Cars sit in the parking lot at the Amazon regional distribution center on June 6, 2019 in Las Vegas, Nevada. Amazon is expanding into more self delivery of their packages. (Photo by George Frey/Getty Images)
In the four years since Amazon became the leading employer of Nevada Medicaid recipients, the retail giant has surged from having 7,892 employees and dependents on Medicaid to 18,093.
That’s a 143% increase since 2020.
It’s also almost double the number of people associated with Walmart, the second largest employer of Nevada Medicaid recipients.
The Nevada Department of Health and Human Services each year analyzes the number of Medicaid recipients working full time at businesses with 50 or more employees. Many interpret the list as a who’s who of the corporations that are not paying workers enough, since Medicaid eligibility is largely dependent on income.
The 2025 report, released this month, shows relatively few changes to the top 20 list of employers with the most number of employees enrolled in Nevada Medicaid. But it notes that the number of Amazon employees enrolled in Medicaid is rapidly growing compared to other top employers.
Nearly 9,000 Amazon employees were enrolled in Nevada Medicaid last year, according to the report, compared to approximately 7,500 Amazon employees the prior fiscal year.
For comparison, Walmart last year employed approximately 4,500 Medicaid enrollees and approximately 4,700 the year prior.
Four years ago, the two retail companies both had roughly 3,500 Medicaid-enrolled employees.
Since then, Amazon has opened several new facilities in Nevada. The company benefits from tax abatements provided by the state. In 2016, the Nevada Governor’s Office of Economic Development approved $1.8 billion in abatements, some of which was over a 10-year period, meaning they are still receiving them.
Critics of Amazon and Walmart argue the costs associated with Medicaid coverage should be considered a public subsidy.
Medicaid covered approximately 183,000 employees of large companies across Nevada, as well as 197,000 of their dependents. Those 380,000 people are slightly less than half of all Nevadans who were enrolled in Medicaid and CHIP in 2024.
The cost of care for those 380,000 people was more than $1.1 billion in state fiscal year 2024.
The cost of Medicaid coverage is split between the federal and state governments. For FY2024, Nevada paid 21%, or $240 million.
Amazon employees and their dependents alone cost $51 million, $11 million of which was paid by the state.
The total number of Medicaid-eligible employees and dependents listed in the DHHS report is believed to be artificially inflated because they include an unknown number of people who were covered by Medicaid through covid-era continuous enrollment policies. The “unwinding” of those federally set policies was completed during the fiscal year covered by the 2025 report and won’t be fully reflected until 2026.
The report notes that, of the 183,534 Medicaid recipients working for large employers, 82,709 made median wage. The state believes many of these workers became eligible for Medicaid during the covid public health emergency and have been disenrolled.
According to Nevada Medicaid, 787,705 people were enrolled in the program as of October 2024. In any given month in 2023, more than one in four Nevadans was eligible for Medicaid. The state has estimated only 36% of them used their health care monthly.
Other takeaways from the top Medicaid employers report:
Clark County School District, Wynn Las Vegas, and the State of Nevada rounded out the top 5 employers of Medicaid recipients. All three have been staples of the top 10 for several years.
Bowtie Hospitality, the sole operator of the Fontainebleau Las Vegas, made its debut on the list in the first year of the property’s operations. Bowtie is the eighth largest employer of Medicaid recipients, with 1,476 employees covered. The Fontainebleau opened in late December 2023 after more than two decades of development and delays.
The other businesses in the top 10 were: Sitel Operating Corporation, Smiths Food & Drug, Universal Protection Service, and Aria Resort.
Southern Nevada is overrepresented in the report. Clark County made up 80% of the employees and dependents captured in the report but make up 73% of the general population.
Two separate analyses by DHHS looked at recurring State of Nevada employees on Medicaid and found they skewed heavily female. Of the 889 state employees who were on Medicaid in fiscal years 2023 and 2024, 80% were female.
Of the 1,733 state employees enrolled in Medicaid last year, more than half worked in DHHS, which includes the Division of Welfare and Supportive Services and the Aging and Disability Services Division.