Q&A with Karen Kimsey, Virginia’s Medicaid Director

Karen Kimsey is the Director of the Virginia Department of Medical Assistance Services (DMAS). She’s been at DMAS for more than 15 years during two stints. She was promoted to director in September, 2019.

Recently, Kimsey experienced a health issue that brought her in to direct contact with the health care system that she helps maintain and regulate. This interview touches on that experience and how it has informed her work. She also talks about the lessons from COVID and the next steps for improving the safety net in this year’s legislative session.

 

DJ Wilson:  So, why don’t we start. Tell me about your recent health experience, and how that has informed the work you do?

Karen Kimsey: “I had my own challenge just this past summer where I was diagnosed with a condition. It’s a tumor, and required treatment. It was interesting because it took over 9 months to figure it out, especially with COVID delaying elective procedures. There was a routine procedure they did, and that is when they discovered the issue that I was dealing with, in which I had to do either immediate surgery or chemotherapy as treatment.

The reality is that if I were an African American woman, it would’ve taken twice as long to receive the diagnosis that I received. It’s also a harsh reality that our our health care system can be difficult to navigate for those who have not spent their careers in this field, and that’s particularly true for minorities and especially minority women. My experiences have made me even more aware of this disparity because I have worked in the health care field for a number of years, and understand the system from the inside.

The condition that I have is rare so that is why it took them a while to figure it out. But, if I had waited any longer my options would have been very limited and my life would have been very different. If I were a minority woman, then my options would have likely been very different. I may not have even survived. So, one of the things I am very grateful for is the treatment, but navigating the system can be tough, even for those of us who have spent our careers in health care. We support and represent individuals who, for very valid reasons in history, have experienced systemic racism or unconscious bias towards them in terms of gaining access to and using health coverage.”

 

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DJ:  How do you think this experience has changed your approach to the work that you at the Department of Medical Assistance Services?

KK:  “Well, I have always been very passionate about my work as a long term public servant for over 25 years, with Medicaid in particular. I’ve always been passionate about Medicaid as a safety net and critical health insurance program for our vulnerable populations, especially those individuals who are high-risk, seniors and people with disabilities, children and women of all different populations.

Now, having gone through this experience and still going through this experience, I am pleased to say that I am doing well and feel very honored to still be in this role. It’s made me more passionate about making sure people are able to have access to coverage. I cannot imagine how I would have been able to afford this if I didn’t have health coverage. That is one big piece because a predominant driver for people going into bankruptcy is medical bills, and so we are very pleased in Virginia to have had our uninsured rate decrease thankfully due to Medicaid expansion, which allows us to now serve one in five Virginians.”

 

DJ:  Has this experience driven home the importance of having an advocate when one enters the system, and perhaps the importance of health coverage in Virginia?

KK:  “Absolutely, but, it is not only being able to gain access to health coverage, but it’s also the ability to use the coverage, knowing what to do and being able to advocate for yourself. As an individual, I am keenly aware of people we know and support who are afraid to do that, do not necessarily know how to do that or have a lot of fear when it comes to advocating for their health needs and get the treatment that they need.  Also, sometimes [they] are also impacted by other social determinants of health.

So, I think it is even more important for us to make sure that the program is available and that people actually use the services to their benefit, especially if they have a chronic health condition and during the pandemic.”

 

DJ: How has the American experience with structural racism and issues of social justice in the last year catalyzed or changed your thinking about how to manage the safety net for Virginians as you head into 2021?

KK:  “Well, one of the things that we think is very important is that we can only do our very best if we listen to those who we serve. We recently, over the last two years, created a member advisory committee, where we have a diverse  committee who use the benefit and their families meet with us on a regular basis to discuss how the Medicaid program is working for them. They are actually helping us think through how our program is designed and how we can continue to move forward.

We also care very much about our providers who support our members everyday and what their needs are. We are a managed care state, but we see it as a trifecta with the members always in the center, the state and our health plan partners, but also our provider partners as critical corners of the triangle.”

 

DJ:  How has your department thought about getting your beneficiaries vaccinated during the pandemic?

KK: “Well, the vaccine is a huge issue and it is showing where we have pockets of people who may be hesitant to take the vaccine for a lot more than, ‘I’m just afraid to get a shot in my arm.’

We have to do our best to get out there and talk to people and actually set up projects where we are going to meet people where they are in their communities with community health workers, with people they know and trust to get the vaccine. It’s not a matter of doing business the way we always knew how; we have to change to meet them where they are, and acknowledge that this mistrust runs deeper than just the right now. That is the important part.

The way to vaccinate people is not a one size fits all approach, and that is where we can leverage our program’s experience to help reach people and help close that gap a little bit more.”

 

DJ: How do you think policy can reflect some of the lessons from what we’ve learned in the pandemic? How can health policy better support the needs of the Medicaid system you run?

KK: “Actually, one of the biggest needs that we saw was to open up the program to telehealth.  Even though there were some initial concerns about how we were going to leverage telehealth through the pandemic, we knew we just had to open it up.

The reality was that we had a struggle to ensure this would work for folks — not everybody can afford a smart phone, right? We partnered with our managed care plans to make sure our members had cellphones. Then, also, not only had cellphones, but had enough minutes and data usage to be able to take advantage of that benefit.  This enabled people to gain access to their doctors and mental health practitioners during the pandemic in the safety of their homes.

There is state-level legislation moving through right now that would make telehealth a permanent priority, not just a temporary approach that helps us through public health emergency. We are very pleased to be working on that, and that also helps close the gap as well for individuals who might not be able to safely get to a practitioner’s office. If sometimes all you can do is pick up a phone, then that is going to be available to you.”