Nevada Medicaid Recipients Employed by Employers with 50 or More Employees January 2020 Office of Analytics Department of Health and Human Services Steve Sisolak Richard Whitley, MS Governor Director State of Nevada Department of Health and Human Services Acknowledgements Prepared, Compiled, and Edited by: Kyra Morgan, MS Chief Biostatistician Office of Analytics Department of Health of Human Services State of Nevada Shannon Litz Public Information Officer Director’s Office Department of Health of Human Services State of Nevada Sara Byers Economist I Office of Analytics Department of Health of Human Services State of Nevada Madison Lopey Public Service Intern Office of Analytics Department of Health of Human Services State of Nevada For additional information please contact: [email protected] Office of Analytics Department of Health of Human Services State of Nevada 2 | Page Table of Contents Acknowledgements ....................................................................................................................................... 2 Background ................................................................................................................................................... 4 Technical Notes ............................................................................................................................................. 4 Results ........................................................................................................................................................... 5 Top 10 Employers by Number of Employees and Dependents on Medicaid ........................................... 6 Employee Demographics .......................................................................................................................... 6 Dependent Demographics ........................................................................................................................ 8 Median Wage Subset ................................................................................................................................ 9 Appendix .....................................................................................................................................................10 3 | Page Background The following report considers the cost of providing Medicaid to members who work for an employer with 50 or more employees for State Fiscal Year (SFY) 2019. This report was created to meet the requirements set forth in Senate Bill 366 of the 2017 Legislative Session. Senate Bill 366 requires “… the Department of Health and Human Services to prepare an annual report which lists all employers in this State which have 50 or more employees and the number of full-time employees of such an employer who are enrolled in Medicaid.” Technical Notes Determining if a company had employees on Medicaid was done by matching Medicaid members to records in the Department of Employment, Training, and Rehabilitation (DETR). This match provided quarterly wage information and the identification number of the employers that Medicaid members worked for during each quarter of SFY 2019. Employment was then defined using the wage threshold associated with earning minimum wage in Nevada. More specifically, the group of Medicaid members presented in this report represents employees who earned $3,480.00 or more in gross wage earnings for any 12-week consecutive period (one quarter) in SFY 2019, as reported to DETR. This gross quarterly wage represents the minimum wage of $7.25 an hour paid to employees who worked 40 hours per week. DETR also supplied a file with the employer identification number, company name, and address for employers in Nevada with 50 or more employees. The wage file and employer file were then combined to identify which Medicaid members were employed by companies with 50 or more employees. It is important to note that a Medicaid member may have had more than one employer during the year. The total cost to Nevada Medicaid represents a distinct cost to the state. However, the cost associated with each company considers the complete cost of the employees and dependents of that company and may be duplicated across companies when an individual is employed by multiple employers. To determine dependents of Medicaid members who work for a company with 50 or more employees, corresponding case IDs (ICIs) were identified for the list of Medicaid members who work for companies with 50 or more employees and all other members of the case were counted. Determining whether or not an employer offered health coverage benefits was done by matching the employer’s Employer Identification Number (EIN) against the Department of Labor’s Employee Benefits Security Administration’s database of Form 5500’s filed by the employer. Form 5500 identifies the different welfare, health, and pension plans offered by an employer. A value of 4A in line 8b on Form 5500 indicates that the employer offers a health benefits plan and a value of 4U in line 8b on Form 5500 indicates that the employer has a collective-bargained welfare arrangement. However, not all employers need to file a Form 5500 and may offer health benefits to their employees. The Division of Insurance does not currently track which employers offer health insurance unless there is a consumer complaint. 