Amida Care marks 20-year legacy of supporting New Yorkers with HIV

Nonprofit community health plan Amida Care, specializing in providing comprehensive health coverage and coordinated care to people on Medicaid suffering from chronic conditions, including HIV/AIDS and behavioral health disorders, is celebrating two decades of service to New Yorkers. And to mark the milestone, the organization published a 20-year legacy report on Dec. 1 in commemoration of World AIDS Day. The organization serves close to 10,000 people across all New York’s five boroughs, including individuals living with HIV/AIDS, as well persons experiencing homelessness and who are transgender, regardless of HIV status. Amida Care also hosts community wellness events and a walk-in clinic. 

New York Nonprofit Media spoke with Doug Wirth, CEO of Amida Care, about his and his staff’s role at the health plan, the 20-year legacy report, and what’s next for the health plan. 

This interview has been edited for length and clarity. 

Can you share a little bit about Amida Care and the work that you all do?

Absolutely, thank you for asking. So Amida Care, we were founded as one of New York's first Medicaid HIV, special needs health plans. We opened our doors 20 years ago, and we came into being to offer a customized approach to care for people impacted by HIV. We began serving only HIV-positive persons. The idea was really about bringing best practices to the health plan space for serving people with HIV, and our job, we knew was always going to be to innovate and advance a model of care for people in the plan. So we're the largest SNP today with close to 10,000 members. We're experts in HIV, sexual health and gender-affirming care, and we developed this integrated model of care to think about the whole person, advancing access to primary care, gender-affirming care, behavioral health services, so mental health and addiction services, but also peer support. So our members know about living with HIV and they can help other members. We refer people to social services like housing and nutritional supports. We help people who are HIV positive to become undetectable. That means that the level of HIV that's active in the blood and the body is so low that it's nearly impossible to transmit it. And then [we provide] sexual health services … making sure that people [know] … about PrEP (pre exposure prophylaxis) and post exposure prophylaxis, or PEP, so that HIV negative members can stay negative. We do this with community partners and we're focused on providing comprehensive care, culturally competent care. What I would say to you is we want our members to be well so that they can get about the business of living their lives instead of focusing on managing disease.

Please talk about your 20-year legacy report.

When we came into being, we were the first HIV special needs plan in New York. There was no road map; we knew about general Medicaid-managed care and how health plans operate. But our job was really to innovate and so the 20-year legacy report is really about telling our story, about learning the business of Medicaid managed care, but actually improving on what health plans do for people living with HIV and then not repeating bad practices. So our job is not to put speed bumps in the way of getting care. Our work actually is about reducing or eliminating the speed bumps so that people get the care and services that they need so that they can get well and then pay attention to all the things that are important to people: jobs, school, relationships, being involved in people's communities. We help people to be well so that they can live a life that's authentic and one of contribution.

What has the public reaction been to Amida Care and the work that you all do?

When we opened our doors back in August of 2003, I think people were surprised a group of HIV providers came together to sponsor their own health plan. We had to create staff, find people to come and work in the mission. And I think people were skeptical, like what was possible. But our 20-year legacy report tells the dynamic story of impact, helping people be well. Providers and satisfied customers sharing about us in the community that ultimately brought more people to us, not because of fancy marketing strategies, but because of serving people, meeting needs and growing organically. When I came to the plan, there were just 200 members in 2005. Today, we serve nearly 10,000 people impacted by HIV.

What has been the political response and have any elected officials or administrators responded to Amida Care?

We enjoy widespread political support and appreciation for the work that we do in communities across New York City. We're the only special needs plan that's in all five boroughs of New York City, serving members from Staten Island to the Bronx throughout Manhattan and then into Brooklyn and Queens. And we're quite proud of the support that we've received from governors across our 20 years to the health committee leadership in the Assembly and the state Senate, and certainly appreciated the support of the Medicaid director and the AIDS Institute.

You share a lot about the successes of Amida Care and I think with every success comes a challenge. What has been the biggest challenge, or challenges, in operating Amida Care?

A lot of the challenges come or stem from what government does, and how they finance and support. So lots of political leaders can say they're committed to ending the HIV epidemic, but you actually need to follow the money. Do they invest in HIV care and services? We've benefited from operating in New York, where we have broad political support from multiple governors, but one of the things that's really been important is Gov. Hochul’s support for gender-affirming care. We've been a leader in terms of providing access to gender-affirming care through the Medicaid program. Today, we have, again, about 10,000 members, but about 3,000 of those members are people of transgender, gender non-conforming or non-binary experience. So getting government to do the right thing and be a responsible partner in funding has always been the biggest challenge.

What does the future look like for Amida Care, especially with in-coming administration and political changes on the horizon?

