RI Was In the Federal Audit of Who Needs Medicaid

Rhode Island is one of six states the federal government looked at when it wanted to know who, exactly, employs the working poor. The answer, published last month by the Government Accountability Office, will not shock anyone who has ever worked a warehouse shift or a register: Walmart and Amazon sit at or near the top of the list.

The GAO's report — Federal Social Safety Net Programs, published June 22 and released publicly on July 22 — pulled Medicaid employer data from Georgia, Indiana, Maine, Massachusetts, Oklahoma and Rhode Island, and SNAP data from nine more states. Across the states sampled, 16,055 Walmart workers were enrolled in Medicaid, a 55% jump from the agency's last look six years ago. Amazon had 11,338 — nearly triple its earlier count.

And now the price tag. Popular Information, in an analysis published today, took the GAO's state-level numbers, worked out an average Medicaid enrollment rate for each company, extrapolated to the rest of the country, and multiplied by each state's average annual cost per non-elderly, non-disabled enrollee as published by the Medicaid and CHIP Payment and Access Commission. The result: roughly 156,000 Walmart employees on Medicaid at about $1.04 billion a year, and about 123,000 Amazon employees at $927 million. Call it $2 billion.

That figure is an estimate, and Judd Legum is upfront about why it's probably low. It counts only the workers themselves — not the spouses and kids whose eligibility flows from the same household income. Counting dependents, the analysis says, would roughly double the number. And MACPAC's most recent per-enrollee cost data is from fiscal 2023.

What this looks like here

The state courted Amazon hard. Its fulfillment center in Johnston is 3.8 million square feet, built on a $400 million investment, employing more than 1,500 full-time associates who pick, pack and ship, according to the governor's office, which called the grand opening a major economic milestone. Walmart, for its part, runs nine stores across eight Rhode Island cities — Warwick, Coventry, Cranston, Newport, North Kingstown, North Smithfield, Providence and Westerly.

Starting pay in Johnston runs as high as $22 an hour. Forty hours a week, fifty-two weeks a year, that's about $45,760. Walmart says its associates average $18 an hour and that starting wages have climbed 93% since 2015.

Here's the catch, and it's the whole story: those are not poverty wages by the old definition, and workers still land on Medicaid, because eligibility keys off household income and family size. A single worker at $22 an hour is fine. That same worker supporting two kids is a different arithmetic problem entirely.

The GAO did not publish a Rhode Island-only breakdown, so how many Amazon and Walmart workers in this state are on Medicaid isn't public.

The GAO reports 66.1% of employed Medicaid enrollees work full-time. And the Bureau of Labor Statistics counted 4.7 million people in June who wanted full-time work and were stuck part-time because hours were cut or they couldn't find a full-time job. Part-time isn't always a preference. Sometimes it's a schedule handed to you.

Meanwhile the profits kept climbing. Amazon's annual profit went from $11.59 billion to $77.67 billion over the period the GAO covers; Walmart's from $14.88 billion to $21.89 billion. Between them, roughly $100 billion in 2025.

What comes next

Other states have started sending the bill back. New Jersey now charges employers per Medicaid-covered employee and dependent — $325 a head for companies with 50 to 249 beneficiaries, rising to $725 for those with at least 500. Lawmakers in California, Colorado, Oregon and Connecticut have floated versions of the same idea.

Nothing like it has surfaced at the Rhode Island State House. But this state handed Amazon a warehouse the size of a small city, and it was one of six states federal auditors chose to find out who is quietly on the public books. Economic development isn't only what a company builds. It's also what the rest of us pay to keep its workers healthy.