What Amida Care does

Amida Care is a nonprofit Medicaid Special Needs Health Plan (SNP) founded in 2003 and headquartered in New York City, operating as the largest Medicaid SNP in New York State. The organization serves over 9,360 members across NYC's five boroughs, specializing in care for people living with HIV/AIDS, transgender and gender non-conforming individuals, and individuals experiencing homelessness who qualify for Medicaid. Approximately 15% of members are people of transgender experience and 30% are TGNC overall, with the membership being approximately 55% African American and 32% Hispanic/Latine. Founded by seven nonprofit community-based health organizations including Housing Works, Acacia Network, and Harlem United, Amida Care operates under President and CEO Doug Wirth (since 2006).

The core product is the Medicaid Live Life Plus plan, offered at $0 monthly premium, supplemented by an integrated suite of member-facing programs. The underlying technology platform combines an Integrated Care Team (ICT) care management model with bidirectional health information exchange through two Regional Healthcare Information Organizations (Bronx RHIO and Healthix), enabling real-time admission/discharge alerts and weekly lab data feeds. Supporting modules include the My Amida Care member app, a secure Provider Portal with 600+ registered providers, the Healthy Rewards Visa incentive program, the Live Your Life Wellness Program, the Live Your Life Undetectable viral suppression initiative, Medically Tailored Meals (partnered with God's Love We Deliver since November 2020), and PrEP/PEP prevention services. Member outcomes include 80% viral load suppression (up from 60% in 2006), 95% Hepatitis C cure rate across 1,200 members cured, 74% reduction in hospital readmissions, and 64% decrease in ER visits.

The business model is capitation-based: Amida Care receives per-member monthly premiums from New York State Medicaid, generating over $500 million in annual premiums. Member acquisition occurs through NY State of Health marketplace enrollment, provider referrals across a network of 200+ HIV-specialist PCPs, 6,800+ general PCPs, 17,000+ specialists, 48 FQHCs, and 37 hospitals, supplemented by community organization partnerships and field outreach. Wellness programs are funded separately through private donations (e.g., $170,000 raised at the 2019 Live Your Life Celebration and Fundraiser). Documented cost impact includes $160 million in Medicaid savings to NY State between 2008 and 2018.

Name

Amida Care

Legal name

Amida Care, Inc.

Website

https://amidacareny.org

Company type

Private

Founded year

2003

Operating status

Operating

Headcount range

101–250 employees

Short description

Amida Care is a nonprofit Medicaid Special Needs Health Plan founded in 2003, serving over 9,360 members across New York City's five boroughs with specialized care for people living with HIV/AIDS, transgender individuals, and those experiencing homelessness. It operates as New York State's largest Medicaid SNP with over $500 million in annual premiums.

Ownership category

akta.pro rank

Product category

Medicaid Managed Care

NAICS

Health Care and Social Assistance (62), Services for the Elderly and Persons with Disabilities (624120)

SIC

Hospital & Medical Service Plans (6324)

akta.pro primary industry

Integrated Physical-Behavioral-Social Care (Whole-Person) Medicaid Plans (HLAEAEAI)

akta.pro secondary industries

Aged, Blind & Disabled (ABD) Managed Care Plans (HLAEAEAC), Medicaid Expansion (ACA Adult) Managed Care Plans (HLAEAEAB)

Keywords

• Medicaid managed care
• Special Needs Health Plan
• HIV/AIDS care coordination
• Gender-affirming health services
• Community health plan

Headquarters

HQ city

New City

HQ country

United States

HQ region

North America

Offices1 record

Markets served

GTM type

B2C

Offering type

Services

Cost components

Personnel, Operations, Technology or R&D, Marketing or Sales, Infrastructure

Revenue model

1. Medicaid Managed Care Premiums: Amida Care receives capitation payments from New York State Medicaid for each enrolled member. The organization manages care for Medicaid recipients with complex conditions including HIV/AIDS, behavioral health disorders, and those eligible for Special Needs Plans (SNPs). Over $500 million in annual premiums.
2. Member Wellness Program Donations: The Live Your Life wellness program and member wellness events are privately funded through donor contributions at the annual Live Your Life Celebration and Fundraiser, as well as year-round donations. 100% of these programs funded through private donations.

