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Low-Income Workers: Millions of Full-Time Workers in the Private Sector Rely on Federal Health Care and Food Assistance Programs

GAO-21-410T Published: Feb 25, 2021. Publicly Released: Feb 25, 2021.
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Fast Facts

Millions of American adults who earn low wages rely on federal programs to meet basic needs, such as Medicaid for health care and the Supplemental Nutrition Assistance Program for food.

To learn more about the people who use these programs, we analyzed employment data from 11 states and Census data.

We testified that:

About 70% worked full time

Most worked for private sector employers in places like restaurants, department stores, and grocery stores

Others worked for state governments, public universities, or nonprofit organizations

Some employers in selected states had thousands of beneficiaries in their workforces

Cash on a pay stub.

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What GAO Found

The 12 million wage-earning adults (ages 19 to 64) enrolled in Medicaid—a joint federal-state program that finances health care for low-income individuals—and the 9 million wage-earning adults in households receiving food assistance from the federal Supplemental Nutrition Assistance Program (SNAP) shared a range of common labor characteristics. For example, approximately 70 percent of adult wage earners in both programs worked full-time hours (i.e., 35 hours or more) on a weekly basis and about one-half of them worked full-time hours annually (see figure). In addition, 90 percent of wage-earning adults participating in each program worked in the private sector (compared to 81 percent of nonparticipants) and 72 percent worked in one of five industries, according to GAO’s analysis of program participation data included in the Census Bureau’s 2019 Current Population Survey. When compared to adult wage earners not participating in the programs, wage-earning adult Medicaid enrollees and SNAP recipients in the private sector were more likely to work in the leisure and hospitality industry and in food service and food preparation occupations.

Estimated Percentage of Wage-Earning Adult Medicaid Enrollees and Supplemental Nutrition Assistance Program (SNAP) Recipients Working at Least 35 Hours per Week, by Number of Weeks Worked in 2018

GAO’s analysis of February 2020 program data from 15 agencies—six Medicaid agencies and nine SNAP agencies—across 11 states shows that a majority of working adult Medicaid enrollees and SNAP recipients in these states worked for private sector employers. GAO’s analysis also shows that the percentage of working adult Medicaid enrollees and SNAP recipients working for any one employer did not exceed 4 percent in any state that provided data. Most working adults in the programs worked for private sector employers concentrated in certain industries, including restaurants, department stores, and grocery stores. Smaller percentages of working adults in each program in these states worked outside the private sector. For example, less than 10 percent worked for public sector employers, such as state governments, the U.S. Postal Service, or public universities; others worked for nonprofit organizations, such as charities, hospitals, and health care networks, or were self-employed.

Why GAO Did This Study

In October 2020, GAO issued a report entitled Federal Social Safety Net Programs Millions of Full-Time Workers Rely on Federal Health Care and Food Assistance Programs (GAO-20-45.) This testimony summarizes the findings of that report, which examined (1) what is known about the labor characteristics of wage-earning adult Medicaid enrollees and SNAP recipients, and (2) what is known about where wage-earning adult Medicaid enrollees and SNAP recipients work.

To answer these questions, GAO analyzed recent Census Bureau data on the labor characteristics of working adults in the two programs. GAO also analyzed recent (Feb. 2020) non-generalizable data on the employers of working adult Medicaid enrollees and SNAP recipients obtained from 15 state agencies across 11 states. GAO selected state agencies that (1) collected, verified, and updated the names of Medicaid enrollees’ and SNAP recipients’ employers; and (2) could extract reliable data.


GAO made no recommendations.

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