Q&A with Kody Kinsley of North Carolina's Dept. of Health and Human Services

Q. Kody, thanks so much for taking the time to talk about the work you’ve been doing in North Carolina. You’ve often spoken about your personal connection to healthcare. How has growing up uninsured shaped your views on healthcare and your leadership at the Department of Health and Human Services?

Growing up, I saw access to healthcare as a central burden on my family. Routine things like going to the dentist, getting vaccines, or having physicals weren’t part of our lives. Instead, it was about finding free clinics, programs at the local health department, or providers who worked on a sliding scale.

When emergencies happened—like when I fell out of a tree and ripped my leg open—I could see my mother’s fear. She juggled the emotional stress of her child being injured and a deep fear of how we could afford the cost.

Sadly, that experience mirrors what many Americans still face today. For too many, healthcare is about the price tag and the difficulty of navigating the system, not about their health or well-being. In North Carolina, we’re changing that. We’ve expanded access to insurance for over 600,000, tackled $4bn in medical debt, raised the bar on accessing charity care, transformed out mental health system, and invested in the fundamentals of what make us healthy:  food, housing, employment, and more.

Q.  North Carolina’s Medicaid expansion has been a hallmark of your leadership. How did you approach building consensus, and what factors ultimately drove its success?

Building consensus for Medicaid expansion was a team effort, but first and foremost, the credit goes to Governor Cooper for his leadership. From the moment he took office, he was committed to this goal. What made his approach unique was bringing in new voices to the conversation—sheriffs, local law enforcement, small businesses, chambers of commerce. These weren’t groups that normally thought Medicaid expansion was relevant to them, but we showed them how it could help their communities.

This coalition-building neutralized opposition over time. Behavioral health advocacy also became a critical factor—policymakers recognized that addressing mental health and substance use disorders was impossible with so many uninsured people.

The final piece was the financial argument. By structuring the deal so that hospitals and payers covered the non-federal share (for which I am most thankful), Medicaid expansion brought in $8 billion annually at no cost to state taxpayers. I framed it as a deal that no responsible board of directors could turn down.

Q. Operationally, Medicaid expansion is a massive undertaking. How did you prepare for and execute the rollout?

We took advantage of the the time leading up to the bill passage and during the COVID public health emergency to re-work our systems while redeterminations were paused.

We relied on technology and automation, using ex-parte data from programs like SNAP to identify eligible individuals. On December 1, 2024, we automatically enrolled 280,000 people. They received letters saying, “Congratulations, you have Medicaid.”

But technology wasn’t the whole story. At the same time, we activated coalitions of faith leaders and civic organizations to combat mistrust. Many people had been denied Medicaid for years and didn’t believe it would work this time. Those trusted voices made a big difference.

When we launched expansion last year, we projected that it would take us two years to enroll the more than 600,000 that were eligible. As of December 23, North Carolina enrolled more than 608,000 people in just one year – a testament to the community leaders and partners that were committed to getting North Carolinians covered.

Q. Alongside Medicaid expansion, your team has made major investments in behavioral health. What were the key focus areas?

Behavioral health was central to Medicaid expansion and the broader work we’re doing. Governor Cooper proposed investing $1 billion from the federal Medicaid “signing bonus,” and the General Assembly allocated $835 million.

We focused on four key areas:‍

1. Provider Rate Increases: We increased rates for mental health and substance use disorder treatment for the first time in a decade. We invested in services that are evidenced based and where care was needed most.‍

2. Crisis Systems: In a moment of crisis, we want easy to find options or individuals in need, their friends, and their families. We built behavioral health urgent cares, facility-based crisis centers, peer living rooms, co-responder models and much more.‍

3. Justice-Involved Populations: With 60% of incarcerated people experiencing substance use disorders, we allocated $100 million to break cycles of recidivism.  Investing in treatment saves lives and reduces costs across the system.‍

4. Youth Mental Health: Our kids are our future.  Meeting them where they are with school based interventions, investments in child welfare, restructuring out our medical programs serve them, and investing in pediatric metal health care has been key.

