DES MOINES, Iowa (AP) — Iowa’s effort to cut a key Medicaid benefit could foreshadow other state-level efforts to change the safety net program after Congress repeatedly failed to repeal the Affordable Care Act.

Federal health officials could decide as early as this week whether to back Iowa’s proposal. It would reduce retroactive payments for poor or disabled residents eligible for Medicaid. The plan was in the latest Republican effort to repeal the health care law, but it didn’t get a Senate floor vote.

Although the Trump administration has yet to approve any major proposed changes to state Medicaid programs, some experts predict that soon could change. Iowa says the reduction to retroactive pay would save more than $37 million annually — more than $9 million of that for the state.