Maryland stands to lose more than $1 billion if federal lawmakers go through with proposed changes to two provisions of Medicaid, the federal health program for millions of low-income residents.

State health officials have spent weeks trying to assess the impact of what they see as increasingly likely cuts outlined by GOP lawmakers on Capitol Hill. Those Republicans leaders have said they are searching for savings in Medicaid to fund a tax-and-spending plan pushed by President Trump.

During a news conference Tuesday, state health officials in Maryland said they foresee two big change to the program that could lead to massive reductions in Medicaid spending.

The first would impose a new work requirement for recipients that could cost Maryland an estimated $317 million and eliminate coverage for some 56,000 people. Another possible change to Medicaid would require the state to check the eligibility of recipients more often, potentially costing $864 million and kicking an estimated 130,000 people off their insurance.

Any major changes to Medicaid rules and regulation could have an enormous impact on Maryland’s bottom line. The $14.6 billion in Medicaid funding comprises about 20% of the entire Maryland budget and provides health insurance for 1 out of every 4 residents in the state. About 60% of Maryland’s Medicaid costs are covered by federal dollars.

“Every change proposed by the federal government will impact individuals receiving coverage through Medicaid and the providers that serve them,” Maryland Secretary of Health Dr. Meena Seshamani said in a statement. “Children, families, and older adults rely on the state and federal government to work in partnership to provide their critical care.”

Medicaid helps pay for about 40% of births in the state and about half of all children in Maryland are covered by the program. About 80% of nursing home revenue also comes from Medicaid, according to state officials.

The program supports more than 120,000 providers in hospitals and clinics in Maryland.

Ryan Moran, deputy secretary of health care financing and the state’s Medicaid director, said the proposals “shift the government’s focus from providing quality health coverage to children and families to, instead, reducing investment in our already-strained health care system and creating unnecessary, inefficient barriers to care.”

Before state lawmakers adjourned their annual session in April, they passed a bill to reconstitute a commission to keep watch over changes in federal health care laws and funding. The idea is that the commission will advise lawmakers and help them act quickly to adapt to cuts and fill in funding cracks, if possible.

The bill is on Gov. Wes Moore’s desk, awaiting his action. He has until May 27 to sign the bill into law, allow it to become law without his signature or veto it.

“We know there are a lot of big questions ahead for state finances, and one of the big drivers that we’ve talked a lot about is on Medicaid and the access to health care,” state Senate President Bill Ferguson said during an event at the State House Tuesday.

Ferguson called the moves by Congressional Republicans a “slash and cut approach” that would cause low-earning Americans to lose their health care while enriching high-earning Americans with tax cuts.

House of Delegates Speaker Adrienne A. Jones decried the proposed billions of dollars worth of cuts to Medicaid in order “to fund tax cuts for the rich.”