Kody Kinsley reflects on milestones before stepping down as health secretary
By Jaymie Baxley
After three eventful years, Kody Kinsley is stepping down from his role as North Carolina’s top health official.
The New Hanover native’s relatively short run as secretary of the N.C. Department of Health and Human Services was marked by several achievements that will likely be felt across the state for years to come. Under his leadership, North Carolina became the 40th state to expand Medicaid — a decade-in-the-making measure that has given hundreds of thousands of low-income residents access to health insurance.
In an interview with NC Health News, Kinsley described his time at the department as a “dream fulfilled.”
“I’ve had some of the saddest moments and the happiest moments of my life in this position,” he said. “Yet through all of it, I’ve had the opportunity to make an impact, and that has just been truly amazing.”
Kinsley noted that he’d been at the department for almost seven years in all, “but part of that was COVID, so it’s more like 47 years,” he quipped.
Nonetheless, he added, “this has been the hardest job of my life and the most exciting job of my life.”
He is especially proud of recent strides DHHS has made in improving access to behavioral health services through money earmarked by the legislature out of a $1.6 billion sign-on bonus the state received from the federal government as an incentive to pass expansion. The $835 million allocated to mental health, he said, allowed the state to “rebuild its crisis response system” and increase Medicaid reimbursement rates for behavioral health providers for the first time since 2012, among other advancements.
“Behavioral health was my passion area when I was growing up in North Carolina, and it’s the area that I worked in when I was fresh out of college in North Carolina,” Kinsley said. “To be put in a position to make a difference in that space was such an amazing full-circle moment.”
Finding his calling
The 39-year-old said behavioral health is an issue that hits close to home.
When he was younger, Kinsley watched his father struggle with substance use disorder. Other members of his family also faced “mental health challenges,” he said.
Those experiences led him to take a job with a behavioral health care company in western North Carolina after he graduated from Brevard College.
“Our mission and passion in that space was to serve people of means and without means at the same time, and I saw firsthand the amazing, life-changing work that could happen,” he said. “I had experienced for myself the sense of hopelessness and fear that people have when they’re struggling to find care, and I think the basic takeaway for me at that moment was that mental health illness is too often treated like more of a moral failing than a medical issue.”
Kinsley noted that one in five people in the general population will develop a “diagnosable kind of mental illness, whether it’s transient depression or something more serious” each year. But care for these increasingly common issues, he said, is often treated like a “specialty service.”
“Having a continuum of care that has been kind of carved out of the medical system and forgotten for so long, for something that is already so rife with stigma, struck a deep nerve of injustice,” he said.
After receiving his master’s degree in public policy from the University of California at Berkeley, Kinsley served as assistant secretary of management for the U.S. Treasury Department and held positions in the White House and the federal Department of Health and Human Services. He returned to his home state as an undersecretary for NCDHHS in 2018.
One of Kinsley’s first major assignments at the agency was overseeing a collection of state-run psychiatric hospitals and facilities that treat adults and children with neuro-medical disease, substance use disorders and developmental disabilities. He later played a key role in coordinating the state’s testing and vaccination efforts during the COVID-19 pandemic.
When former Secretary Mandy Cohen left the department at the end of 2021, Kinsley was tapped by Gov. Roy Cooper to serve as her successor.
Making a ‘miracle’
In his first year as secretary, Kinsley worked closely with Cooper to get Medicaid expansion passed in North Carolina.
Cooper had tried multiple times to make the measure a reality, but he was repeatedly thwarted by a majority of Republicans in the General Assembly. A turning point came after a series of town halls in which Cooper and Kinsley extolled the benefits of expansion to local sheriffs, business owners and other constituent groups that held sway with lawmakers who opposed expansion.
“I think the biggest hurdle we faced was that Medicaid expansion was part of ‘Obamacare,’ and that made this an extremely political issue for Republicans,” Cooper said in a recent interview with NC Health News, adding that Donald Trump, who was elected the same year Cooper was, spent much of his first term as president working to dismantle the program colloquially named after his predecessor. “We had the challenge of moving Medicaid expansion past the politics of ‘Obamacare,’ and the way we needed to do that was get the constituents of Republican legislators to ask them for it.”
But Kinsley is noted for working across the aisle with Republicans. He forged strong ties with Sen. Jim Burgin (R-Angier), a co-chair of the Senate Health Care Committee; the two have traveled the state together, attending more than a dozen town hall meetings focused on mental health.
