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States Consider Identifying Employers With Medicaid Workers as Federal Work Requirement Takes Effect
With the Trump administration's January deadline approaching for states to enforce federal Medicaid work requirements, lawmakers in California and other states are advancing measures to name or penalize large companies whose workers rely on the program. The moves follow enactment of HR 1 and come as enrollment losses mount among children.
Jul 14, 5:00 AM·2m read1 source
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The Trump administration has set a January deadline for states to enforce a new Medicaid work requirement under HR 1, the GOP tax-and-spending law known as the One Big Beautiful Bill Act. The provision requires nondisabled enrollees ages 19 to 64 in most states to prove they are working, volunteering, or going to school at least 80 hours a month to keep coverage.
California lawmakers are seeking to revive an expired law that would require the state to identify companies employing 100 or more people who have workers enrolled in Medi-Cal.
Nearly 5 million of the state's more than 14 million Medi-Cal residents will be subject to the requirement. Democratic state Sen. Lola Smallwood-Cuevas, the bill's author, said the measure is about fairness and that taxpayers deserve transparency about which large employers are shifting healthcare costs onto the public.
Nevada has required public identification of such companies since 2017. Its latest report for fiscal year 2025 listed Amazon with 4,914 full-time or unconfirmed-status employees on Medicaid, followed by Walmart with 3,503. The top five also included the Clark County School District, state government, and Tesla.
Nevada Medicaid spent nearly $950 million on healthcare for more than 133,000 full-time employees and more than 140,000 dependents that year, with the average cost per member rising nearly 17 percent. New Jersey Gov. Mikie Sherrill signed a bill in June that fines businesses with at least 50 Medicaid-enrolled employees.
Companies with 50 to 249 such workers pay $325 per person annually, while those with 500 or more pay $725. Similar penalty bills failed this year in Washington state and Colorado. A proposal in Oregon stalled when the legislative session ended in March.