Pricing tiers

Go-to-market motion2 records

Distribution channels4 records

Marketing channels10 records

Core offering

Amida Care operates the Medicaid Live Life Plus Special Needs Health Plan, a $0-premium Medicaid managed care product serving New York City residents living with HIV/AIDS, transgender and gender non-conforming individuals, and people experiencing homelessness. Each member is assigned an Integrated Care Team that coordinates medical, behavioral, and social support services, with care delivered through a network of HIV-specialist PCPs, hospitals, FQHCs, and community-based providers across the five boroughs.

Product overview

Amida Care is a nonprofit community health plan operating as a single Medicaid managed care product—the Live Life Plus plan—supplemented by member-facing modules and provider tools. The core Live Life Plus plan provides comprehensive health coverage for New Yorkers with complex conditions. Supporting modules include My Amida Care (member portal/app), the Provider Portal (for network clinicians), Find a Provider (directory), Live Your Life Wellness Program (member activities), Healthy Rewards (incentives), Live Your Life Undetectable (viral suppression program), Coordinated Care/Integrated Care Teams (care management), Medically Tailored Meals (nutrition support), and PrEP & PEP Services (HIV prevention). The organization participates in healthcare data exchanges via Bronx RHIO and Healthix for care coordination.

Differentiator

Problem solved

Functional benefit

Brands

• Medicaid Live Life Plus: The primary health plan offered by Amida Care, a Medicaid Special Needs Health Plan (SNP) serving members with HIV/AIDS, transgender individuals, and people experiencing homelessness.
• Live Your Life Wellness Program
• Live Your Life Undetectable
• Healthy Rewards
• My Amida Care

Products and services

• Medicaid Live Life Plus Plan $0-premium Medicaid Special Needs Health Plan serving NYC Medicaid-eligible members living with HIV/AIDS, transgender and gender non-conforming individuals, and people experiencing homelessness. Provides comprehensive coverage including dental, vision, mental health, behavioral health, pharmacy, gender-affirming care, and HIV prevention (PrEP/PEP) services.
• My Amida Care Mobile Application Member-facing mobile application and portal enabling members to access their health information, manage their account, view plan benefits, and engage digitally with Amida Care services.
• Live Your Life Wellness Program Monthly member wellness events and activities held throughout the five boroughs of NYC, including healthy cooking, art therapy, meditation, yoga, African and Latin dance, Zumba, and fitness classes. Privately funded through donations to the annual Live Your Life Celebration and Fundraiser.
• Healthy Rewards Program Visa gift card incentive program that rewards members for completing health-related activities and maintaining wellness goals. Cards can be used at any U.S. retail location accepting Visa, excluding alcohol and tobacco purchases.
• Live Your Life Undetectable Program Financial incentive program rewarding HIV-positive members for achieving and maintaining viral load suppression, combined with treatment adherence strategies and care coordination support.
• Medically Tailored Meals Home-delivered medically tailored meal service in partnership with God's Love We Deliver, providing nutrition-tailored meals and nutrition counseling for members with chronic illness who are unable to shop and cook for themselves. Meals are approved by a Registered Dietitian Nutritionist after nutritional assessment.
• PrEP and PEP Services HIV prevention services providing pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) medications, education, counseling, and access support for at-risk populations.
• Amida Care Provider Portal Secure web-based portal enabling network healthcare providers to access real-time claims data, authorization status, member eligibility, Explanations of Payments, and patient information. Over 600 providers have registered.

Quantifiable outcome

• 94% of members engaged in regular outpatient care
• +6 more outcomes

Named customers7 records

Segments4 records

Ideal customer profiles4 records

Technology focussed No

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Integration2 records

Feature5 records

Partnerships

24 partnerships are on record, tiered strategic, core and minor.

