A new analysis from the Department of Health and Human Services’ Office of Analytics (DHHS OOA) reported that during state fiscal year 2024, there were 380,522 individuals (employees and dependents) covered by Medicaid that work for companies with 50 or more employees in Nevada. The total cost to support these Medicaid services exceeded $1.1 billion from state and federal funds.

Amazon had the highest number of employees in Nevada on Medicaid, surpassing other private companies with approximately 18,093 employees, along with their dependents, for the fiscal year that ended in mid-2024. This amount has more than doubled since 2019, when there were only 7,892 Medicaid beneficiaries under the company. It is also important to note that under Amazon’s wage structure, full-time employees in Nevada earn $18 per hour ($37,440 annually), which would likely disqualify them from SNAP or Medicaid services; however, part-time and flex employees in the company may still qualify for these benefits by having a lower annual income.

Public entities with 50 or more employees also made it on the list alongside private corporations. The Clark County School District had the third highest count of individuals supported by Medicaid for state fiscal year 2024, with 7,476 individuals supported (employees and dependents). The State of Nevada had the fifth highest count of individuals supported by Medicaid for state fiscal year 2024, totaling 3,706 individuals (employees and dependents). The data provided in the chart above do not detail whether this coverage is used for full- or part-time employees.

Aside from employer usage of Medicaid, total Medicaid enrollment, which includes individuals and their dependents, was 787,705 individuals statewide as of October 2024, as well as 32,536 enrolled under the CHIP (Children’s Health Insurance Program). That is roughly around 29 percent of the state’s population. Nationally, Medicaid together with CHIP covers more than one-third of all children’s health coverage. In Nevada, Medicaid funds 44 percent of child births. These trends not only highlight the prevalence of government-assisted programs; they also show how companies, like Amazon, may contribute to reliance on state and federally funded Medicaid, which could be impacting taxpayers. Critics state that this may be a “quiet subsidy” for profitable corporations.
 

The Drain on Taxpayers and State Resources

With nearly 30% of Nevada’s population enrolled in Medicaid, the costs to taxpayers continue to rise at unsustainable levels. As more employees of large corporations rely on Medicaid instead of employer-sponsored healthcare, taxpayers effectively subsidize major businesses that have the resources to provide private insurance options. Over $1.1 billion in state and federal funds is a substantial drain on resources that could otherwise go toward education, infrastructure, and tax relief.
 

How DOGE NV Fits In

DOGE NV exists to scrutinize inefficiencies in state spending and propose free-market solutions to reduce waste. Medicaid’s growing burden is a prime example of inefficient government resource allocation. While providing healthcare access is important, reliance on taxpayer-funded services by profitable corporations undermines financial responsibility. DOGE NV aims to identify policy changes that lower dependency on government assistance while encouraging employer-based solutions.
 

Recommendations for Lawmakers in the 2025 Legislative Session

To address this crisis, Nevada lawmakers should implement the following reforms:

1. Incentivize Employer-Sponsored Health Savings Accounts (HSAs) – Employers should be encouraged to offer HSAs with high-deductible health plans (HDHPs), allowing employees to manage their medical expenses more efficiently. HSAs empower employees with tax-advantaged healthcare funds while reducing reliance on Medicaid.
2. Promote Direct Primary Care (DPC) Models – Large employers can transition toward DPC healthcare arrangements, where employees pay a monthly membership fee to primary care providers. This model eliminates excessive insurance bureaucracy, reduces costs, and improves access to care.
3. Require Greater Price Transparency – Employers and employees should be able to access transparent pricing in healthcare services to make cost-conscious decisions. Increased competition will drive down prices, reducing the need for Medicaid enrollment.
4. Expand Telemedicine Services – Nevada should encourage telehealth adoption in employer healthcare plans, particularly for part-time and flex workers, to improve accessibility and reduce emergency room visits that inflate Medicaid costs.
5. Evaluate Medicaid Enrollment Eligibility Standards – Lawmakers should review the Medicaid eligibility thresholds to ensure those receiving benefits truly need them, rather than subsidizing major corporations that should provide healthcare to their workforce.
6. End Corporate Welfare in Healthcare – If major corporations continue to shift healthcare responsibilities onto taxpayers, Nevada should consider modifying business tax incentives to account for their disproportionate reliance on public healthcare funding.

The Path Forward

Nevada cannot afford to continue subsidizing Medicaid costs for businesses that can and should be providing better healthcare options for their employees. By implementing free-market solutions and enforcing accountability, lawmakers can protect taxpayer dollars, reduce government dependency, and encourage innovation in employer-sponsored healthcare. The time to act is now—before Medicaid’s cost spiral becomes unsustainable.
 

Sources:

• Nevada Medicaid and Employer Enrollment Report 2024
• Amazon Tops List of Companies Using Taxpayer-Funded Medicaid
• Medicaid and Nevada Check-Up Fact Book