BOISE, ID – In Idaho, nearly 8% of people on Medicaid expansion work in the food industry for restaurants or fast food chains, a state government report found.

The report by the Idaho Department of Health and Welfare details how hundreds of employees for major companies — and even public colleges and government entities — are on the public assistance program.

Walmart, one of the biggest private businesses in Idaho, and Sam’s Club had the most employees on Medicaid expansion, with 444 employees accounting for 1.4% of the employees with known income sources.

But more than a dozen other big businesses were on the top 25 employer list — including Amazon, McDonald’s and Albertsons.

Todd Achilles, a former Democratic state legislator turned U.S. Senate candidate, said he requested the report because many state lawmakers were worried about Medicaid expansion’s enrollment growth.

“I’m concerned about it too. But when you peel back the layers, and you understand what’s driving the growth — it’s not a bunch of lazy people that should be able to take care of themselves,” Achilles said in an interview. “It’s people who are working. But they’re working for employers who are manipulating the system to increase their profits, and pushing those costs onto the state of Idaho.”

Walmart could not be immediately reached for comment.

In January, Health and Welfare shared the report with Achilles. This week, the agency shared the report with the Idaho Capital Sun.

Two decades ago, former Republican Idaho House speaker floated a bill on company insurance coverage

In 2018, Idaho voters approved Medicaid expansion through a ballot initiative. The policy extended Medicaid coverage to a population often called the “working poor” that fell in a health care assistance gap.

Idahoans are eligible for Medicaid expansion if they earn less than 138% of the federal poverty level, which is $21,597 annually for a single person, or $44,367 for a family of four.

But even well before Medicaid expansion, major companies relying on Medicaid for employee health coverage was on Idaho’s radar.

In 2005, former Idaho House Speaker Bruce Newcomb, a Republican, was exploring a state law to require Walmart to provide insurance to Idaho employees, or repay the state for its Medicaid coverage, High Country News reported.

At the time, that idea didn’t gain steam, Newcomb told the Sun this week. But he was fired up about it.

“For a family-owned business like Walmart, to be the richest in the world, having the taxpayers of Idaho and throughout the United States subsidize their operation was just blatantly wrong,” Newcomb said.

Achilles said many major employers intentionally keep workers in part-time jobs “so they don’t have to pick up the health care costs.”

“This is the hard look that the Legislature needs to do, which is to understand why these highly profitable companies are not taking care of their workers and forcing them to the safety net,” he told the Sun.

This year, the Idaho Legislature and Gov. Brad Little approved a new state law to require people on Medicaid to prove that they work.

In Nevada, a state report earlier this year found that Amazon had by far the most employees on Medicaid, the Nevada Current reported.

Report only analyzed a third of Idahoans on Medicaid expansion

The report analyzed the employers and industries that Idaho Medicaid expansion enrollees with known, recent income sources enrollees worked in.

But the analysis, using enrollment figures from November 2024, only tracked about a third of Idahoans on Medicaid expansion, or roughly 30,900 people. The report also excluded enrollees who only reported self-employment income.

Department of Health and Welfare spokesperson Greg Stahl said the agency hadn’t done this analysis before, and cautioned that the data could have errors.

“Individuals may have other creditable insurance in addition to Medicaid. Also, the analysis was based on a free form text field which means there could be some level of error in the data compilation,” he told the Sun in an email. “… the information provided excluded self-employment and the data does not provide any context about how many hours per week an individual may work at the listed organization, potentially impacting wages and their qualifications for employer sponsored benefit/insurance.”

In November 2024, when the report’s data is based on, the program’s enrollment was 87,500 people. Now, about 89,600 Idahoans are enrolled in Medicaid expansion, according to the state’s latest figures.

Nationally, most adults on Medicaid are working, according to the health policy research group KFF. In Idaho, about 48% of able-bodied adults on Medicaid are working, according to an August report by the Department of Health and Welfare.

The top industries with workers on Medicaid expansion in Idaho

Here’s some of what the report found:

• Restaurant and fast food industry was the top industry, with 7.7% of enrollees with known income sources, or 2,378 employees on Medicaid expansion. Three major chains were in the top 25 employer list: McDonald’s came in fourth, with 246 employees; Taco Bell came in 15th, with 100 employees; and Burger King came in 16th, with 99 employees.
• Home health care or assisted living services was the second highest industry, with 4.6% of enrollees with known income sources, or 1,420 employees.
• School districts were the third largest industry, with 4% of enrollees with known income sources, or 1,238 employees.
• Supermarket or grocery stores came in fourth, with 4% of enrollees with known income sources, or 1,231 employees. Behind Walmart’s first place ranking, Albertsons came in fifth, Ridley’s came in 10th, Fred Meyer/Kroger came in 14th, Broulim’s Supermarket came in 24th, and Winco came in 25th.
• Universities and colleges came in fifth on the industry ranking, with 3.1% of enrollees with known income sources, or 955 employees. Three of Idaho’s four-year universities were on the top 25 employer list: Boise State University, or BSU, came in eighth, followed by Idaho State University, or ISU, in ninth; and University of Idaho in 17th.
• Hospitals or hospital systems came in sixth place for top industries, with 2.4% of enrollees with known income sources, or 746 employees. Two major hospital systems were on the top employer list: St. Luke’s came in seventh, and Saint Alphonsus came in 21st.

City and state governments were also on the top industry list, along with a range of other fields like child care, dollar stores, churches, construction, hotels and retail stores.

This story first appeared on Idaho Capital Sun.