeper into their pockets at the expense of other necessities or forgo treatment under new rules approved by the Bush administration.

States will be allowed to set the premiums and raise copayments they charge Medicaid recipients for doctor visits, emergency room use or prescription drugs. The move, endorsed by many states, is meant as a measure to contain the escalating costs of Medicaid.

Medicaid recipients will pick up $1.5 billion in higher costs over the next five years, while the states and federal government will save about $2.5 billion, not just from increased revenue but from an expected reduction in use of services.

The rule will hit about 13 million low-income people, or about one-fifth of those who rely on the program for health care, according to the Congressional Budget Office.

States will be permitted to charge a sliding scale for co-payments and premiums. For a family of three below the poverty level of $17,600, states can charge up to $3.40 for a doctor's visit or other service. Above the poverty level, families can be asked to pay from 10 percent to 20 percent of the state's cost for a service.

The rules place an upper limit on the cost of 5 percent of a family's income. A family of three at the poverty level of $17,600 — those with little disposable income — could pay out $880 a year, money that will come from other expenses or basic needs.

Beneficiaries who do not pay their premiums or copayments can be denied care or coverage.

The AARP was one of several organizations, including the American Academy of Pediatrics and the National Association for Home Care, that opposed the rule. David P. Sloane, senior vice president of AARP, told the New York Times, "Denying necessary care to people who are unable to pay is unconscionable."

Copayments are intended to make recipients aware of the cost of their medical treatment and encourage them to seek less costly alternatives. But several studies have shown that copayments can deter people from seeking treatment or medication that can prevent more serious, avoidable illnesses, which might also be more costly to treat.

States need to exercise restraint when deciding to raise copayments that can have such adverse consequences.