Medicaid Uncovered: Decoding the System

Kody Kinsley has been called many things—operator, innovator,
Medicaid “nerd”—but above all, he’s a fierce advocate for the
health and well-being of the populations Medicaid serves. Now a
senior advisor at the Milken Institute and recently North
Carolina’s Secretary of Health and Human Services, Kinsley joins
Keith Figlioli for a wide-ranging conversation about how Medicaid
works, why it matters, and where innovation is reshaping its
future. 


A native of North Carolina, Kinsley brings personal experience
and professional depth to his perspective. Growing up uninsured,
he watched his mother navigate pediatric clinics, sliding-scale
providers, and supply closets offering free samples to keep her
kids healthy. That formative exposure ultimately propelled him
into a career spanning healthcare operations, behavioral health,
public policy, and government leadership. 


As North Carolina’s health secretary, Kinsley led one of the
country’s largest and most complex human services agencies,
overseeing everything from Medicaid operations and public health
to psychiatric hospitals and child welfare. He played a central
role in advancing Medicaid expansion in the state—an achievement
shaped by bipartisan negotiation, careful balancing of federal
and state resources, and a deep understanding of the healthcare
landscape. 


In this episode, Kinsley and Keith cover: 


The structural realities behind state Medicaid programs.
Kinsley describes how mega-agencies like North Carolina’s bring
together financing, public health, regulation, and direct care
delivery—touching millions of lives daily, often invisibly. 

Federal-state dynamics and looming policy shifts. From
federal match rates to provider taxes and budget triggers,
Kinsley explains the intricacies of how money moves between
federal and state governments—and what’s at stake when Congress
debates Medicaid cuts or structural reforms. 

The human cost behind budget debates. Behind every line item
is a person: whether it’s dental coverage, hospice services, or
in-home care, Kinsley argues that policymakers must weigh the
downstream impacts of funding decisions on real lives and
long-term system costs. 

Bright spots and innovation. Kinsley highlights North
Carolina’s “Healthy Opportunities” pilot—one of the first
initiatives nationally to use Medicaid dollars for non-medical
needs like food, housing, and transportation. Early results show
promise, including improved outcomes and significant cost
savings, suggesting a roadmap for other states. 

Looking forward. While political winds may shift and
financial pressures mount, Kinsley remains optimistic. He points
to growing public support for Medicaid and hopes the nation can
move beyond divisive debates over whether healthcare is a right
or privilege—focusing instead on smarter, more sustainable ways
to deliver care. 



To hear Kody Kinsley and Keith Figlioli unpack these topics and
more, listen to this episode of Healthcare is Hard: A Podcast for
Insiders.