The Hidden Gem on Enabling Technology in HCBS

By the time the final day of the ADvancing States HCBS Conference in Baltimore (August 2025) arrived, the energy was noticeably different. Attendees were wrapping up, flights were calling, and yet one of the most thought-provoking discussions of the week was just about to begin. Buried at the end of the agenda, the Enabling Technology Engagement Network (ETEN) Advisory Group Panel brought together state leaders who are actively shaping what a “tech-first” future could look like for home and community-based services (HCBS).

Moderated by Courtney Priebe of ADvancing States, the conversation was candid, dynamic, and deeply relevant to the policy-to-practice pipeline. Panelists included:

• Donald Clark (DC) – Program Development Specialist, DC Dept. of Disability Services

• Wanda Crocker (MO) – Assistant Deputy Director of Operational Compliance, MO Dept. of Mental Health

• David Ward (OK) – Senior Director of LTSS, OK Healthcare Authority

Together, they explored not just what enabling technology can do, but how states can overcome cultural, policy, and workforce barriers to make sure it delivers on its promise.

Key Themes from the Panel

1. From Reactive to Predictive

• Clark described the shift from reactive service models to predictive, tech-enabled supports — an approach that benefits individuals and reduces system costs. Building digital literacy for consumers, providers, and direct support professionals (DSPs) was highlighted as essential.

Why it matters: The potential here isn’t futuristic — sensors, wearables, and supportive technologies already exist. The challenge is embedding them into workflows and empowering staff to use them as advocates, not gatekeepers.

2. Building Momentum Through State Collaboration

• Crocker reminded us that Missouri was early in defining remote services back in 2012 and has worked with like-minded states ever since. Collaboration across agencies — and even across state lines — has proven vital for keeping momentum and establishing trust in communities.

Why it matters: No state can move this work forward alone. Policy alignment, Medicaid buy-in, and cross-department collaboration are the cornerstones of scaling tech-first initiatives.

3. Smart Homes, Wearables, and Rural Gaps

• Ward showcased how their smart home demonstration projects and partnerships with hospitals and vendors are enabling people with ID/DD to live independently. The state is also tackling rural broadband gaps, deploying fiber to tens of thousands of homes.

Why it matters: Closing rural access gaps is not just about equity — it’s a prerequisite for making enabling technology viable. Without broadband, there is no telehealth, remote monitoring, or smart home functionality.

4. Overcoming the “What Ifs”

Across states, panelists shared how fear and cultural hesitation often block adoption:

• Families worry about safety (“What if something goes wrong?”).

• Administrators and providers hesitate (“What if it fails under our watch?”).

• Even when individuals themselves are willing, stakeholder fear can stall progress.

Takeaway: The antidote is small pilots, visible success stories, and strong leadership that frames technology as empowering, not replacing.

5. Tech-First, Not Tech-Only

Both Crocker and Ward emphasized that enabling technology must enhance, not erase, the human touch. Think of it like medicine: the right tool, in the right dose, at the right time. Younger DSPs — often more tech-savvy — can be key allies in building this balance and even develop new career paths as tech support trainers or “tech champions.”

Takeaway: Tech-first is about prioritizing independence, dignity, and choice, not chasing the latest gadget. It reframes DSP roles as higher-value supports while alleviating workforce strain.

6. Breaking Down Silos

• Crocker called for unifying departmental voices and collaborating with media to reshape public narratives (moving away from the “iRobot” fears as Ward put it).

• Clark pushed for intermediaries who can bridge public and private sectors to pilot technology safely.

• Ward urged partnerships beyond state boundaries to “think big, pilot, and adapt.”

Takeaway: Cross-sector collaboration is not optional. The policy lag behind technology means states, providers, and vendors need to be in the same room — and on the same page — well before CMS rules catch up.

7. Tennessee’s SHIFT Accreditation

Although not on the panel, Tennessee’s Tech First SHIFT model was lifted up as an emerging framework:

• Tech is considered first, not last in service planning.

• Supports are person-centered, not gadget-centered.

• Training, education, and culture shifts help providers and DSPs build capacity and confidence.

Why it matters: With workforce shortages and budget pressures mounting, traditional staffing models are unsustainable. Tech-first strategies expand capacity, foster independence, and reallocate staff to tasks only humans can do.

Why This Session Stood Out

This panel crystallized a truth that ran underneath the entire conference: technology and policy cannot be separated from workforce realities.

• Tech without digital literacy won’t scale.

• Policy without collaboration stalls in silos.

• Workforce without empowerment will burn out.

By anchoring in the “tech-first, not tech-only” ethos, the panel showed that enabling technology is less about devices and more about changing culture, funding priorities, and leadership mindset.

My Reflection

What struck me most was how this session challenged the binary of “past accomplishments” and “future aspirations” that dominated so much of the conference. Instead, the ETEN panel lived in the present tense: What can we do now to prepare for the policies and realities of tomorrow?

The OBBB Act and other federal shifts are coming. The states that embrace enabling technology today — through pilots, partnerships, and culture change — won’t be scrambling later. They’ll be leading.

Further Reading

Learn more about ADvancing States’ Enabling Technology Engagement Network (ETEN).