Many MindedMedicaid work rule may spare the district of the congressman who helped write it
Beginning in January, a law signed by President Trump last summer requires many nondisabled Medicaid adults in 43 states and Washington, D.C. to work, volunteer or attend school at least 80 hours a month. Rep. David Valadao (R-Calif.) voted for the bill and says he helped secure the work provision, which he calls "not an unreasonable ask." KFF Health News reports that his own district may be largely spared.
The law lets states seek a short-term hardship exception for counties where unemployment is at least 8%, or at least 1.5 times the national rate, whichever is lower. Valadao's website says every county in his district, CA-22, would qualify on current numbers. About 6 in 10 residents there are enrolled in Medi-Cal. Researchers estimate 60,000 more residents could lack coverage by 2034, because of the law and the expiration of enhanced ACA premium tax credits last year.
For health access, the exception shows how much coverage now depends on administrative detail. KFF found at least 21 Republican lawmakers seeking reelection who voted for the bill represent counties that could qualify. The count of eligible counties swings with the data used: 95 using July 2026 unadjusted rates, 120 using a 12-month average, and 64 under any measure. Where an exception is granted, people keep coverage. Where it isn't, paperwork and work-hour rules become a gate to care.
The open questions are large. CMS has said states may submit data from a "reliable" source, but it hasn't set the time frame of the data or how long exceptions last, and hasn't said which states applied. California asked in September to use state data it considers timelier and is waiting for a response. Indiana, Iowa and Missouri do not plan to seek the exception, and five Democratic-led states asked for a delay. Valadao and his campaign declined to comment. He faces Democrat Randy Villegas in a redrawn district.
Source: KFF Health News