For the fifth year in a row, Amazon is the leading employer with the most recipients on Medicaid in Nevada.

There were 18,093 Amazon employees and their dependents who were on Medicaid, a government-funded insurance program serving people with low incomes, during the fiscal year that ended in mid-2024. The number of Amazon-linked beneficiaries has climbed since 2019, the year before it took the number one spot from Walmart — which is now second after Amazon. 

The total now is more than twice the number in 2019, when there were 7,892 Medicaid beneficiaries with links to Amazon. The retail giant did not say how many employees it has in Nevada.

The findings are part of a new analysis published by the state that determined more than $1.1 billion in public funds last fiscal year went to support Medicaid benefits for people working for companies with 50 or more employees in Nevada. It includes employees who made wages that were at least equivalent to working 40 hours a week at the minimum wage of $10.25 an hour.

Critics have pointed to the report, required annually by a bill passed by the Nevada Legislature in 2017, as evidence that large, profitable companies are being subsidized by taxpayer funds. But according to an Amazon spokesperson, there are “a ton of nuances” and “lots of reasons why people would be on Medicaid, not just because of income.” 

Medicaid coverage typically applies to people with household incomes up to 138 percent of the federal poverty level, but pregnant women, children and people with disabilities can also qualify. 

Federal law doesn’t exclude employed individuals from Medicaid if they meet the requirements, including having a low income, and doesn’t require them to leave Medicaid even if they are eligible for affordable health insurance from their employer. Amazon also has part-time employees and flex employees who “qualify for Medicaid as opposed to full time employees.” 

Flex employees are people who help deliver Amazon packages using their own vehicles rather than the company’s. Despite part-time and flex workers having access to Amazon’s health insurance, it may not be as “beneficial” because Medicaid is free and there’s “that incentive for them to apply.” 

However, Erika Washington, executive director for the progressive workers’ rights organization Make it Work Nevada, says Amazon is incentivizing its employees to help the company have “larger revenues.”

“When it comes to insurance, there’s a front end cost that the employees pay and then there’s a back end cost that the employers pay,” Washington said. “If they’re [Amazon] not having to pay that back end cost, then it sounds like they’re saving money.”

Washington says big corporations such as Amazon should be ashamed of themselves, noting that some hospitals and doctors don’t accept Medicaid.

Washington empathizes that health insurance is expensive, but believes big companies such as Amazon, Walmart and Clark County School District (CCSD) should offer employment at livable wages that includes full benefits for their employees and families. 

The Amazon spokesperson said full-time employees wouldn’t qualify for Medicaid because they make $18 an hour in Nevada. That means full-time employees make about $3,117 per month, or $37,404 a year, “likely disqualifying them from SNAP or Medicaid.” 

For Nevadans to qualify for Medicaid, households would need to have an annual income up to the 138 percent of the federal poverty level — $16,753 per year for an individual or $34,638 per year for a family of four.

A key finding in the analysis is that the cost of providing Medicaid to people employed by companies with 50 or more employees went down in 2023 by 22.8 percent and the cost of each member declined by 23.6 percent. That’s likely because many Nevadans lost their Medicaid coverage through a process known as “redetermination” during the fiscal year reflected in the report. 

During the COVID-19 pandemic, it was mandated that the state keep individuals on Medicaid even if their income went up and they no longer qualified for it; more frequent eligibility checks that disqualified some beneficiaries resumed in 2023. The report still reflects people who had Medicaid coverage at some point in the fiscal year, even if they were later removed from the rolls and expected to find other health insurance. 

Walmart and CCSD are far behind Amazon. Walmart had 9,279 recipients on Medicaid and CCSD had 7,476 recipients. 

CCSD has about 44,000 employees who are full-time, part-time or substitute/temporary employees. Nearly 36,000 employees are eligible for group insurance coverage with CCSD for full-time and part-time employees. 

CCSD told The Nevada Independent “we strive to ensure that employees have access to reliable health benefits.” 

Walmart did not provide comment on the report’s findings or say how many employees it has in Nevada.