Q. Leading a team of 18,000 staff, how do you and your leadership team manage such a large operation and stay focused on so many initiatives?

What sets North Carolina apart is the collaboration across divisions. Medicaid works hand-in-hand with mental health, public health, and child and family well-being teams. This breaks down silos and leads to truly impactful solutions.

From an operational perspective, I focus on retail-level excellence. If you can’t deliver on the small things, you won’t be trusted with the big ones. That focus on operational soundness drives everything we do.

I give a lot of credit to our Medicaid team. They’ve been instrumental in launching managed care plans, the Healthy Opportunities Pilot, integrated care for kids, and more.

Q. What lessons have you learned from working with managed care plans, particularly through initiatives like the Healthy Opportunities Pilot?

The Healthy Opportunities Pilot (HOP) is a great example of shared success. HOP is an initiative the state launched to address non-medical factors that influence health — like housing, food, and transportation - and integrating these services into Medicaid. We had to build external infrastructure for coordinating services and referrals to community-based organizations, while partnering with payers for claims and billing.

This flexibility allowed us to learn what works and what doesn’t as we push further into addressing social determinants of health. They’re important partners in helping us assess the effectiveness of interventions. There’s still work to simplify processes, but these partnerships are key to scaling solutions that improve outcomes for North Carolinians.

Q. During Hurricane Helene, your team led efforts to ensure the well-being of communities, such as access to essential services like food and medical care. How did you coordinate resources across government agencies and community organizations to provide a comprehensive response? What lessons from this experience can be applied to future disaster preparedness and recovery?

Communication and preparation. North Carolina is no stranger to hurricanes and the state, from Emergency Management and the NC National Guard to us to the Department of Transportation and everyone in between, works with our local partners to respond to hurricanes and floods every year. Table-top exercises and statewide and local trainings are done each year to ensure we are always storm-ready. Helene caused unprecedented damage to our state and communities out west, but the mission is the same — to respond, rescue, rebuild and recover. NCDHHS is in storm response right now and for the long haul as communities work through the devastation.   

During the first hours, days and weeks of Hurricane Helene response, my team at NCDHHS worked around the clock to connect with people and communities. We were connecting with vulnerable populations — nursing homes, people that utilized oxygen tanks, foster children — helping ensure their safety. We were also connecting with service providers to make sure there were supplies, medications, and basics like food, water, formula and diapers. NCDHHS and our partners worked in collaboration with local and state emergency management to make sure we were able to mobilize quickly to get people what they needed.  

Q. Future Healthcare Challenges: Looking ahead, what do you see as the biggest healthcare challenges for North Carolina in the next 5-10 years?

Two key things weigh on my mind: our older North Carolinians and rural health care. 

1. Gov. Cooper directed his cabinet agencies to work collaboratively, ensuring North Carolina's approach to aging is both comprehensive and evolving. We and our partners developed All Ages, All Stages NC, a 10-year multisector plan for aging designed to help older adults thrive in North Carolina. This comprehensive plan outlines actionable steps state agencies and partners can take to ensure all North Carolinians feel supported, valued, and empowered at every age and stage of life.

By next year, 20% of our population will be 65 or older. At the same time, health care costs and workforce shortages are making it even harder to age gracefully. The burden of chronic disease: obesity, diabetes, and hearth disease in particular, are making aging more complicated, especially in our rural communities. Building communities that allow individuals to thrive at every age and every stage of life is a recipe for success in North Carolina.

2. There are challenges when it comes to rural health care, but also opportunities:

Working with our General Assembly to expand the Healthy Opportunity Pilots statewide will provide more opportunity for rural residents to benefit in regard to food, housing, transportation and ending partner violence in their own communities.

Our rural communities also have unique challenges around workforce and internet access. While there are opportunities for loan repayment and other incentives for health care providers, community vitality and engagement, including education for their children, lack of housing or affordable housing, and lack of internet access can make it difficult for providers to stay serving rural communities. Increasing access to internet in rural areas increases telehealth utilization, improves education for children and adults in those areas, and increases the flow of information.