Health Care · Report · File No. 261102-152
Valadao backed Medicaid work rules; his California district may be exempt from them
Rep. David Valadao voted for the Medicaid work requirement, but every county in his Central Valley district could qualify for a high-unemployment exemption. KFF Health News found at least 21 Republicans seeking reelection in the same position.
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Rep. David Valadao, a California Republican facing one of the closest House races in the country, voted for the 2025 law that requires some Medicaid enrollees to work. His own voters may not have to meet that rule, KFF Health News reported Monday. 1
Valadao defended his vote and noted his role in securing a key provision in the law. His website says “every county in CA-22 would qualify for this exemption,” based on current numbers. 1
How the exemption works
Medicaid is the federal-state health program for people with low incomes and disabilities. Starting in January, the One Big Beautiful Bill Act requires many nondisabled adults in 43 states and Washington, D.C., to work, volunteer or attend school at least 80 hours a month. 1
The law lets states ask for a short-term hardship exception for people in counties where unemployment is at least 8%, or at least 1.5 times the national rate, whichever is lower. The exception is optional, and states must request it. 12
From Channel GOPOssoff: Medicaid cuts mean an hour's drive in laborSenator Jon Ossoff · 1.3K plays · captioned, with the source named
Valadao declined an interview request, and his campaign spokesperson declined to comment. 1 Roughly 6 in 10 residents in his district are enrolled in Medi-Cal, California's Medicaid program. 1
A pattern beyond one district
KFF Health News found at least 21 Republicans running for reelection who voted for the 2025 bill and represent counties that could qualify for a hardship exception. 1 Sixty-four counties have unemployment high enough to likely qualify no matter which data is used, and most have a Republican representative. 1
Researchers have estimated that 60,000 more residents of Valadao's district could lose coverage by 2034. They attribute that to the One Big Beautiful Bill and to last year's expiration of enhanced Affordable Care Act premium tax credits. 1
Much is still unclear
The Centers for Medicare & Medicaid Services (CMS) is implementing the law. It has not said how long exceptions will last, which states have applied, or what time frame of unemployment data states must use. 1
That choice matters. Using July 2026 rates, 95 counties would qualify. Using a 12-month average, 120 would. 1
California asked CMS in September to use its own unemployment data, which it says is timelier, and has asked to delay the start date. Five Democratic-led states have asked for delays. 1 Indiana, Iowa and Missouri do not plan to seek the exception. 1
KFF's earlier analysis, from September 2025, found that expansion enrollees in California account for over 50% of all enrollees living in counties that meet the criteria. It used older data and a different method than the new count. 2
The Record
- KFF published its first analysis of the high-unemployment hardship exception, finding 158 counties in expansion states could qualify on a 12-month average 2
- California asked CMS in September for permission to use its own unemployment data for the exception 1
- KFF Health News reported at least 21 Republicans seeking reelection who backed the 2025 law represent counties that could qualify 1
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Sources
- KFF Health News, “A GOP Congressman Backed Medicaid Work Requirements. His Voters Might Be Exempt.” (2026-11-02). kffhealthnews.org/elections/medicaid-work-rules-california-v
- KFF, “A Look at the Potential Impact of the High Unemployment Hardship Exception to Medicaid Work Requirements” (2025-09-29). kff.org/medicaid/a-look-at-the-potential-impact-of-the-high-
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More from the files
Valadao defends Medicaid vote in California swing-district race: 'no actual cuts'
Republican Rep. David Valadao says his vote for the GOP tax and spending law cut no Medicaid benefits. Democrat Randy Villegas says it will take coverage from Valley families in a district that could help decide House control.
Judge blocks Medicaid rule requiring proof of medical frailty for work exemptions
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Georgia's Medicaid work-rule program may end Dec. 31 as federal rules go national
Georgia Pathways, the state program that helped inspire national Medicaid work rules, expires at year's end unless renewed. More than 20,000 people are enrolled, and the next governor will have to decide its fate.
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