Congress is ahead of next year's budget, but the most controversial plan in the chopping neighborhood - Medicaid - is creating a rift within the Republican Party.

Earlier this year, Congress adopted a budget blueprint that includes billions of dollars in cuts to federal spending. But changes in popular government-funded health care plans are imminent as lawmakers phase out details of spending plans.

Republicans scramble to find creative ways to achieve budget cuts on their vote without covering up Medicaid, a politically risky move that will harm health care for more than 71 million people nationwide and have a cascading effect on hospitals and nursing homes.

So far, even as Republicans branded their visions with “waste, fraud, and abuse,” a vision used by Trump administration officials, these options have a huge impact on Medicaid, even if eligibility and job requirements are increased and access to immigrants is restricted, which is to reduce the size of federal government departments and programs.

"The Republican Party is strengthening Medicaid for those who need it by eliminating things like fraud, waste and abuse, which is a huge problem in the program, including removing illegal foreigners."

Other options lawmakers consider involve a substantial cut in the money the federal government provides to states that expand Medicaid coverage under the Affordable Care Act. If the minimum threshold is removed, California could lose up to $156.5 million in federal funds for the program, according to an analysis by the Robert Wood Johnson Foundation.

“States in general can’t really raise that revenue,” said Kathy Hempstead, a senior policy officer at the foundation. “What states are going to do is increase some revenue, but they have to start cutting services.”

Johnson said Tuesday he has gotten rid of the consideration.

Still, advocates warn that other options to limit eligibility will be unintentionally disadvantageous, with millions of people eligible for the program.

The Budget Congress passed an order from the House Energy and Commerce Committee that manages Medicaid spending, cutting $880 billion in 10 years. The non-partisan Congressional Budget Office said that only by entering Medicaid can the level be lowered.

In a letter to committee leaders on Wednesday, the CBO outlined the federal changes to Medicaid will lead to a reduction in the program.

It expects states to spend more on Medicaid, lower payment rates to healthcare providers, limit optional benefits and reduce enrollment.

Last week, the committee postponed a meeting of a plan to discuss ongoing disagreements among members of the bill. Matt Herdman, the state director of California protecting our care, sees the delay as a partial victory.

"They clearly noticed that there was a huge problem on their hands. They had a lot of weak members," Hedman said. "If they thought it was a deal, they wouldn't postpone it."

But Johnson refuted the idea that a postponement was “a barrier,” saying they decided that after meeting with President Trump over the weekend and reviewing the numbers, “it makes sense to let us pause for a week… to be right.” The speaker said he was still passing the budget before Memorial Day.

Meanwhile, Johnson quarreled on the party’s far-right side, supporting refunds and reforms to Medicaid and other Republicans, who begged party leaders to avoid forcing them to vote for cuts.

Twelve members representing high Medicaid populations, including California Rep. David Vallador (R-Hanford) and Young Kim (R-Anaheim Hills) - sent a letter to House leaders last month warning that a vote to cut Medicaid would endanger their tough areas in future elections.

“We cannot and will not support the final settlement bill, which includes reducing the scope of Medicaid vulnerable populations,” the letter said. It concluded: “Communities like us have won our majority and it is our responsibility to deliver on our commitments.”

Valadao told Politico that he would meet with colleagues regularly in Congress to work on alternative solutions. Valadao has a serious driving force to save the program - he represents the California area with the highest percentage of Medicaid recipients, and he lost a seat in Congress after repealing the Affordable Care Act in 2017.

His office declined to be interviewed for this article.

Protests to preserve Medicaid have swept the country for weeks. The Service Staff International Union is home to many caregivers in the United States, including Kim's, organized several demonstrations outside the Republican Congress office in recent weeks.

“I saw incredible energy,” Hedman said. “I haven’t seen anything I’ve seen on legislative issues since the pandemic.”

Rep. Debbie Dingle (D-Mich) who sits on the Energy and Commerce Committee told reporters Tuesday that she has been hearing letters from voters who rely on Medicaid to maintain their health care.

"Medicaid is a lifeline. It can keep children healthy, help parents work, and care for seniors in nursing homes," Dingle said. "The American people can't afford the cuts in Medicaid, especially when the economy collapses around President Trump."