As federal Medicaid work requirements approach enforcement, several states are advancing legislation to publicly name large employers who have significant numbers of employees enrolled in Medicaid. This move aims to highlight the shifting of healthcare costs onto public programs, according to state lawmakers and health policy researchers, amid concerns that Medicaid safety nets will fray under new rules.
What Happened
With a January deadline under the Trump administration’s Medicaid work requirements nearing, states such as California and Nevada are acting to increase transparency around employers whose workers rely on Medicaid. California lawmakers are seeking to revive a law that would require disclosure of companies employing 100 or more people with Medi-Cal coverage. Nevada has maintained a similar law since 2017, annually reporting companies with Medicaid-enrolled employees. Oregon considered such legislation but did not pass it during its last session. Meanwhile, Nebraska and Montana have begun enforcing the new federal requirements that obligate most nondisabled Medicaid beneficiaries aged 19 to 64 to prove 80 hours a month of work, volunteering, or education to keep coverage.
Key Facts
According to Medicaid data for 2025 in Nevada, leading companies with full-time employees on Medicaid include Amazon (4,914 employees), Walmart (3,503), the Clark County School District, the state government, and Tesla. Nevada Medicaid spent nearly $950 million on healthcare for more than 133,000 full-time employees and over 140,000 dependents in 2025. Although total spending slightly declined, the average cost per member rose by nearly 17% over the previous fiscal year.
Nearly 5 million Californians—out of more than 14 million enrolled in Medi-Cal—will be subject to the new work requirements. Studies project the requirements nationwide could lead to an increase of over 5 million uninsured individuals by 2034, according to the Congressional Budget Office.
What This Means
These state efforts to name and sometimes fine large employers with many Medicaid-dependent workers underscore broader concerns about the accessibility and affordability of employer-sponsored health insurance for low-wage workers. The reports serve not only to shed light on who bears the cost of healthcare for working populations but also to spark debate about employer responsibilities and social safety nets.
The emerging work requirements threaten to significantly reduce Medicaid coverage, raising fears of increased strain on emergency healthcare services and broader social safety nets. Advocates highlight that many Medicaid recipients are already working or meet exemptions, indicating systemic issues with healthcare affordability. The data spotlight gaps in the labor market where full-time employment no longer guarantees health insurance, prompting discussions about minimum wage policies and employer-provided benefits.
Background
The Medicaid program, a joint federal-state initiative serving low-income and disabled populations, has expanded over the last decade to cover a substantial portion of the American workforce, particularly those in low-wage jobs without employer health benefits. The Trump administration’s Medicaid work requirements represent a policy shift intended to reduce program enrollment by restricting eligibility based on self-reported work or community activity.
Opponents argue these requirements disproportionately affect vulnerable populations, risking coverage losses that could exacerbate health disparities. The program’s cost—projected at nearly $932 billion government spending in 2024—has sparked debates over cost-shifting from private employers to taxpayers.
Analysis
Edwin Park, research professor at Georgetown University’s Center for Children and Families, explained the complexity faced by many low-income workers. “There’s a whole set of people who are working—they may not satisfy the work requirement provisions, may not get exemptions, and have no access to employer-sponsored insurance,” he noted, emphasizing that Medicaid eligibility hinges on household rather than individual income.
Employers such as Amazon and Walmart dispute the accuracy of these reports, pointing out the inclusion of part-time and seasonal workers in Medicaid counts and highlighting their wage and benefits structures. Amazon’s spokesperson referred to the issue as a “red herring,” advocating instead for higher federal minimum wages to improve family incomes broadly.
What Remains Unclear
The long-term effects of Medicaid work requirements on enrollment and healthcare outcomes remain uncertain. States are still adjusting to enforcement challenges, including exemption processes and the administrative burdens faced by Medicaid recipients. The full impact on children’s coverage and healthcare access is also unclear, although early reports indicate significant declines in Medicaid and CHIP enrollment among children in affected states.
What Comes Next
California lawmakers continue to debate legislation to reinstate transparency measures and explore taxing large employers to offset costs borne by the state’s health system. Governor Gavin Newsom has agreed to study potential tax options, with final decisions expected from the incoming governor. Other states may follow Nevada’s reporting model or impose financial penalties on companies with substantial Medicaid-dependent workforces, although some proposals have failed in legislatures.
Sources
This article is based on reporting and publicly available information from the following sources:
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