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Environmental services aid Charlie Fletcher pushes a gurney at UMC Trauma Center on Thursday, July 20, 2017. (Jeff Scheid/The Nevada Independent)

Nevada Medicaid spent a little more than $677 million on health care for roughly 240,000 full-time employees and dependents in 2017, a little more than a third of the number of current enrollees in the program, according to a report released by the state.

The companies with the largest number of employees who worked full-time — meaning they brought home at least $3,480 in a quarter, representing 40 hours a week worked for 12 consecutive weeks at a $7.25 an hour minimum wage — were Walmart, the Clark County School District and Sutherland Global Services. The report, which was mandated by a bill passed in 2017, was published online at the end of November but is dated January 2018.

Julie Kotchevar, administrator of the Division of Public and Behavioral Health, said the state recently posted the report online on its new reports and data page in preparation for the legislative session. She said department staff were under the impression it had been previously posted, but a review showed of the website showed it had not; it is unclear who received a copy of the report before it was published online.

As a subset of those who made $3,480 in a consecutive 12-week period, the report examined workers who made at least $7,963.20 at any point in a quarter, representing those who worked 40 hours a week for 12 weeks at Nevada’s $16.59 an hour median wage. Julie Kotchevar, administrator of the Division of Public and Behavioral Health, said the two groups allowed the state to look overall at full-time employees on Medicaid, the $7.25 an hour group, as well as the subset of those who may have participated in gig or short-term work, the $16.59 group.

The legislation required the state to total the number of full-time workers and their dependents enrolled in Medicaid and the cost of providing coverage to them per employer with 50 or more workers, but didn’t specify how the state should determine who is employed on a full-time basis.

“It’s not just minimum wage people, it’s people who have intermittent work,” Kotchevar said. “It’s both full time, low-wage and people who are working median wage, which does happen when you have seasonal work. It is higher paid but is time limited.”

The report concluded that Medicaid spent nearly $345 million on 104,512 employees and $332 million on dependents overall, including $89 million on 27,873 employees and $107 million on 59,301 dependents in the gig or short-term work category. Those roughly 240,000 individuals are a little more than a third of the state’s current 660,000-person Medicaid caseload.

“People forget that Medicaid is low-income. It’s not necessarily no income. If you do the math, if you are a single parent with two or three children and you’re working a full-time job at minimum wage, you’re still going to qualify for Medicaid. If you’re two parents with two kids working full time, you’re still going to qualify for Medicaid,” Kotchevar said. “$7.25 an hour, $8.25 an hour is not a lot of income. This report shows there are a lot of people on Medicaid who work and don’t earn enough to be able to afford or to be able to qualify for insurance under a different plan.”

Kotchevar noted some employers may choose not to offer health insurance to employees — though the Affordable Care Act’s employer mandate requires companies with 50 or more employees to provide coverage to full-time workers or pay a penalty — or that workers may not qualify for health insurance based on the hours or time period over which they work.

Employees who worked for more than one employer in 2017 are only counted once in the report, Kotchevar said. However, the individual employer totals are not de-duplicated, meaning that there could be overlap between them if a person held more than one job.

Of the individual employers, Walmart had the highest number of employees and their dependents on Medicaid overall, followed by Clark County School District and Sutherland Global Services The state paid $21.2 million for 7,332 Walmart employees and dependents; $10.4 million for 3,892 Clark County School District (CCSD) employees and dependents; and $9.5 million for 3,127 Sutherland Global Services employees and dependents.

In the gig-economy or short term group — a subset of the overall group — the state shelled out $3.3 million on 1,311 Walmart employees and their dependents; $3.5 million for 1,472 CCSD employees and their dependents; and $1.8 million for 712 Sutherland Global Services employees and their dependents.

School district spokeswoman Melinda Malone said in an email that roughly 31,000 of the district’s 40,000 employees are eligible for health insurance coverage as full- or part-time employees who work 4.1 hours per day or more. Licensed employees and administrators can enroll with the Teachers Health Trust or the the Clark County Association of School Administrators and Professional-Technical Employees (CCASAPE) Welfare Trust, respectively; support professional and police employees can enroll in the CCSD Support Professionals and Police group insurance with $20 or $36.20 in out-of-pocket costs per payroll, respectively.

“We strive to ensure that employees have access to reliable health benefits,” Malone said. “This report indicates that approximately 1,500 of our employees have opted to choose Medicaid benefits instead.”

Walmart and Sutherland Global Services did not respond to requests for comment on Wednesday about their health-care policies for employees or why their companies topped the state’s list.

The report also looked at the demographics of those who received full-time wages and were on Medicaid. Twenty-three percent were 18 to 25, 31 percent were 26 to 34, 22 percent were 35 to 44, 15 percent were 45 to 54, 8 percent were 55 to 64, and only 1 percent 65 or older. They were also 36 percent Caucasian, 31 percent Hispanic and 23 percent African-American, with 10 percent identifying as other.

Workers were also by and large a part of the Medicaid expansion population — 79 percent overall.

The report did not include full-time employees who work for businesses with fewer than 50 employees. Kotchevar said examining that group would not “necessarily uncover a lot of low-wage workers” but that it was hard to know without further analysis.

Update 12-13-18 at 9:35 a.m.: This story was updated to correct that the total number of full-time employees enrolled in Medicaid in 2017 was about 240,000, not 330,000. Julie Kotchevar, administrator of the Division of Public and Behavioral Health, told The Nevada Independent on Wednesday that the two groups examined in the report — the $7.25 and $16.59 groups — were unique. On Thursday, she corrected that information and said that the $16.59 group is a subset of the $7.25 group and therefore the total number of full-time employees enrolled in Medicaid is about 240,000.

Update 12-13-18 at 12:32 p.m.: This story was updated to correct the total number of employees and dependents on Medicaid for individual employers.

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