NYS Medicaid SNPs Expand Access to All Medicaid-Eligible Transgender Individuals Regardless of HIV Status

As of today, New York State Medicaid Special Needs Health Plans (SNPs) will be open to all transgender individuals who qualify, regardless of their HIV status. Until now, New York SNPs have only enrolled eligible individuals who are HIV-positive or people who are experiencing homelessness (regardless of HIV status). Amida Care, the largest of the three Medicaid SNPs in New York, currently provides comprehensive health coverage and coordinated care to over 6,400 New Yorkers, including more than 400 people of transgender experience.

The expansion supports the goals of Governor Andrew Cuomo's Blueprint to End the AIDS Epidemic (ETE) in New York State by 2020. The care coordination and integrated social support services that SNPs are designed to provide will now be accessible to more transgender individuals, who often experience significant barriers to care.

Despite major advances in both treating and preventing HIV, transgender individuals still face an alarmingly high rate of new infections. The prevalence of HIV among transgender women is nearly 50 times higher worldwide than the general population. For transgender women of color, this health disparity is even greater-from 2007 to 2011, 90 percent of transgender women in New York City diagnosed with HIV were black or Latina.

"We've made great strides toward ending the HIV/AIDS epidemic, but our job won't be done until we reach every community affected by this crisis. Rampant stigma, discrimination, and socioeconomic challenges prevent the transgender community from accessing HIV prevention methods like PrEP and PEP, getting tested for HIV, and being linked to essential treatment and care," said Doug Wirth, President and CEO of Amida Care. "Amida Care has a long history of helping the transgender community access respectful, high-quality, culturally competent health care, including gender-affirming services and HIV treatment. We also work with community-based organizations to help our members access support for housing, employment, and legal issues. We're excited to be able to expand our health plan to reach more transgender individuals and help provide them with the care and services they need to be healthy and live their authentic lives."

"Amida Care is breaking the mold more than any other health care plan in terms of meeting the needs of the trans community," said Victoria Ferrell, an Amida Care member and representative on Amida Care's Member Advisory Council. "At the end of the day, if you're a member, they go above and beyond to make sure your health needs are met and you're as healthy as possible."

By addressing the comprehensive medical, behavioral, and supportive needs of their members, SNPs have proven to be a highly effective care model to help HIV-positive members become virally suppressed, which means they have the chance to live longer, healthier lives, and, as the U.S. Centers for Disease Control and Prevention (CDC) recently confirmed, they cannot transmit the virus to others.

Young men having sex with men (MSM) of color also have a disproportionately higher risk of HIV infection, with half of Black gay men and a quarter of Latino gay men projected to be diagnosed with HIV during their lifetimes according to the CDC. SNPs would also be a great resource to support those young MSM of color in remaining HIV negative.

"We now know that undetectable equals untransmittable. We also know that PrEP is more than 90 percent effective in preventing HIV infection," said Dr. Jerome Ernst, Chief Medical Officer of Amida Care. "Health is about more than doctor's visits and taking pills -- at Amida Care, we take a holistic approach that empowers individuals to access the full spectrum of care and services to get the treatment they need to become undetectable if they are HIV positive. Now, we can apply that same successful approach to helping HIV negative transgender individuals stay negative."

Reducing the number of new HIV infections also produces large cost savings. The ETE goal to reduce the annual number of new HIV infections in the state from 3,000 to 750 or less by 2020 would result in an estimated medical cost savings of over $804 million. Amida Care has experienced impressive results firsthand, achieving a 78 percent viral suppression rate among its HIV-positive members. This saved New York State more than $115 million between 2008 and 2015.

Employment is one of the most important social determinants of health. Having a living-wage job is key to staying healthy -- physically, mentally, spiritually, and emotionally. Transgender people experience unemployment at three times the rate of the general population. Amida Care's Innovator Consumer Workforce program creates living-wage jobs for graduates of peer workforce training programs. The program provides grants for health service providers to hire consumer workers and is supported by the New York City Council's Ending the Epidemic Initiative. Many of those jobs involve giving back to others through positions in health navigation and outreach.