U.S. Rep. David Valadao, a Republican from California, defended his vote for a bill aimed at reducing Medicaid spending by billions, citing his role in securing a provision that requires some adult beneficiaries to work. The One Big Beautiful Bill Act, signed into law by President Donald Trump, mandates that many nondisabled adults enrolled in Medicaid work, volunteer, or go to school for at least 80 hours a month.
However, voters in Valadao’s California Central Valley district might be exempt from the Medicaid work rules due to high unemployment rates in the area. According to Valadao’s website, every county in his district could qualify for this exemption, which is based on the number of people out of work.
Medicaid Work Requirements
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. This exemption is important, as it takes into account real-life situations where job opportunities are limited.
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Valadao’s district has one of the highest enrollment rates in Medi-Cal, the state’s Medicaid program, with roughly 6 in 10 residents enrolled. Researchers estimate that 60,000 more residents could be without coverage by 2034 due to the new law and the expiration of enhanced premium tax credits for Affordable Care Act insurance plans.
Valadao faces Democrat Randy Villegas in a district that was redrawn last year to lean more blue, and the two sides have booked more than $16 million in advertising through Election Day. Villegas and other Democratic challengers have made Republicans’ Medicaid vote a centerpiece of their campaigns, saying most enrollees already work, are disabled, or are caregiving.
Implementation of the Law
The press office for the federal Centers for Medicare & Medicaid Services said that states may submit unemployment data from a “reliable” source, including figures from their own labor departments. However, the agency hasn’t said exactly what time frame of unemployment data states should provide, which could affect the number of counties that qualify for the exemption.
Using unemployment rates, the number of qualifying counties varies depending on the data used. The uncertainty surrounding the implementation of the law has led some states to wait for answers.
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California officials are waiting for a response from the Centers for Medicare & Medicaid Services regarding their request to use state unemployment data. This data is considered timelier than federal data, according to Griselda Melgoza, a spokesperson for the California Department of Health Care Services.
Exemptions and Accountability
According to Jennifer Tolbert, deputy director of KFF’s Program on Medicaid and the Uninsured, the data used to determine exemptions matters. She stated that there is still a lot unknown about the implementation of the law.
The Centers for Medicare & Medicaid Services 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.