• Unite UsstrategicTechnology or Integration · 1 January 2024Partnership to connect health, human, and social service organizations through a coordinated care referral platform. Aims to improve care coordination across community services.
• God's Love We DelivercoreStrategic or Co-development Partner · 1 November 2020Amida Care partnered with God's Love We Deliver to provide medically tailored home-delivered meals for members with chronic illness who are unable to shop and cook for themselves. Meals are approved by a Registered Dietitian Nutritionist after nutritional assessment. Partnership began November 1, 2020.
• Weill Cornell MedicineminorStrategic or Co-development Partner · 15 May 2019Co-sponsored CME provider dinner on PrEP with Weill Cornell Medicine and Northeast/Caribbean AIDS Education & Training Center Program. Fifty providers attended the May 15, 2019 event at Ruth's Chris Steakhouse.
• Callen-Lorde Community Health CentercoreStrategic or Co-development Partner · 30 November 2016Collaborated on PrEP education initiative - Get Schooled on PrEP: Know the ABCs. Launched groundbreaking PrEP 101 video series and panel discussion/webinar. Partnership for World AIDS Day event on November 30, 2016 at The LGBT Community Center.
• The LGBT Community Center (The Center)coreStrategic or Co-development Partner · 30 November 2016Host venue for Get Schooled on PrEP: Know the ABCs community event and video series premiere. Partnership for World AIDS Day programming and ongoing community health education events.
• Community Healthcare NetworkminorStrategic or Co-development Partner · 1 September 2016Co-sponsored 5th annual Transgender Health Conference in September 2016 at Pace University. Physicians, nurses, and behavioral health professionals gathered to discuss urgent health issues affecting the transgender community.
• Bronx RHIOcoreTechnology or IntegrationRegional Healthcare Information Organization providing data exchange with Bronx-based health care organizations including Bronx Lebanon Hospital Center, Montefiore Medical Center, St. Barnabas Hospital Bronx, Housing Works, Brightpoint Health, and Harlem United.
• Healthix RHIOcoreTechnology or IntegrationRegional Healthcare Information Organization connecting physician practices and health care organizations in Manhattan, Queens, Brooklyn, and Staten Island including Mount Sinai Health System, SUNY Downstate Medical Center, and Callen-Lorde Community Health Center.
• Health HomesstrategicStrategic or Co-development PartnerCare coordination partnerships with Health Homes for optimal care coordination, particularly for members eligible for Home and Community-Based Services (HCBS) under New York State's MRT guidelines.
• Housing WorkscoreStrategic or Co-development PartnerSponsor organization and co-founder of Amida Care. Beta-tested Amida Care Online provider portal. Partner in Workforce Initiative Network (WIN) vocational training program. Community health care provider in network.
• Acacia Network, Sun River Health, Community Healthcare Network, Harlem United, St. Mary's Center, Village CarecoreStrategic or Co-development PartnerSponsor organizations that founded Amida Care in 2003. These nonprofit community-based health organizations established Amida Care to provide specialized health coverage and coordinated care to New Yorkers with complex conditions.
• Beacon Health OptionsminorStrategic or Co-development PartnerBehavioral health services partner providing webinar series for providers and office staff on topics such as managing metabolic side effects of antipsychotics in children and adolescents.
• Northeast/Caribbean AIDS Education & Training Center ProgramminorStrategic or Co-development PartnerPartner in CME provider education on HIV prevention and PrEP prescribing practices for health care providers in the Northeast region.
• Greater New York Hospital Association (GNYHA)strategicStrategic or Co-development PartnerPartnership for DSRIP implementation support - GNYHA works with Performing Provider Systems statewide to support delivery system reform and HIV/AIDS project implementation outside of NYC.
• End AIDS 2020 CoalitioncoreStrategic or Co-development PartnerCoalition of over 60 AIDS service and community-based organizations, medical providers, and elected officials working to implement Governor Cuomo's Blueprint to End the AIDS Epidemic. Coalition co-sponsored World AIDS Day events and advocates for increased funding.
• NYC DSRIP HIV/AIDS CoalitioncoreStrategic or Co-development PartnerCoalition of seven Performing Provider Systems (PPSs) implementing HIV/AIDS Domain 4.c.ii projects. Coalition operates six subcommittees guiding implementation of early access to and retention in HIV care. Amida Care facilitates statewide learning collaborative.
• Undetectables VLS ConsortiumcoreStrategic or Co-development PartnerLed by NYC DOHMH and Housing Works, consortium focused on viral load suppression best practices and implementation strategies. Amida Care actively participates in Models of Care for VLS workgroup.
• Community Healthcare NetworkminorStrategic or Co-development PartnerPartner in PrEP/PEP and sexual health programs. Health centers in Bronx, Brooklyn, Manhattan, and Queens, as well as mobile van services. Listed as resource for members seeking PrEP access.
• Harlem UnitedminorStrategic or Co-development PartnerPartner providing PrEP navigation services via [email protected] and community healthcare PrEP services. Listed as resource for members seeking HIV prevention services.
• Mount Sinai Health SystemminorStrategic or Co-development PartnerPartner for HIV/AIDS services, Men's Sexual Health Project, walk-in HIV testing, and PrEP access throughout NYC locations. Listed as resource for comprehensive HIV care.
• Ali Forney CenterminorStrategic or Co-development PartnerPartner providing PrEP/PEP counseling, housing, and other social services for homeless and runaway LGBTQ youth (ages 13-29). Listed as resource for LGBTQ youth members.
• Iris HouseminorStrategic or Co-development PartnerPartner providing HIV prevention including PrEP counseling, support, and other services for women, families, and the underserved affected by HIV/AIDS. Offices in Harlem and Plainfield, NJ.
• SAGE (Services & Advocacy for LGBTQ Elders)minorStrategic or Co-development PartnerPartner for PrEP seminars and SAGEPositive Program for LGBTQ elders over 50. Provides HIV and STI testing as well. Listed as resource for older LGBTQ members.
• NYS Department of Health AIDS InstitutecoreStrategic or Co-development PartnerFunded Amida Care to facilitate statewide learning collaborative supporting NYC PPSs to implement HIV/AIDS projects and support HIV/AIDS-focused CBO involvement in DSRIP population health projects.

