The Enabling Technology Intensive — Bridging Beliefs, Markets, and Medicaid

While the ETEN Advisory Panel on the last day of the ADvancing States HCBS Conference (next in this series coming out on September 26) was brimming with stories from the field, another session earlier in the day — the Enabling Technology Intensive — drilled down on the harder structural question: How do we actually integrate enabling technology into Medicaid and HCBS systems at scale?

Led by April Young (ADvancing States) and Jeanine Zalocki (NASDDDS), this session pulled back the curtain on the gulf between vendors, health plans, and states when it comes to technology’s future in HCBS.

The Perception Gap

A survey conducted two years ago revealed a striking divergence in expectations:

• Vendors: Technology was going somewhere — toward opportunity and growth.

• Health Plans: Technology was going somewhere — toward value-based integration.

• States: Technology was going nowhere.

That pessimism from state leaders wasn’t surprising to those in the room. Medicaid agencies are notoriously cautious — bound by federal rules, state legislatures, and budgetary silos. But when compared to the optimism of vendors and health plans, the gap underscored a central challenge: beliefs about the role of technology directly shape investment, adoption, and policy momentum.

Why This Intensive Mattered

The session represented the first organized effort to bring these groups together in one conversation:

• State policymakers (DC, MD, TN, OK, OH, MA, MI)

• Health plans (Elevance, Molina, Centene)

• Vendors (SimplyHome, GroundGame Health, Letmedoit, Lumi Care, NOSS, SafeinHome, Uber Health, THS)

• Associations and national groups

This wasn’t about one pilot project or one state initiative. It was about setting the stage for a national dialogue on outcomes, challenges, and — most critically — how to break into the Medicaid space in a way that lasts.

Core Themes and Challenges

1. Funding and Sustainability Go Hand-in-Hand

Panelists were blunt: you cannot talk about technology adoption without simultaneously addressing funding streams and sustainability. Grants and pilots are important, but they are not strategies. Without clear reimbursement pathways, even the most promising technologies stall after the pilot phase.

2. Partnerships with Federal Government

Another theme was the need to foster federal solutions. CMS policies set the tone for what states can and cannot do, yet the pace of federal approvals often lags behind innovation. Remote supports, telehealth, and enabling technologies all sit at the intersection of Medicaid rules, waiver authority, and state interpretation.

Implication: Without proactive federal-state-vendor collaboration, technology risks becoming a patchwork of isolated projects rather than a cohesive shift.

3. Education Across the Ecosystem

Education is needed at every level:

• State leaders must understand what technology can realistically deliver and how to fund it.

• Case managers and providers need training to be advocates, not gatekeepers.

• Consumers must be supported in understanding their options and risks.

• Vendors need guidance on how to navigate the complexity of Medicaid markets, which vary drastically by state and program.

4. The Medicaid Maze

One point that resonated throughout the room: every state operates differently. Rules, provider requirements, and federal interpretations vary, making it daunting for vendors and health plans to scale solutions across multiple states.

For Managed Care Organizations (MCOs), this patchwork means re-negotiating every time they cross state lines. For vendors, it means re-customizing products and business models endlessly.

Takeaway: Until there is more alignment — or at least clearer federal pathways — technology integration will remain fragmented.

Why This Matters for Providers and the Workforce

For providers and caregivers, these debates may feel abstract. But the implications are very real:

• Delayed adoption means caregivers continue to shoulder preventable burdens.

• Fragmentation across states makes it harder for multi-state providers to standardize training or workflows.

• Uncertain funding streams discourage investment in tools that could reduce burnout and expand independence for clients.

My Reflection

Where the ETEN Advisory Panel showcased lived examples of how technology is already enhancing independence, this intensive highlighted the structural friction points that slow progress. The truth is, states’ skepticism isn’t entirely unfounded — without sustainable funding models, technologies risk becoming shiny pilots that fade away.

At the same time, the gap between what vendors/health plans believe is possible and what states fear is feasible is exactly why sessions like this matter. Bringing all parties together, even in a room where tensions surface, is the only way to build the trust and alignment needed to move forward.

If OBBB Act provisions and future CMS guidance push states toward broader adoption, the groundwork laid by groups like ETEN — advisory bodies, affinity groups, and collaboratives — will be critical. States that start reconciling these differences now will be far better prepared when federal nudges become federal mandates.

Further Reading

Learn more about the Enabling Technology Engagement Network (ETEN), including its advisory group, affinity group, and collaborative model.