State Lawmakers Push for Transparency in Medicaid Work Requirement Laws

As the Trump administration nears a January deadline for states to establish new Medicaid work requirements, some legislators are advocating for increased transparency. They want to publicly identify major companies that enroll their employees in government programs designed for low-income and disabled individuals.

In California, there was a law—now expired—seeking to make businesses employing 100 or more people, who also enrolled workers in Medi-Cal (the state’s Medicaid program), publicly known. Nevada has had a similar requirement since 2017, but Oregon’s effort faltered when the Legislature adjourned in March.

State Senator Laura Smallwood-Cuevas, the sponsor of the California bill, expressed her concern about the potential impacts of these work requirements. According to the state, nearly 5 million out of approximately 14 million residents could be subject to the new Medi-Cal requirements.

“This bill is fundamentally about equity,” Smallwood-Cuevas stated. “Taxpayers deserve to know which large employers are offloading health care costs onto the public.”

Large companies like Walmart and Amazon, frequent entries on Nevada’s Medicaid list, argue that the state counts part-time, seasonal, and full-time hourly workers. A Walmart representative claimed the company provides affordable health insurance to most of its employees, including eligible part-timers, and many plans include free virtual care options.

“Healthcare affordability remains a major challenge for many Americans, and Walmart is committed to being part of the solution,” Proffitt added.

This drive for transparency reflects differing perspectives on the major players benefiting from Medicaid, a program that calls for extensive taxpayer funding. The Trump administration, under the leadership of Centers for Medicare and Medicaid Services Director Mehmet Oz, has accused Democratic states of inadequately addressing fraud and abuse in the system. Conversely, state Democrats have pointed out that many large employers fail to offer affordable health benefits, placing the financial burden on taxpayers who support low-wage workers.

Some states are contemplating fiscal penalties for companies that enroll their workers in Medicaid. In New Jersey, Governor Mikie Sherrill signed a bill in June that could impose fees on businesses with at least 50 employees on Medicaid. These fees could reach $325 annually for businesses with 50 to 249 enrolled employees and up to $725 for those with 500 or more.

Efforts to penalize companies in states like Washington and Colorado, however, were unsuccessful this year. Meanwhile, in Sacramento, California, Democrats are working on strategies to compel large corporations to provide health insurance for their employees. Lawmakers are collaborating with Democratic Governor Gavin Newsom, who, as he wraps up his final year in office, is considering running for president. Decisions regarding tax increases will ultimately rest with the new governor.

The changes brought about by HR 1, a Republican tax-and-spend initiative, could lead states to lose billions in funding. This controversial measure mandates that non-disabled Medicaid enrollees between the ages of 19 and 64 demonstrate employment, volunteer work, or education for at least 80 hours a month to maintain coverage.

However, projections indicate that these work requirements could result in over 5 million Americans losing insurance by 2034. States like Nebraska and Montana are already enforcing such regulations.

Edwin Park, a health policy researcher, noted the significance of the employer Medicaid report in bringing to light the limited healthcare options available for low-wage workers. Interestingly, over half of adults on Medicaid without dependent children already meet the work threshold or likely qualify for an exemption.

“Many people are working but may not satisfy the specific requirements for exemptions or find their employer insurance inadequate,” Park explained.

Employers Respond

Proponents of the employer identification push argue that while it hasn’t led to reduced Medicaid costs, it could serve as a first step in raising awareness about the burden borne by taxpayers and advocating for necessary reforms.

According to a Nevada report, Amazon has hired more Medicaid recipients than any other company since 2020, with Walmart, Clark County School District, state government, and Tesla rounding out the top five for the fiscal year 2025.

Amazon contended that the report was misleading since it included part-time and seasonal workers, whereas the state’s latest report focused solely on those whose employment status could not be definitively categorized.

This situation brings forward numbers showing, for 2025, that 4,914 Amazon employees and 3,503 Walmart employees in Nevada will rely on Medicaid.

Interestingly, there are no penalties imposed on companies listed. Amazon stated it pays more than double the federal minimum wage and emphasized that Medicaid eligibility varies based on household income and size rather than individual wages. Hence, two workers earning the same salary might face different Medicaid eligibility depending on their family circumstances.

“Attributing Medicaid reliance solely to Amazon is misguided,” said Alisa Carroll, a spokesperson for the company. “What we truly need is a substantial increase in the federal minimum wage—this would make a significant impact on American families.”

Nevada’s Medicaid expenditures for 2025 total nearly $950 million, covering over 133,000 full-time employees and more than 140,000 dependents. Although total spending has declined, the average annual costs per member have risen by almost 17%.

Former Nevada Representative Ivanna Cancella, who championed the Medicaid reporting bill, noted that these annual reports spark vital discussions about the workforce and the economy’s structure, questioning whether it’s right for full-time workers to struggle with health insurance costs.

Challenges to the Safety Net

Health experts indicate that uninsured individuals often delay or avoid seeking necessary medical care, which can also affect their children’s coverage.

Recent findings reveal that since Trump took office, approximately 2 million fewer children are enrolled in Medicaid and the Children’s Health Insurance Program than beforehand.

Smallwood-Cuevas warned that the reduction in health insurance would be compounded by cuts to public food assistance as her bill awaits congressional consideration.

Drawing a poignant comparison, she likened Medi-Cal to a worn-out trampoline, overwhelmed by the many individuals relying on it. The current political climate and legislative changes, she argued, are eroding the safety net that helps vulnerable populations.

She emphasized that many families are now forced to make tough decisions between essential needs like medicine and rent. “We’re likely to witness more individuals living in cars, more on the streets, and an increase in emergency room visits—this poses a risk to everyone in California,” she concluded.