4 | Page Results In SFY 2019 there were 115,830 Medicaid members employed by employers with 50 or more employees and an additional 145,321 dependents. The total cost of providing health care to these employees was approximately $422,032,965. The total cost for providing health care to the dependents of these employees was approximately $312,289,084. Combining these costs, the overall cost of health care to these Medicaid members was $734,322,050. SFY 2017 SFY 2018 SFY 2019 Cost to Nevada Medicaid $ 676,547,896 $ 638,563,801 $ 734,322,050 Over the past three state fiscal years, the annual average cost per this subset of Medicaid members has slowly declined from $2,801/member in 2017 to $2,747/member in 2019. Still, the overall cost to Nevada Medicaid has increased, due to an increase in the number of Medicaid members working for employers with 50 or more employees. Total Employees Dependents Average Annual Cost per Member 300,000 250,000 SFY 2019 $2,747 200,000 267,286 267,286 SFY 2018 $2,788 150,000 241,501 229,059 229,059 100,000 SFY 2017 $2,801 145,321 145,321 50,000 136,989 123,164 123,164 115,830 115,830 104,512 104,512 105,895 - $- SFY 2017 SFY 2018 SFY 2019 $1,000 $2,000 $3,000 The average company with 50 or more total employees, and with employees on Medicaid, had 31 employees on Medicaid and 35 dependents associated with these employees on Medicaid, with an average cost to Nevada Medicaid of $190,922 annually and a median cost to Nevada Medicaid of $72,125 annually. Average Annual Cost per Employer $190,922 Cost $157,282 $177,448 $- $20,000 $40,000 $60,000 $80,000 $100,000 $120,000 $140,000 $160,000 $180,000 $200,000 SFY 2019 SFY 2018 SFY 2017 As shown in the table on page 6, this average is highly skewed by the top companies with the most employees and dependents on Medicaid. For example, the health care coverage costs associated with Medicaid members who were employed by Wal-Mart Associates Inc. and their dependents alone cost 5 | Page Nevada Medicaid $19,630,091. The table below displays the companies who made up the top 10 employers when ranked by the number of employees and dependents on Nevada Medicaid. Top 10 Employers by Number of Employees and Dependents on Medicaid Employees on Dependents on Total Medicaid Medicaid Rank Company Name Form 5500 Number Cost Number Cost Number Cost 1 WAL-MART ASSOCIATES INC No 4A or 4U Benefits Provided 3,056 $ 10,876,376 3,910 $ 8,753,715 6,966 $ 19,630,091 2 CLARK COUNTY SCHOOL DISTRICT 5500 Form Not Filed 1,845 $ 7,176,948 2,616 $ 5,373,530 4,461 $ 12,550,478 3 AMAZON.COM LLC No 4A or 4U Benefits Provided 2,096 $ 7,573,219 1,944 $ 4,407,296 4,040 $ 11,980,514 4 SMITHS FOOD & DRUG CTRS INC 5500 Form Not Filed 1,193 $ 4,198,300 1,393 $ 3,205,248 2,586 $ 7,403,547 5 STATE OF NEVADA 5500 Form Not Filed 739 $ 2,111,591 1,092 $ 1,925,523 1,831 $ 4,037,113 6 SUTHERLAND GLOBAL SERVICES IN No 4A or 4U Benefits Provided 853 $ 2,727,278 886 $ 1,834,825 1,739 $ 4,562,103 7 SITEL OPERATING CORPORATION No 4A or 4U Benefits Provided 782 $ 2,851,666 856 $ 1,908,676 1,638 $ 4,760,343 8 TESLA INC No 4A or 4U Benefits Provided 790 $ 1,747,692 793 $ 2,963,436 1,583 $ 4,711,128 9 WYNN LAS VEGAS LLC 5500 Form Not Filed 647 $ 2,302,064 848 $ 1,908,390 1,495 $ 4,210,453 10 PEPPERMILL CASINOS INC No 4A or 4U Benefits Provided 531 $ 1,818,855 740 $ 1,354,292 1,271 $ 3,173,147 • Wal-Mart Associates Inc. has been the leading employer of Nevada Medicaid recipients consistently for the past three years, followed by Clark County School District. • Amazon has been ranked third for the past two consecutive years, after not appearing in the top 10 in SFY 2017. • Smith’s Food and Drug, State of Nevada, Sutherland Global Services, Sitel Operating Corporation, Wynn Las Vegas, and Peppermill Casinos are consistently among top employers of Medicaid recipients. • Tesla Inc. appears on the top 10 list for the first time in SFY 2019, ranked eighth. • Aria Resort & Casino LLC was in the top 10 in previous years but has moved out of the top 10 in SFY 2019. Employee Demographics The majority of these Medicaid members lived in Clark County (77%), with 13% in Washoe County and 9% in the remainder of the state. Region of residence was unknown for 1% of these members. Thirty-four percent (34%) were Caucasian, 31% were Hispanic, 25% were African American, and 10% were of another race/ethnicity. Region Race/Ethnicity Unknown 1% Rural Other Washoe 9% 10% 13% Washoe Caucasian 13% 34% Hispanic 31% Clark African - 77% American 25% 6 | Page Most of these Medicaid members spoke English as a primary language (83%), with 5% listing Spanish as their language spoken. One percent (1%) listed another language and 11% had an unknown language. Twenty percent (20%) of these Medicaid members were 18-24 years old, 36% were 25-34 years old, 22% were 35-44 years old, 13% were 45-54 years old, 8% were 55-64 years old, and 1% were 65 years old and older.