Positive Healthcare

What Positive Healthcare does

Positive Healthcare is the managed care division of AIDS Healthcare Foundation (AHF), a global non-profit organization. The division operates two specialized health plans serving people living with HIV/AIDS in Los Angeles County, California: PHP (Positive Healthcare Partners), a Medicare Advantage HMO Special Needs Plan (SNP) recognized as the first HIV-specific SNP approved by the Centers for Medicare & Medicaid Services (CMS); and PHC California, a Medi-Cal managed care plan established in 1995 as the first AIDS special needs plan in the United States. Both plans function as risk-bearing managed care entities that contract with CMS and the California Department of Health Care Services to receive capitated payments in exchange for providing comprehensive healthcare coverage, prescription drug benefits administered through partner MedImpact, RN-led care management, and access to specialist provider networks. PHP reports close to 700 members and earned a 4-star Medicare rating for plan year 2026.

The plans are AAAHC-accredited and operate on a standard Medicare/Medicaid managed care technology stack, including a CMS Interoperability API implemented with 1up Health and a MedImpact-powered pharmacy benefit. Member benefits extend beyond clinical and pharmacy coverage to include access to AHF Fitness Centers and partner gym locations, layering wellness programming onto the core SNP product. Both products are confined to Los Angeles County and serve narrow, medically complex populations requiring coordinated HIV care, antiretroviral adherence support, and management of common comorbidities. Revenue is generated entirely through government capitation payments from CMS (PHP) and the California DHCS (PHC California), with no disclosed commercial or employer-sponsored lines of business. The plans inherit AHF's three-decade operating history in HIV/AIDS care delivery, which supplies brand credibility, clinical protocols, and a referral pipeline through AHF's provider and testing infrastructure, but the division itself is geographically and demographically concentrated, with a structurally bounded addressable population tied to LA County HIV prevalence.

Name

Positive Healthcare

Legal name

AIDS Healthcare Foundation

Website

https://positivehealthcare.net

Company type

Private

Founded year

1995

Operating status

Operating

Short description

Positive Healthcare is the managed care division of AIDS Healthcare Foundation, operating two HIV/AIDS-focused health plans—PHP (Medicare Advantage SNP) and PHC California (Medi-Cal AIDS SNP)—that serve people living with HIV/AIDS in Los Angeles County, with approximately 700 PHP members.

Ownership category

akta.pro rank

Product category

Managed Care / HIV Special Needs Health Plans

NAICS

Health Care and Social Assistance (62), Other Ambulatory Health Care Services (6219)

SIC

Hospital & Medical Service Plans (6324), Services-Health Services (8000), Services-Misc Health & Allied Services, Nec (8090)

akta.pro primary industry

Chronic Condition Special Needs Plans (C-SNP) (FSAIAGAE)

akta.pro secondary industries

Medicare Advantage HMOs (HMO/HMO-POS) (HLAEAMAH), Medicare Advantage (MA) Plans (FSAIAGAA), Healthcare-Linked Social Benefits Administration (e.g., Medicaid/Means-Tested Health Coverage) (BPAIAKAH)

Keywords

• HIV managed care
• Medicare Advantage SNP
• Medi-Cal health plan
• AIDS special needs plan
• HIV-specialized coverage

Headquarters

HQ city

Fort Lauderdale

HQ country

United States

HQ region

North America

Offices2 records

Markets served

GTM type

B2C

Offering type

Services

Cost components

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

Revenue model

1. Medicare Advantage Premiums (PHP): PHP (HMO SNP) generates revenue through Medicare Advantage premiums paid by CMS on behalf of enrolled Medicare beneficiaries. The plan includes Medicare Part A, Part B, and Part D coverage with no monthly premium for members in 2026. Revenue is capitated based on member enrollment and risk adjustment factors.
2. Medi-Cal Managed Care Premiums (PHC California): PHC California is a Medi-Cal managed care plan generating revenue through premiums paid by the California Department of Health Care Services (DHCS) for enrolled Medi-Cal recipients who have prior AIDS diagnosis. Services are covered with no co-pays, no premiums, and no deductibles for eligible members.

Pricing tiers

Go-to-market motion1 record

Distribution channels3 records

Marketing channels5 records

Core offering

Positive Healthcare is the Managed Care Division of AIDS Healthcare Foundation, offering two specialized health plans for people living with HIV/AIDS in Los Angeles County: PHP (HMO SNP), a Medicare Advantage Prescription Drug plan that is the first HIV-specific Special Needs Plan approved by CMS, and PHC California, a Medi-Cal managed care plan that is the first AIDS Special Needs Plan in the country. Both plans deliver comprehensive medical, prescription drug, and ancillary benefits through a contracted network of HIV specialist providers, with capitated revenue from CMS and the California Department of Health Care Services.

Product overview

Positive Healthcare operates as AIDS Healthcare Foundation's Managed Care Division, offering two specialized health plans for people living with HIV/AIDS in California. PHP (HMO SNP) is a Medicare Advantage Prescription Drug plan (the first HIV-specific Special Needs Plan approved by CMS), while PHC California is a Medi-Cal managed care plan (the first AIDS Special Needs Plan in the nation, operational since 1995). Both plans provide comprehensive medical coverage, prescription drug benefits, and added benefits tailored to HIV/AIDS patients, with services including primary care from HIV specialists, hospitalization, preventive care, and wellness programs.

