California Lawmaker's District May Escape Medicaid Work Mandate

U.S. Rep. David Valadao championed a federal law requiring Medicaid recipients to work, yet the constituents in his California district may be exempt from the mandate. The Republican voted for the One Big Beautiful Bill Act, which President Donald Trump signed into law last summer. The legislation imposes new labor requirements on nondisabled adults in 43 states and Washington, D.C.

Starting in January, eligible adults must work, volunteer, or attend school for at least 80 hours monthly. However, the law includes a hardship waiver for counties with high unemployment. Valadao’s campaign website states that every county in his district, California’s 22nd congressional district, qualifies for this exemption based on current figures. The site argues the waiver acknowledges limited job opportunities for those seeking employment.

Approximately 60% of residents in Valadao’s district are enrolled in Medi-Cal, the state’s Medicaid program. Researchers estimate that 60,000 additional residents in the district could lose coverage by 2034. This projection accounts for the new work rules and the expiration of enhanced premium tax credits for Affordable Care Act plans last year. Valadao declined an interview request, and campaign spokesperson Paige Ash also did not comment.

Valadao is one of at least 21 Republican lawmakers facing reelection who voted for the 2025 bill and represent counties potentially eligible for the hardship exception. The law permits states to request a short-term waiver if county unemployment is at least 8% or 1.5 times the national rate, whichever is lower. It remains unclear how the Trump administration will implement this relief.

Five Democratic-led states have requested a delay in the work requirements, citing insufficient time to comply before year-end. The Centers for Medicare & Medicaid Services, the agency implementing the law, told KFF Health News in an unsigned email that states may use unemployment data from reliable sources, including state labor departments. The agency has not specified which time frame for unemployment data states should provide.

The choice of data significantly impacts the number of qualifying counties. Using July 2026 unemployment rates, 95 counties would qualify for the exception. If a 12-month average is used, the number rises to 120 counties. Sixty-four counties have high unemployment rates that likely qualify them regardless of the data method used. The vast majority of these counties have Republican representatives.

California is among the states seeking to push back the start date. In September, state officials asked CMS for permission to use state unemployment data, which they argue is timelier than federal figures. Griselda Melgoza, a spokesperson for the California Department of Health Care Services, said officials are waiting for a response and details on how long exemptions could last. Indiana, Iowa, and Missouri do not plan to seek the hardship exception, according to a KFF tracker.