Republicans say work requirements are the most likely Medicaid change in a reconciliation bill, though a conservative push for deeper cuts could force more changes to the safety net program.

Why it matters: Medicaid is caught in the middle as House Republicans debate the extent of budget cuts, with conservatives pushing for as much as $2.5 trillion in spending reductions, Victoria and Peter report.

Driving the news: Lawmakers leaving a House GOP Conference meeting this morning said that work requirements could be the likeliest Medicaid change to make it into reconciliation and win support across the caucus.

• House Energy and Commerce Chair Brett Guthrie said sentiment within the GOP conference was favorable to tightening eligibility criteria, requiring work for able-bodied people and equalizing payments for the Medicaid expansion population.
• But Guthrie and some others want to go further and enact per capita caps, which he termed "a better way to go for states."

Guthrie said his committee discussed offering up a minimum of $200 billion in savings during the recent GOP retreat in Florida.

• Medicaid work requirements are estimated to save around $120 billion, per a recent GOP House Budget Committee document.
• A 2023 CBO estimate of work requirements found they would save over $100 billion over 10 years and 600,000 people would become uninsured.

State of play: But hardliners are pushing for more. Conservative Budget Committee member Ralph Norman told reporters this morning that he wants $2.5 trillion in cuts, a hard target to reach.

• He would impose work requirements in Medicaid and in SNAP. Asked if he wanted to go further and also cap Medicaid spending, Norman acknowledged the political challenge: "That would be my dream. Now the likelihood of that? We struggle with work requirements."
• House Freedom Caucus policy chair Chip Roy said that "there's a lot of agreement" across the conference on Medicaid work requirements. He added that there's some "general agreement" on dialing back federal matching payments for the expansion population, though the impact would vary across states.

Between the lines: President Trump's comments last week about not wanting cuts to "affect" Medicaid beneficiaries are also complicating the discussion, since major cuts could lead to coverage loss.

• "We're still trying to determine and getting some clarification, that will come today and tomorrow with the president, about exactly what he meant with the Medicaid cuts," Rep. Buddy Carter told reporters.
• Adding to the challenge, Senate Republicans and some in the House are still pushing for two reconciliation bills instead of one, which would likely roll any health care cuts into the second bill.
• Rep. Byron Donalds left this morning's conference meeting pushing for two bills, enabling Republicans to move first on a border and energy proposal.

The bottom line: Winning over conservatives and moderates for any cuts is a major challenge.

• Asked if he had heard moderate concerns about Medicaid cuts, Guthrie acknowledged, "Everybody's concerned about their rural hospitals."
• He added further discussions will help. "It just takes a while to explain it," he said.

House Republicans are bringing the HALT Fentanyl Act to the floor this week, marking the first legislative step to crack down on the trafficking of the synthetic opioid this session, Victoria reports.

Why it matters: The legislation would permanently give fentanyl-related substances Schedule I classification under the Controlled Substances Act after lawmakers extended a temporary scheduling order from the first Trump administration multiple times.

What they're saying: "It empowers law enforcement to seize those deadly drugs and go after their producers and distributors and stop the flow," Speaker Mike Johnson said at his press conference today.

The Senate Judiciary Committee held a hearing yesterday focused on fentanyl class scheduling, and House Energy and Commerce is holding its first health hearing of the 119th tomorrow, on combatting illicit drugs.

Flashback: The HALT Fentanyl Act passed the House in May 2023 with a bipartisan 289-133 vote.

• Former President Biden supported the bill, but it stalled in the Senate.

Catch up quick: The legislation would permanently change the scheduling of fentanyl-related substances from Schedule II to Schedule I, so they would join substances like heroin and LSD.

• That means there could be increased law enforcement activity and lead to mandatory minimum sentences without parole for those who distribute the drugs.
• Some congressional Democrats who previously opposed the bill said it could increase the number of people in prison without a proven public health strategy to reduce fentanyl overdose deaths.

What we're watching: Whether President Trump's actions freezing some government spending and reshaping federal agencies could douse Democratic support.

1. Online safety: The Senate Commerce Committee today advanced the Kids Off Social Media Act, which would set a minimum age of 13 to use social media platforms, Axios' Mackenzie Weinger reports.
2. DOGE at CMS: Elon Musk's so-called Department of Government Efficiency has access to key CMS payment and contracting systems, the WSJ reports.
3. Health worker "targets": A website called "DEI Watch List" published photos, names and public information of some federal health workers, describing them at one point as "targets," NBC News reports.