Differentiator

Problem solved

Functional benefit

Brands

• PHP (HMO SNP): Medicare Advantage Prescription Drug health plan specifically for Medicare beneficiaries living with HIV who reside in Los Angeles County, California. First HIV-specific special needs health plan approved by CMS.
• PHC California

Products and services

• PHP (HMO SNP) PHP (HMO SNP) is a Medicare Advantage Prescription Drug health plan specifically designed for Medicare beneficiaries living with HIV who reside in Los Angeles County, California. It is the first HIV-specific Special Needs Plan approved by CMS and provides comprehensive medical coverage (Part A and Part B), prescription drug benefits (Part D), and added benefits including dental ($1,550/year), vision ($400/year), hearing ($2,500/year), gym membership/OTC items ($550/year), acupuncture, transportation (24 round trips/year), meal benefit (56 meals/year), therapeutic massage for AIDS-related neuropathy, pest control, air filters, and laundry services for qualifying members. Members have access to HIV specialist primary care providers, RN care managers, and a 24/7 nurse hotline.
• PHC California PHC California is a Medi-Cal managed care plan for Medi-Cal recipients who live in Los Angeles County and have a prior AIDS diagnosis. As the first AIDS Special Needs Plan in the country, it provides comprehensive coverage with no co-pays, no premiums, and no deductibles, including primary care from HIV experts, hospitalizations, emergency/urgent care, prescription drugs, and added benefits such as gym membership or up to $200/year in OTC pharmacy items. The plan is accredited by AAAHC.

Quantifiable outcome

• 4-star Medicare rating for 2026
• +2 more outcomes

Named customers2 records

Segments3 records

Ideal customer profiles2 records

Technology focussed No

API detail

Has API

Yes

API docs

API detail

Core technology

AI maturity

App detail

Integration1 record

Feature4 records

Partnerships

Eleven partnerships are on record, tiered core and secondary.

• AIDS Healthcare FoundationcoreStrategic or Co-development PartnerAHF is the parent organization and nation's largest HIV healthcare provider with 30+ years of HIV care experience. AHF founded Positive Healthcare as its Managed Care Division in 1995, providing the organizational expertise, infrastructure, and brand backing for PHP and PHC California plans. AHF Pharmacy is also the exclusive provider of OTC fulfillment for member benefits.
• MedImpactcoreTechnology or IntegrationMedImpact manages PHP's pharmacy benefit including the member portal for drug searches, copayment viewing, drug pricing, formulary searches, and pharmacy locator. Handles pharmacy claims processing and formulary management.
• CVS PharmacycoreChannel Partner/ Reseller/ DistributorContracted pharmacy chain within PHP's network. Members can fill prescriptions at any CVS location, including when traveling outside Los Angeles County.
• Walgreens PharmacycoreChannel Partner/ Reseller/ DistributorContracted pharmacy chain within PHP's network. Provides accessible prescription filling across Los Angeles County and nationwide.
• Rite Aid PharmacycoreChannel Partner/ Reseller/ DistributorContracted pharmacy chain within PHP's network. Provides accessible prescription filling options for members.
• AHF PharmacycoreChannel Partner/ Reseller/ DistributorOperated by AIDS Healthcare Foundation, AHF Pharmacy is part of PHP's contracted pharmacy network and handles OTC item fulfillment for members. Available for prescription needs.
• 24 Hour FitnesssecondaryChannel Partner/ Reseller/ DistributorGym chain option for PHP's fitness benefit. Members can select 24 Hour Fitness for gym membership access at any of their facilities.
• LA Fitness/Esporta FitnesssecondaryChannel Partner/ Reseller/ DistributorGym chain option for PHP's fitness benefit. Members can select LA Fitness/Esporta Fitness for gym membership at any location in California.
• AHF Fitness CentersecondaryChannel Partner/ Reseller/ DistributorAHF-operated fitness center at 4905 Hollywood Blvd., Los Angeles, CA 90027. One of three gym options for PHP fitness benefit.
• 1up HealthsecondaryTechnology or IntegrationInteroperability API vendor for Positive Healthcare's CMS Interoperability and Patient Access Rule compliance. Handles registration, documentation, and API access for third-party developers wanting to offer interoperability services to Positive Healthcare members.
• California AIDS Drug Assistance Program (ADAP)secondaryStrategic or Co-development PartnerState program that helps cover costs of certain HIV prescription drugs for members who don't qualify for Extra Help. Especially helpful for Medicare beneficiaries in the coverage gap stage. Income threshold: up to 500% of Federal Poverty Level.

Scale indicators6 records

Recent moves6 records

Expansion highlights4 records

Market position

Strengths4 records

Competitive moat4 records

Key risks6 records

Key highlights6 records

Customer concentration

Compliance2 records

Revenue estimate

Valuation estimate

Number of profiles

Subsidiaries2 records

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 Positive Healthcare