A new lawsuit in the U.S. District Court for the Northern District of Texas says the state’s Department of Health and Human Services (DHHS) is improperly requiring primary care practitioners to pay for the services that primary care providers receive through Medicaid and Medicare.

The lawsuit, filed Monday in U.T. Austin, claims the lawsuit violates the U,S.

Constitution’s Free Exercise Clause.

The suit was filed on behalf of nine plaintiffs, including seven family members of primary care physicians who are now suing the state, claiming that the state has violated their First Amendment rights.

The plaintiffs include:Anita B. Dennison, who has been a primary care physician in San Antonio since 1998; her husband, Robert Dennon; and their two sons, Jacob and Matthew.

The Dennons are seeking compensatory and punitive damages and attorneys fees and court costs.

A spokesperson for the Texas Department of State Health Services (DSHS) said in a statement that the department is aware of the lawsuit and is reviewing it.

“The DSHS is committed to providing primary care services in a manner that is consistent with the state Constitution and our policies and practices, and does not discriminate based on any of these criteria,” the statement said.

“As with all of our programs, primary care is available to all Texans regardless of income level.”

“We welcome the opportunity to work with the law firm and hope that this lawsuit will prompt the courts to reconsider their decision to force this unnecessary fee,” said state Sen. Sylvia Garcia, D-Houston.

Dennison said in an interview Monday that she has worked with the Texas Drought Relief Coalition, a statewide nonprofit group that works to end drought and protect farmers, ranchers and other landowners, since the Dennisons’ first home was flooded in 2009.

The Dennoneses are the only plaintiffs in the lawsuit.

They have requested a hearing date with the judge overseeing the case and are seeking class action status in the case.

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“We have seen a dramatic decrease in the number of primary and specialty doctors in the state of Texas,” said Patricia Kelleher, co-chair of the Drought Reduction Coalition and a law professor at Texas Southern University.

“In the last six years, there have been more than 5,000 primary care doctor layoffs.”

The lawsuit is the latest in a series of lawsuits challenging the state health care system’s approach to primary care.

In May, the U-T published a report saying the Texas Legislature was moving toward requiring primary and other health care providers to cover the cost of services in the form of insurance or the Medicaid expansion.

The Tribune reported on a recent survey that found the majority of Texas adults have no idea the state requires primary care doctors to provide primary care, with 61 percent not knowing that it is an option.

A 2014 survey of primary caregivers found that only 38 percent of Texas primary care residents know that it’s mandatory for primary care professionals to provide their primary care patients with primary care care services.

“If you don’t know that you’re going to be covered by the state and that you have to pay a fee, how is it that you think that the law allows it?” said Dennonee B. Buss, a family doctor and a member of the Texas Primary Care Association, a state advocacy group.

“This is a case where we are trying to make sure that the health care workers who are paying for these services know what’s going on.”

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