A new hurdle for poor Americans, approved by the House, would cause millions to lose coverage, including many who are working but can’t meet reporting rules.

Last-minute changes to the GOP budget plan that House Republicans voted through early Thursday morning may have a wider impact on Medicaid coverage for mental health services. More than 70 million Americans rely on government programs like Medicaid for healthcare.

The House-approved budget bill includes proposals for significant spending cuts to Medicaid and new work requirements.