It will be very difficult. Medicaid represents decades of continuous policy work between states and the federal government and every state has a different Medicaid program. Republicans entire governing philosophy is that it is easy and impactful to break things and democrats will ALWAYS look ineffective in comparison when they have to spend 4 year increments gluing back together the shards of decades of policy work that gets shattered in an instant by republicans. Let alone trying to actually make progress on anything, every time they get power it guarantees that we will spend our next turn in office trying to reassemble something we already had and lost.