Scale indicators11 records

Recent moves6 records

Expansion highlights5 records

Direct peers

• MetroPlusHealth: NYC-based Medicaid managed care plan owned by NYC Health + Hospitals, serving 700,000+ members across the five boroughs including HIV-positive and homeless populations. Directly comparable as a public-option NYC Medicaid plan competing for the same SNP and mainstream Medicaid members.
• Healthfirst: One of the largest not-for-profit Medicaid plans in NYC with 1.7M+ members across Medicare, Medicaid, commercial, and individual products. Direct peer as a major NYC-focused health plan competing for Medicaid members and provider network depth.
• VNS Health: NYC-based nonprofit formerly known as Visiting Nurse Service of New York, now operating a Medicaid managed long-term care plan plus mainstream Medicaid and Medicare Advantage products serving complex and dual-eligible populations. Comparable for its community-based, complex-population focus and NYC footprint.
• Fidelis Care: New York State-wide Catholic-affiliated Medicaid and Medicare Advantage plan owned by Centene, with significant NYC presence. Competes for the same Medicaid SNP and mainstream Medicaid members in Amida Care's service area.
• EmblemHealth: New York-based nonprofit health plan offering Medicaid, Medicare, and commercial products through HIP and EmblemHealth brands. Direct peer in NYC Medicaid market following its 2022 acquisition of Affinity Health Plan.
• Positive Healthcare (AIDS Healthcare Foundation): AIDS Healthcare Foundation operates Positive Healthcare, a Medicaid HIV/AIDS Special Needs Plan in California and Florida. Closest functional analog to Amida Care as a dedicated HIV/SNP managed care plan; comparable for the same population specialization and outcomes-driven model.

Broad incumbents

• Molina Healthcare: National managed care company focused on Medicaid, Marketplace, and Medicare, with presence in New York. Broad incumbent with overlapping capabilities in government-sponsored plans but lacking Amida Care's HIV/SNP specialization.
• Centene Corporation: Largest U.S. Medicaid managed care company operating across all 50 states including NY (via Fidelis Care, WellCare, and Ambetter). Broad incumbent whose scale and capital could outbid Amida Care in any future SNP procurement.
• UnitedHealthcare Community & State: UnitedHealth Group's Medicaid division, operating in 30+ states including NY. Broad incumbent offering dual-eligible, complex-population, and SNP-adjacent products that could compete for Amida Care's members if it chose to invest in HIV/TGNC specialization.

Others

• Healthix: Regional Health Information Organization serving NYC that Amida Care integrates with for clinical data exchange. Listed as a peer only to flag the broader NYC healthcare data ecosystem; not a direct competitor but an enabling infrastructure partner.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat7 records

Key risks7 records

Key highlights7 records

Customer concentration

• Xx.com/amidacareny
• YouTubeyoutube.com/user/AmidaCare
• Facebookfacebook.com/AmidaCare
• LinkedInlinkedin.com/company/amida-care
• Instagraminstagram.com/amidacare

Revenue estimate

Valuation estimate

Number of profiles

Profiles1 record

Funding overview

Funding rounds

Investors

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about Amida Care