When U.S. Rep. David Valadao defended voting for a bill aimed at reducing Medicaid spending by billions, the Republican noted his role in securing a key provision that will require some adult beneficiaries to work — a mandate he called “not an unreasonable ask.”
But the voters in his California Central Valley district, home to one of the most competitive House races in the nation, might get a pass from the Medicaid work rules in the One Big Beautiful Bill Act, which President Donald Trump signed into law last summer.
Starting in January, the law requires many nondisabled adults enrolled in Medicaid in 43 states and Washington, D.C., to work, volunteer, or go to school for at least 80 hours a month. But those who live in counties where a high number of people are out of work could get relief — one of several carve-outs in the law.
Based on current numbers, every county in CA-22
“Based on current numbers, every county in CA-22 would qualify for this exemption,” Valadao’s website says, referring to his district. “This waiver is important because it takes real-life situations into account, and if someone is trying to work but opportunities are limited, they won’t be required to.”
The congressman, who has said enrollees in Medicaid — the federal-state program covering the poor and disabled — should “put in a fair day’s work” if they can, declined an interview request. Valadao campaign spokesperson Paige Ash also declined to comment.
Valadao is among at least 21 Republican lawmakers running for reelection who voted for the 2025 GOP bill and represent counties that could qualify for a hardship exception, according to a KFF Health News analysis.
Roughly 6 in 10 residents in Valadao’s district
Roughly 6 in 10 residents in Valadao’s district are enrolled in Medi-Cal, the state’s Medicaid program. Researchers have estimated 60,000 more residents of his district could be without coverage by 2034 as a result of the One Big Beautiful Bill and the expiration last year of enhanced premium tax credits for Affordable Care Act insurance plans.
“It feels akin to an arsonist trying to take credit for helping put out a fire that they themselves ignited when all of this was avoidable pain from the outset,” said Miranda Yaver, an assistant professor of health policy and management at the University of Pittsburgh.
Valadao faces Democrat Randy Villegas in a district that was redrawn last year to lean more blue, and the two sides had each booked more than $16 million in advertising through Election Day, according to data compiled by AdImpact. Villegas and other Democratic challengers nationwide have made Republicans’ Medicaid vote a centerpiece of their campaigns, saying most enrollees already work, are disabled, or are caregiving.
The law allows states to apply
The law allows states to apply for a short-term hardship exception for enrollees who live in counties where unemployment is at least 8%, or at least 1.5 times the national rate, whichever is lower. But it’s unclear how the Trump administration intends to implement that relief.
Some states have yet to submit their applications. Five Democratic-led states have asked the federal government to delay the work requirements, citing insufficient time to comply before the end of the year.
The press office for the federal Centers for Medicare & Medicaid Services, which is implementing the new law, told KFF Health News in an unsigned email that states may submit unemployment data from a “reliable”e agency hasn’t said exactly what time frame of unemployment data states should provide
Unemployment data can be reported in a variety
Unemployment data can be reported in a variety of ways. It can be from the most recent month, or a 3-, 6-, or 12-month average. That data will determine how many counties — and how many people — might qualify.
Using July 2026 unemployment rates, which are not adjusted for seasonal swings, 95 U.S. counties would qualify for the exception, according to an analysis by KFF, a health information nonprofit that includes KFF Health News. Using the 12-month average, the number of qualifying counties jumps to 120.
“Which data is used matters,” said Jennifer Tolbert, deputy director of KFF’s Program on Medicaid and the Uninsured. “I think there’s a lot still unknown.”
Sixty-four counties have high unemployment rates that will
Sixty-four counties have high unemployment rates that will most likely qualify them no matter what data is used. The vast majority of the counties have a Republican representative. CMS declined to say how long exceptions would last or which states have applied. Indiana, Iowa, and Missouri do not plan to seek the hardship exception, according to KFF’s Medicaid work requirements tracker.
Some states are waiting for answers. California is among those that have asked to push back the start date. In September, the state asked CMS for permission to use state unemployment data that it says is timelier than federal data. State officials are waiting for a response, as well as for details about how long exemptions could be granted, said Griselda Melgoza, a spokesperson for the California Department of Health Care Services.
While blue states like California are seeking exceptions to help minimize the fallout of the new Medicaid rules, Yaver said any exceptions to the work rules could serve Republicans politically in the future.
“I think that exemptions and strategic burden reduction will ultimately undercut the accountability,” she said. “Because voters will just not really see the full reach of the law.”
