Driven to make health care more accessible for all, Sarah Kuh has led Vineyard Health Care Access Program to be the program it is today, helping between 2,500 and 3,000 Islanders annually to get health care coverage. After starting her public health career in Boston and working for many years in California, Sarah moved to the Vineyard 26 years ago, answering the call of family ties and memories of Island summers.

Name: Sarah Kuh, MPH

Profession: Director, Vineyard Health Care Access Program, Vineyard Smiles, Dukes County Social Services

Route to MV: Concord, Mass., to Boston, Mass., to Sonoma, Calif., to Martha's Vineyard.

Washed Ashore: 26 years ago

Favorite Island Spot: Menemsha

Favorite Island Tradition: 
Sunsets in Aquinnah at Gay Head Light

Languages Spoken: English, 
Spanish, Portuguese

Q. Were you always in public health, even before moving here?

A. Yes! I started in college at BU [Boston University], working at community health centers in the Boston area. I was an interpreter – in Portuguese and Spanish – with public health nurses, visiting patients in their homes for pre-and peri-natal care. Then I went to California, lived in Sonoma, and got a master's degree in public health. I stayed there and worked in community health programs for about 20 years.

Q. How did you come to speak Portuguese and Spanish?

A. I studied and learned Spanish in Mexico after high school; having that foundation, I then studied Portuguese in college and traveled in Brazil after college.

Q. What made you decide to make the Vineyard your home?

A. Well, I have family roots here, so I came to be with family. I grew up in Concord, Mass., but I was a summer kid here. My parents weren’t born here but they met here in the ’30s.

Q. So help us understand the Vineyard Health Care Access Program.

A. It was created in 1999 by the Dukes County Health Council to address what they had identified as a high rate of non–insurance for Island residents. They realized that people who needed insurance didn’t know how to go about getting it. They applied for pilot funding to set up a program to work with uninsured adults and families on the Vineyard. After that year we became the Vineyard Health Care Access Program.

Q. How did the work begin?

A. Initially, we were increasing access to MassHealth [Massachusetts health care for low-income individuals and families] through outreach and education. We also developed a reduced-fee plan, which was discounted primary care before there was health care reform in Massachusetts! It was a way to get lower income folks access to care.

Q. So what are some of the most pressing issues you handle?

A. If somebody is healthy and uninsured, it’s a completely different thing versus an individual who is uninsured and finds himself on a helicopter traveling up to Mass General with acute illness or acute symptoms. Those are the most pressing cases.

Q. How do the various issues resolve?

A. That is what our office does. Our whole focus is on enrolling people into Massachusetts insurance plans and so we’re certified to work with the Massachusetts insurance system. Five of us are navigators trained specifically to work with that system.

It’s not 100 percent of the time that we’re able to get people on insurance if they need it; but if they’re eligible, we will certainly get it done. We’re also involved in dental access programs [Vineyard Smiles] and prescription access programs.

Q. Do you deal with a lot of young people just coming off their parents’ health insurance?

A. Sure! Some young people are on their parents’ insurance until they turn 26. And then we help them figure out what kind of plan they can get on their own. And sometimes they come in when they’re younger than 26, because their parents don’t necessarily have a plan that covers children or that keeps them on until 26. So yes, we help all ages.

Q. Do you actually get a lot of young people? We often hear that they feel invincible.

A. Yes, we do. I think Covid is a game changer in that even young people know they may be vulnerable and need health care. So we have a good number of young people we are helping at any point in time.

Q. How else has Covid impacted your work?

A. When it first hit, like everybody else we had to close our offices and go remote. It was a bit of a learning curve. However, after we set up our remote systems, we actually were able to do everything we used to do and perhaps even do it more efficiently. We’re doing everything by phone and video conference.

Q. How would you describe your success rate?

A. We get insurance coverage for 2,500 to 3,000 people a year. There are circumstances which are really unfortunate, where people just can’t afford insurance. Some people who have higher incomes and don’t qualify for subsidies from MassHealth are in a real bind because we have a very high cost of living here. When you tell these people that their insurance is going to cost $800 or $1,000 a month, that’s impossible for them! It’s a very sad situation. We could use universal health insurance but that is not what we have.

Q. Yet you say, we are lucky to have your program. Why?

A. This type of program – where you have people dedicated to helping others apply for insurance and most importantly, to maintain that insurance – is not common. Government systems can be difficult to navigate. They’re bureaucratic, people don’t understand them and the whole process can be confusing. So the Vineyard is fortunate to have a dedicated program to walk people through all these different activities. On the mainland, these type of services are primarily provided through hospitals and community health centers. There are just a handful of community-based programs. The Island is indeed fortunate!

Q. You work hard. What do you do for fun?

A. I have a super fun little dog and we go out for walks all the time. Walking and exploring the trails on the Island is a joy. And of course I spend a lot of time with my family – my son and my husband and my 95-year-old mother, my brother and lots of cousins. We spend quite a bit of time with our extended family and that’s really nice.

Q. You’re happy you returned to Massachusetts and the Island?

A. Yes! This is an amazing place for doing this kind of work. Massachusetts is a very progressive state. We have shown often that we are ahead of the curve on access to healthcare.

Paula Lyons is a former television consumer journalist living in Vineyard Haven.

Learn more about Vineyard Health Care Access Program.