“I’ve thoroughly enjoyed working with him,” Burgin said. “I just saw he had a spirit of wanting to work, get things done. And, you know, we never discussed politics, we just discussed trying to help people, especially kids and folks with mental health issues.”
Burgin has joked that he starts many days by talking with Kinsley.
“He used to say he went to the gym, and then he called the Jim,” Burgin said. “He knows I get up at six o’clock every morning and read. So he would go to the gym, and then he would call me, and we would chat about what was going on, things we were working on and all of that. We still text and talk almost every day.”
He also said that many other Republican lawmakers involved in health policy feel the same respect for Kinsley.
Legislation approving Medicaid expansion finally passed in March 2023 with bipartisan support, a reversal spurred in part by the more than $1.6 billion in federal financial incentives offered by the Biden administration. That December, NCDHHS began the Herculean task of adding hundreds of thousands of newly eligible beneficiaries to the state’s Medicaid rolls.
Kinsley said more than 600,000 people who were previously ineligible for Medicaid have received coverage since expansion took effect, surpassing the state’s projected enrollment for two years in just 12 months.
“Getting [that many] people on Medicaid expansion so seamlessly and so fast is an operational miracle,” he said. “It could have been a bipartisan victory followed by a technology explosion, and we’ve definitely seen those things happen in other places. But that didn’t happen here, and I’m proud of the team for that.”
Cohen, who is now director of the federal Centers for Disease Control and Prevention, praised Kinsley for building on the groundwork she laid as secretary and for carrying expansion “over the finish line.”
“I was so proud of him and the Medicaid team for doing it, and doing it in a bipartisan way,” she said in a phone interview earlier this month.
In a statement to NC Health News, Cooper said Kinsley has “served our state with distinction.”
“He was instrumental in helping get health care for more than 600,000 North Carolinians through Medicaid Expansion, and he helped pioneer our first-in-the-nation plan to relieve approximately $4 billion in medical debt for nearly 2 million people in our state,” Cooper said. “I’m grateful for Secretary Kinsley’s commitment and dedication to making North Carolina a healthier place to live and work.”
Looking ahead
Devdutta Sangavi, a professor at the Duke University School of Medicine who previously served as president of Duke Regional Hospital, has been nominated by Governor-elect Josh Stein to succeed Kinsley as secretary of NCDHHS.
“I think we’ll have a seamless handoff,” Kinsley said of his departure. “I have been planning to be done for some time, and we have worked very thoughtfully on the transition. We’ve got a lot of national eyes on North Carolina, and I’m going to do everything I can to support him and the team’s continued success.”
The state Senate must still confirm Sangavi, who would be the first Indian-American cabinet secretary in North Carolina history, before his appointment is made official. Kinsley made history as the state’s first openly gay cabinet member.
While some cabinet nominees for President-elect Trump’s second administration have voiced interest in reducing or eliminating federal funding for Medicaid, Kinsley said he isn’t overly concerned about the program’s future.
“I’m not one to worry or catastrophize,” he said, adding that his tenure proves it is possible to achieve bipartisan support on seemingly divisive issues. “Health care is not a red issue or a blue issue. It’s really a green issue, as in the color of money. It’s an issue that’s deeply engaged with incentives and structures.”
He pointed to expansion as a “win-win-win” for all involved. The measure, he said, was implemented “at no cost to the state taxpayer” thanks to an arrangement in which the federal government pays 90 percent of the cost of insuring newly eligible beneficiaries while hospitals in the state pick up the remainder of the bill.
“Those hospitals are now drawing down more in Medicaid payments than they ever have to pay in taxes,” he said. “That was a huge win for them and financially, it was a win for providers. Everybody is coming out ahead.”
Kinsley said his immediate plans after leaving DHHS include spending time with his partner. He said he also plans on “catching up with my parents and brother, tending to personal things and cuddling with my dog.”
“One of the things I have tried to do as secretary in my role at the department has been really encouraging people to take leave, take vacation and take rest,” he said. “I think that’s so important. We have to take care of ourselves. We have to put our oxygen mask on before assisting others.”
Looking further to the future, Kinsley said he remains committed to “doing everything I can to improve the health and well-being of the state.”
“There’s no shortage of challenges ahead, and I’m not done yet,” he said.
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