Thousands of workers across Ohio labor for a paycheck, but still lack health benefits from their employer for themselves or their children.

Instead, they rely on Medicaid — a program funded with state and federal tax dollars — to pay for their medical care.

Researchers with the nonpartisan think tank Policy Matters Ohio estimate in a new report that the state spent $111.5 million last year to cover Medicaid costs for more than 111,000 workers and their dependents from the 50 companies with the highest Medicaid enrollment.

The federal government's estimated share of the cost totaled $182 million.

''Right now, we're in a very tight budget,'' said Piet van Lier, the study's author and a senior researcher at Policy Matters Ohio. ''Medicaid is a very big expense — not only for Ohio, but for other states — and here's a substantial benefit going to employers.''

The report analyzes monthly Medicaid enrollment data collected by the Ohio Department of Job and Family Services to estimate the employers statewide with the largest number of employees — or employees' dependents — who received government assistance.

The researchers found Wal-Mart led the list, with a monthly average of 13,141 employees and dependents enrolled in Medicaid last year.

''The point is not that we don't think people should get that help to meet their basic needs,'' van Lier said. ''Other employers are taking the high road and providing benefits. These employers are not.''

Wal-Mart spokesman Greg Rossiter said reports that rank employers based on the number of their workers enrolled in Medicaid are ''notoriously unreliable'' and hard to verify.

He said the company offers ''very competitive'' benefits to hourly employees after 180 days, as long as they work at least 34 hours a week.

Some people seek part-time jobs in retail because they're in school or just want to earn a little extra cash during the holiday season, he said.

''We do obviously have part-time associates as well as hourly, full-time associates and salaried, full-time associates,'' Rossiter said. ''The benefit structure varies, depending on the status of those associates.''

Food stamp data, too

The Policy Matters Ohio researchers also analyzed the number of employees and their dependents covered by the state's food stamp and Ohio Works First cash assistance programs in the report, Public Benefits Subsidize Major Ohio Employers: A 2008 Update.

Last year, more than 79,900 workers and their dependents at the 50 large employers analyzed received food stamps and more than 5,700 qualified for cash assistance, the report found.

Most of the employers included in the lists are retailers, restaurant chains and staffing firms.

Those findings don't surprise Marsha Schofield, executive director of Access to Care.

The program matches about 1,600 uninsured Summit County residents with volunteer doctors who agree to provide their health care for free. About half of the uninsured are employed.

''Most of our enrollees are not offered it through their employers,'' she said. ''They may be working the equivalent of full time, but it's at a number of different part-time jobs.''

Some of the Access to Care patients are working parents who can't get insurance from their employer, but have their children enrolled in Medicaid, which has higher family income limits for children than adults to qualify, she said.

''They're low on the rung in terms of income, and they're working part time,'' Schofield said. ''I think, unfortunately, that it's going to get worse before it gets better in terms of having access to affordable health care through employers.''

Increased numbers

Two Northeast Ohio employers — InfoCision and the Cleveland Clinic Health System — ranked No. 1 and No. 3 in the report, respectively, among employers with the greatest increase in the number of workers and their dependents enrolled in Medicaid from 2004 to 2007.

InfoCision's numbers increased about 62 percent, from 797 to 1,288, according to the report. The Cleveland Clinic's grew about 45 percent, from 1,224 to 1,773.

Officials with InfoCision and the Cleveland Clinic said the increase in the report's numbers corresponds with a period of rapid growth and hiring.

InfoCision, headquartered in Bath Township, has about 3,000 employees in Ohio, an increase from 1,700 in 2004.

''We know our employees are coming to us from a wide variety of backgrounds,'' said Steve Brubaker, senior vice president of corporate affairs. ''Some of those employees, perhaps, have been on public assistance and are transitioning to the work force and we think that's awesome. We can be, perhaps, a steppingstone for their future.''

Every employee who works at least 30 hours a week is eligible for the company's health benefits after 90 days of employment, he said. The company's headquarters also offers an on-site fitness center and doctor's office.

''We feel it's important,'' he said. ''We want everyone to have the same options.''

At the Cleveland Clinic, 27,000 of the health system's 36,000 employees are enrolled in the company-sponsored health plan, spokeswoman Eileen Sheil said.

Employees must work at least 20 hours to qualify for health coverage.

''We have a great health plan,'' she said.

About 50 employees of the health system have children enrolled in Medicaid because the children are disabled, Sheil said.

Others, such as single parents who work in part-time positions, might opt for Medicaid coverage for their children because of extra benefits offered, such as transportation or help with groceries, she said.

Coverage for children

Kristina Altizer, 23, an Akron mother of two, relies on Medicaid to provide health coverage for her daughters.

She stays at home to care for her 9-month-old daughter, Mackenzie, who was born with a heart defect that required several operations and a lengthy hospital stay that racked up bills of more than $500,000. Her husband, Gerald, works as a mechanic.

The baby and the couple's daughter, Madison, 3, qualify for Medicaid coverage based on the family's income. Kristina and Gerald are covered by his employer's health plan.

Without Medicaid, Altizer said, the family's out-of-pocket costs for their baby probably would have been unaffordable.

''I don't know what we would have done if we didn't qualify for it,'' she said.

The Ohio Department of Job and Family Services warns that people should be careful not to jump to conclusions based on the Medicaid enrollment numbers.

''Eligibility for employer-sponsored health-care coverage does not preclude eligibility for Medicaid,'' the department said in a statement. ''Several circumstances could lead people who are eligible for employer coverage to apply for and receive Medicaid.''