From Policy to Practice: Cross-Cutting Themes and Calls to Action from the 2025 HCBS Conference
When hundreds of state administrators, Medicaid directors, policy advocates, and technology innovators gathered in Baltimore for the 2025 ADvancing States HCBS Conference, the conversations reflected both the urgency of today’s challenges and the possibilities of tomorrow’s solutions. Over the course of the week, one message was clear: policy is not abstract. It shapes workplaces, workforces, and the care people receive every single day.
This post distills the cross-cutting themes that emerged across sessions and offers calls to action for states, providers, vendors, and advocates to move from compliance to proactive strategy.
Cross-Cutting Themes
1. Policy Shapes Workplaces and Workforces
Federal policy changes—whether the Medicaid Access Rule, the One Big Beautiful Bill Act (OBBB), or CMS guidance on case management—have immediate ripple effects. They determine staffing ratios, reimbursement models, and the sustainability of programs.
States that wait until final implementation often struggle to catch up.
Providers that anticipate change can smooth transitions and strengthen their workforce.
The takeaway: Implementation planning must start years before deadlines arrive.
2. Technology: Promise and Pressure
From enabling technology pilots to Direct Care Careers platforms, states are leaning on technology to expand reach, streamline operations, and modernize registries. Yet the refrain was consistent: technology is only useful if it enhances human connection.
AI tools may reduce paperwork but cannot replace trust between caregiver and client.
Job-matching platforms succeed when they balance design with accessibility (mobile-friendly, multilingual, easy to navigate).
Technology is an extender, not a substitute.
3. Elevating the Direct Care Workforce
The conference spotlighted a long-overdue shift: direct care workers are moving from invisible to indispensable in policy conversations.
Advisory groups in states like Maine, Kentucky, and Indiana are ensuring worker voices shape rate setting, training standards, and marketing campaigns.
Universal credentialing initiatives (Wisconsin’s CDCP, Michigan’s IMPART Alliance) are creating portable career pathways.
Worker recognition—from badges to conferences—signals professionalization and respect.
When workers are at the table, policies become smarter, outcomes improve, and recruitment and retention benefit.
4. Resilience and Reinvention in Aging Policy
Speakers framed aging as a national transformation, not a regional issue. By 2040, the U.S. will have more older adults than children. Without coordinated strategies, the risk is “crash and burn.”
Ohio, California, and Utah demonstrated what reinvention can look like:
Dashboards linking ROI to outcomes.
Campaigns that meet older adults and caregivers where they are.
Master plans for aging grounded in intergenerational collaboration.
The shared lesson: fragmented, additive approaches are no longer enough. States need a clear North Star for aging policy, supported by evidence-based interventions and quantified returns on investment.
Calls to Action: Moving from Compliance to Proactivity
For States
Start waiver design now. The OBBB Act’s new waiver option (effective 2028) requires years of preparation.
Pilot workforce solutions. Test credentialing systems, registries, and advisory groups before they become mandates.
Leverage federal dollars. Match ARPA, FMAP, and rural health transformation funds to state priorities.
For Providers
Engage workers directly. Establish advisory boards or feedback loops that inform rate-setting and workforce planning.
Invest in training. Portable credentials, specialty training, and peer mentoring boost retention and quality.
Plan for compliance shifts. Don’t wait for final rules—adapt recruitment, scheduling, and supervision structures early.
For Tech Vendors & Health Plans
Co-design with states and workers. Technology must reflect end-user realities like digital literacy and rural access.
Prioritize sustainability. Shared-cost models and federal matching ensure tools last beyond pilot funding.
Integrate with Medicaid. Vendors that can navigate regulatory complexity will find long-term traction.
For Advocates & Workers
Push for representation. Workers must be included in advisory groups, credentialing conversations, and legislative hearings.
Highlight workforce realities. Share stories of unsafe workplaces, unpredictable scheduling, and the toll of low wages.
Promote the profession. Frame caregiving not as “unskilled” labor but as a profession with competencies and career ladders.
Closing: The Moment of Urgency
The 2025 HCBS Conference highlighted resilience, creativity, and innovation—but also underscored the urgency of the moment. Policy windows are opening. States can either scramble to comply when federal rules arrive or act now to shape systems that work for caregivers, providers, and the people they serve.
The question is no longer whether change is coming. The question is: who will be proactive enough to lead it?