We are excited about the potential to further expand who could be a member in Amida Care. If you look at the seroprevalence data about where the most new HIV infections are happening, they're happening in communities of color, LGBTQ communities, places where poverty and poor housing impact people's access to health care. So, our future is centered on continuing to innovate and serve more people impacted by HIV. We want to help anyone who's HIV-positive getting care, get the medications that they need to be well, and then get about the business of living their lives. If someone is HIV negative, we want to support them in accessing sexual health services, get on PrEP, if that's a right choice for them, so that they can stay HIV negative. Now here's the interesting thing: If you help people who are HIV positive be well, costs go down. They don't need to go to the emergency room. They don't need to be admitted to the hospital. And if you help people who are HIV negative to stay HIV negative, you avoid the lifetime costs of treating HIV. So investing in a company like Amida Care and expanding our ability to serve more people has a huge impact in community. But it also makes sense if you're in government, or you pay attention to Medicaid expenses. We help people to be well so that Medicaid costs come down and that there's less HIV in a zip code, less transmission in a zip code, and ultimately, we save government money. We've documented hundreds of millions of dollars in cost savings, not from insurance company gimmicks, not by restricting care, but by providing care so that people get well, and they live at home and they do their work. They're not in costly inpatient facilities. So the individual wins, the community wins, government wins, and so does the taxpayer.

What was your response to the the news of the fatal shooting of the CEO of UnitedHealthcare?

We actually just met on this as an executive team this morning. Carlos [Molina, vice president of marketing and communications] was in the meeting for our staff and for members. We use panic buttons. We've got protocols. We have security in place, but there's also training and emotional support that we provide to our staff so that we can do the business of being in service to our members, but also know that we are safe and that we are a caring community.

What made you come to this work?

When I was in my 20s, I started to have friends, people that I knew, get sick with this unknown condition. I was going to do other things with my life, but watching young men die fundamentally changed the course of my life, and so I became an HIV pre- and post-test counselor, I was a volunteer. I handed out test results in the late 1980s. I was a buddy to people who were dying alone in a hospital because their family wouldn't come and see them. And those moments changed me forever and ultimately, I made the choice for this to be my life's work and to find other human beings that would sign up to make a difference. And ultimately … our whole team, what we're up to is we're fundamentally committed to ending the HIV epidemic in all communities, not just for some, but for all communities. And that's my life's work, and I'm very grateful to human beings like [like those on} our team who said yes to this life calling as well.

How do you choose which staff members and employees can work at Amida Care and you know have the cultural competency and the training to work at Amid Care?

We share about opportunities to work at Amida Care in the community. We put the word out, and we're really proud to hire people that bring lived experience, to being in communities most impacted by HIV. African American, Latinx, Asian Pacific Islander, LGBTQ+ communities. TGVNC, transgender communities. We let the community know when there's opportunities. Our staff, when we do a hiring process, we bring a team of immediate care members together to have conversations with people about their life experience, about their work experience, and about their comfort level in serving people impacted by HIV. It's really the group wisdom that chooses who comes to work and eat and break bread at the Amida Care table.

What does the future look like for Amida Care? What are your next steps?

So we are, after 20 years of great impact and nearly 10,000 members, we're working to expand our reach and so we're hopeful that New York state will continue extending membership in an HIV special needs plan to anyone who's placed at higher risk for HIV, with a particular focus on addressing sexual health needs of New Yorkers. I think the other thing I would tell you is that right now, we're in the five boroughs of New York City, and we're proud of that, but there are other parts of New York that would really benefit from Amida Care coming to those communities. And so thinking about Long Island, thinking about the lower Hudson region, Albany, Rensselaer, over to Syracuse, Buffalo, Rochester, those are all communities where we think we could make a difference. And so our future includes figuring out how to bring Amida Care to places in New York that we could make a difference.

What does your day-to-day look like at Amida Care, and do you have time to rest with all the work that you do?

Our days start early and very often go late.here's all the work of running a health plan being available to our members. We have a walk-in center, our members call us. But we also have live your life, wellness events where we go out in the community and we do a sacred African dance class or a salsa class or an art class. So many of us are meeting with government and going to community meetings throughout the day and into the evening to spread the word and to have conversations about HIV justice, about racial justice, about LGBTQ justice, and so our days are full and long, but I sleep well at night knowing and feeling the conviction of making the right choice about how to spend my life.

Is there anything that you want to share in this interview that I haven't had the chance to ask you yet?

So 2025 is going to be a different year and I think one of the things that is really important to us in Amida Care is that if we're going to end the HIV epidemic in New York, we must continue to invest in the Medicaid program. About 85% of people living with HIV will need access to Medicaid to pay for healthcare during their lifetime. So Medicaid is the largest source of insurance coverage for people living with HIV. We must continue to address and break down barriers, stigma, discrimination. We've come through a political process where some people have been targeted. Some of those targeted people are our members, our community, people we care about. And so in this moment, we must invest in Medicaid. We must fight discrimination and stigma in all of its ugly forms, and doing that is right for those communities. It's also right for government leaders to stand up, but it ultimately benefits taxpayers from knowing that people are well and not in the hospital, or people are preventing HIV transmission so they can go to school and get married, they can go out into the world and work and pay taxes. What we do impacts all those levels, and at this moment where Medicaid and certain communities are under attack, we must stand up, be vigilant and advocate for doing the right thing.