GEOFF BENNETT: President Donald Trump's big budget# law is expected to make the largest cuts ever## to Medicaid, a program that currently provides# health insurance for some 70 million Americans.

As Lisa Desjardins reports, those effects# will be felt in House Speaker Mike Johnson's## home state of Louisiana, which has one of the# highest rates of enrollment in the country.

RITA NOEL, Medicaid Recipient: I# bet you can't swing higher than me.

LISA DESJARDINS: A show of joy.

Rita Noel# and her son, Reese (ph), who's autistic,## have a close bond.

But, for Rita,# neither happiness nor health are givens.

The single mom of three in Morgan City, Louisiana,## works part-time and depends# on Medicaid for health care.

RITA NOEL: This is home for my primary care.

I# come here for all sorts of health care needs.

LISA DESJARDINS: Her family# gets care here at Teche Health,## where doctors say Rita is# becoming a healthier patient.

WOMAN: Next thing you know,# I'm going to be saying,## I will see you back in a year,# because you're doing all... (CROSSTALK) RITA NOEL: I'm doing good.

But, sometimes, it took me repeat business, because# I, sometimes, I a hardheaded.

WOMAN: Yes.

LISA DESJARDINS:.. the joint federal and state health program# for low-income people and the disabled.

The Republicans' big tax cut and spending cut# law puts more of the Medicaid load on states## and requires more of patients, from work# hours to more frequent eligibility checks.

Do you think that your# Medicaid is at rescue yourself?

RITA NOEL: I do, and I often worry about that.

LISA DESJARDINS: She's worried about the## additional paperwork falling# through the cracks, and then: RITA NOEL: And my grandbaby doesn't get the# proper vaccinations she needs to be able to## survive by here.

My son won't be able# to get the services he needs to thrive.## I won't be able to get the services I need# in order for me to be healthy.

I have to be## healthy in order to make sure my family# is healthy.

And so I'm very concerned.

LISA DESJARDINS: But Republicans counter: STATE SEN. HEATHER CLOUD# (R-LA): Here in Louisiana,## it's not our intent to just pull# people off of .. LISA DESJARDINS: Republican# State Senator Heather Cloud,## who grew up low-income and without health# insurance herself, says what she is trying## to do is keep Medicaid stable financially.

In# 2016, Louisiana launched its Medicaid expansion,## adding nearly 800,000 people to the rolls,# but also increasing costs to the state.

This spring, Senator Cloud sponsored# a bill to increase eligibility and## residency checks starting in# January.

That passed unanimously.## She also backed separate legislation called# One Door, that aims to keep the vulnerable from## falling through the cracks.

That package also# passed with overwhelming bipartisan support.

DR. GARY WILTZ, CEO, Teche Health: We're# monitoring everything closely to see.

LISA DESJARDINS: But in clinics across the state,## they're worried federal cuts mean at least some# people will lose coverage in the next two years.

Fewer people with health care coverage,## does that concern you in terms of# the health care itself of the state?

STATE SEN. HEATHER CLOUD: Absolutely.

Yes,# that absolutely can.

I can't tell you that## it doesn't concern me.

And I think that is why# we're being so careful in how we manage this.## We don't want to put anybody in a position# that they don't have access to health care,## critical, life-sustaining care, particularly# in my district, in rural Louisiana.

LISA DESJARDINS: The stakes are especially# high here in Louisiana, which is one of## the most reliant states on Medicaid and, by# almost any measure, one of the least healthy.

DR. GARY WILTZ: If you take away that Medicaid# support, then it's going to really cripple us.

LISA DESJARDINS: Dr. Gary Wiltz Teche Health,## which operates 10 community clinics in the# state.

It provides care in rural areas,## where patients face significant challenges# accessing larger hospitals.

The clinic## depends on Medicaid, which covers about# half of the patients here, young and old.

But Dr. Wiltz can't make related decisions# like cutting back on future plans,## yet because the Trump administration# won't finalize some key specifics,## like for work requirements, until next# summer.

He does feel sure of one thing.

DR. GARY WILTZ: I do expect that some people# will get kicked off the rolls, because they## won't know how to navigate or they may not# have we have a -- we have a -- we have deal## with a population that's not always the# easiest to access.

The practicality is## the implementation of how that's going to play# out.

And, to be frank with you, you don't know.

LISA DESJARDINS: The clinic's trying to reach# patients to explain the potential changes,## but, still, patients like Brenda# Harris don't know what to think.

BRENDA HARRIS, Medicaid Recipient:# It's all a puzzle because you're## hearing one thing.

You see another# thing on Facebook.

Then the TV say## another thing.

So it's all confusing.# So it's like, I will just sit and wait.

LISA DESJARDINS: Mom Rita Noel has more# clear thoughts.

She supports the idea## of some work requirements, but with# flexibility.

She's still worried about## what will happen to her and also about# how the world sees people on Medicaid.

RITA NOEL: I do believe that people think# that most people that are on Medicaid,## they don't work, that they're just kind of,## sort of looking for a handout.

And that's# definitely not the case.

In many situations,## I know many people that are on Medicaid and# they work, and they work hard every day.

LISA DESJARDINS: Major Medicaid cuts and reform## are coming.

Louisiana needs to# keep working hard to get ready.

For the "PBS News Hour," I'm Lisa# Desjardins in St. Mary Parish, Louisiana.