Being poor in America is hard. Temporary Assistance for Needy Families (TANF) has virtually disappeared in many states. Safety net programs such as Medicaid and SNAP have strict income limits, with participants coming under increased pressure to work. Indeed, a KFF study found that as of 2023, roughly two-thirds of nondisabled non-elderly (NDNE) Medicaid recipients had paid employment.
That puts many low-income people in the tricky position of threading a very thin needle. A single mother, for example, may be trying to balance time spent attending community college and raising kids, while working just enough hours to earn some money without violating the Medicaid income limits. A full-time job which provides health care coverage would be best, of course — but finding one that pays enough to cover childcare may not be possible without more schooling.
In this context, the most attractive employers for Medicaid recipients may be those which offer a lot of flexibility in working hours to help stay under the income limits, with the possibility of jumping to full time work when appropriate. A new study from the GAO analyzed data from a small number of selected states and identified the top employers of NDNE Medicaid and SNAP recipients in those states. These included large private employers such as Walmart, Amazon, and Fedex; universities and healthcare systems such as Indiana University, Brown University, Mass General Brigham, MaineHealth, and Emory Healthcare; and public entities such as the Commonwealth of Massachusetts, the U.S. Post Service, and the Georgia Department of Human Resources.
In many ways, being named on the GAO’s list of top employers who hire Medicaid recipients is a badge of honor. Especially with work requirements tightening up in 2027, we need to encourage more employers to hire Medicaid recipients, not discourage them.
It’s not unreasonable to expect that large employers should offer full-time employees access to healthcare. But note that the GAO’s employer analysis contains absolutely no direct information about whether the Medicaid recipients at these large organizations were in full-time jobs. As part of the same paper, the GAO did a separate statistical analysis of the national workforce which suggests that most wage-earning nonelderly Medicaid recipients work for smaller companies, and less than half work full-time, full-year jobs.
Indeed, people — Medicaid recipients or not — often seek out flexible work because they are caregivers, military spouses, students, retirees supplementing Social Security, parents of school-age kids, or have some other life circumstances which require that flexibility. These types of opportunities allow people to be productively employed when they might otherwise be excluded from work altogether.
