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“I’ve pretty much been a caregiver my whole life,” says Misty Jenkins, Long Term Services and Supports (LTSS) Solutions Manager in the Mississippi Division of Medicaid. When she was young, she lived with her mom at her grandparents’ house in central Mississippi. “As the oldest daughter and granddaughter, I’ve basically been the lead helper since birth,” Jenkins says.
While Jenkins’ experience providing direct support for her cousins and great grandparents, and later her mother and grandmother, prepared her to better understand the importance of long-term services and supports, her route to leadership of Mississippi’s LTSS programs was not direct.
Jenkins, 40, attended the University of Mississippi and earned a bachelor’s degree in political science with a minor in history. “At that point, I thought I wanted to be a lawyer,” Jenkins says. She was working as a legal assistant at a law firm in Oxford, Mississippi and started to question whether law school was the right choice. She decided to continue her education at Texas Women’s University for graduate school while she considered her career path. After completing one year of coursework towards a master’s degree in government, she returned to her hometown of Madison, Mississippi to assist her mother and grandmother who were each diagnosed with several health conditions.
While caring for her grandmother and mother, Jenkins took a job with the Mississippi Department of Rehabilitation Services working in their Office of Special Disability Programs which acts as the operating agency for two of the state’s 1915(c) Medicaid home and community-based services (HCBS) waivers in addition to administering three other state and federally funded LTSS programs. Medicaid’s 1915(c) waivers allow people to receive services and supports so that they can stay in their homes instead of in institutional settings.
While Jenkins didn’t know too much about HCBS or waivers, she was exceptionally organized, a self-starter, and eager to learn on the job. She was hired as the referral case manager and was tasked with managing the statewide waiting lists for each of the agency’s five programs.
Jenkins got to work calling people to see if they still needed services, and if so, what their specific needs entailed. “It was a lot of just asking people a set of questions, hearing their stories, and figuring out what services they might benefit from to remain as independent as possible,” Jenkins explains. As she made her calls, if she got a question she couldn’t answer, she’d write it down and then go over her list with her supervisor at the end of the day. “That's really how I learned everything that I know,” she says. The experience was invaluable. “It gave me an opportunity to hear a lot of very tough stories about family caregivers and the obstacles faced by individuals who were trying to stay in their homes in the community instead of going into nursing facilities. Based on my own experience helping take care of sick or elderly loved ones, I immediately formed a kind of bond with the people we were serving,” Jenkins says.
Six years later, Jenkins was promoted to the Field Services Coordinator position where she was able to begin developing policy, training case management staff and assisting with writing the 1915(c) applications that go to the Centers for Medicare and Medicaid Services (CMS) to renew the waivers every five years.
Jenkins also had a unique opportunity to leverage what she calls her ‘Millennial tech skills’ when, in 2012, Mississippi received a grant to improve programs and shift resources from institutional care to more community-based services. As part of that effort, Mississippi chose to implement a single “no wrong-door” case management system that every agency in the state would use for case management on their 1915(c) waiver programs in order to streamline HCBS enrollment processes. Jenkins’ manager needed someone to attend the meetings with the vendor in charge of developing the system. “The Department of Rehabilitation Services wanted someone to represent the operating agency at the meetings with the Medicaid agency and the system vendor to learn about features/changes that might affect program operations and to provide input. So, I became a liaison for that project,” Jenkins says.
In 2017, the Mississippi Division of Medicaid (DOM) was looking for someone to fill a bureau director role in the Office of Long-Term Care. Jenkins was hired to oversee waiver provider enrollment and education, facilitate LTSS systems implementation and integration and support the operational aspects of waiver administration.
In 2020, Jenkins moved into a new role at DOM as the Long-Term Services and Supports Solutions Manager. One of her duties in that role includes managing the contract for the eLTSS case management system – the same system she provided feedback on while she was working at the Mississippi Department of Rehabilitation Services. “I'm one of the few people who participated in the original design meetings back in 2013 who is still involved with the project,” she says.
“I think I have a really good multidimensional perspective of the LTSS landscape in Mississippi,” Jenkins says. “I started in a very boots-on-the-ground position which offered insight into the member’s experience and the barriers they face. Then as field service coordinator, I helped case managers work through the kinds of day-to-day care coordination issues that come with supporting members who may be experiencing a decline or need assistance with triaging a critical incident. And since I've been able to experience the system from a more regulatory role where I have written policy, developed provider onboarding and educational content and evaluated budgetary impacts of programmatic changes. My goal is to use all of that experience on the system side ensuring our software is able to better support the people who are providing the care so that downstream our members have better outcomes.”
However, it’s her personal experience as a caregiver that Jenkins credits with her being able to connect with the people her office serves and the motivation to continue pursuing the agency’s mission. “I know what it feels like to struggle with being a caregiver and a full-time worker,” Jenkins says. “And that gives me a really unique perspective towards advancing LTSS in ways that will support our members and their families.”
Jenkins serves on the Center for Rehabilitation Outcomes 嫩B研究院 (CROR) Rehabilitation 嫩B研究院 Training Center (RRTC) on Home and Community-Based Services Advisory Council where she provides input and feedback about measures under development to evaluate person-centered HCBS.
“Misty’s past experience with direct service in HCBS, along with her administrative experience at the state and Medicaid level make her extremely valuable for our team,” says Bridgette Schram, PhD, project manager for the RRTC on Home and Community Based Services at CROR. “She helps ensure we are thinking about how we can fully support the needs of the individuals in a way that is also feasible for the state agency and helps inform future policies or initiatives. That balance is essential for the success of our work.”
“It's so important to give feedback when you're given an opportunity, especially for projects like this where that research may end up at the Administration for Community Living (ACL) or at CMS to inform future regulations,” says Jenkins.