Patti Killingsworth is an Assistant Commissioner for the Bureau of TennCare, and the Chief of Long Term Services & Supports. She has worked in Medicaid programs for two decades, leading system redesign initiatives, including in Tennessee, a Managed Long-Term Services and Supports program in 2010 that has significantly expanded access to home and community based services, rapidly moving toward a rebalanced system; and in 2016, a new MLTSS model program for individuals with intellectual and developmental disabilities, aligning incentives to help individuals achieve employment and integrated community living.