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Technology First Yet to Impact HCBS Allocation

By Carli Friedman, CQL Director of Research

In recognition of the important role technology plays in people’s health and quality of life, as well as the barriers people with intellectual and developmental disabilities (IDD) face accessing technology, there is a growing movement in the United States for states to become Technology First. Technology First states are those that commit to removing barriers and maximizing people with IDD’s access to technology. While how states implement Technology First differs by state, it represent a commitment to systems change in order to expand people with IDD’s access to technology.

The aim of this study was to examine if, and, how, Technology First initiatives impacted the allocation of technology in Home- and Community-Based Services (HCBS), as they are the primary funding source for technology for people with IDD. To do so, I analyzed data about Medicaid HCBS waivers for people with IDD from fiscal year (FY) 2021 to examine how states allocated assistive technology, environmental modifications, personal emergency response systems (PERS), remote monitoring, specialized medical equipment, and telehealth service delivery.

I found Technology First states were significantly more likely to allow telehealth service delivery in their HCBS waivers for people with IDD (see figure). However, I found no other differences for Technology First states – these states were not more likely to offer any of the technologies (i.e., assistive technology, environmental modifications, PERS, remote monitoring, specialized medical equipment, and telehealth service delivery), project providing them to more people, or project spending more money on these services, even when factors such as waiver size and total spending were controlled.

Technology First and HCBS Telehealth

% of states offering telehealth service delivery in HCBS: NOT technology first state 27.59%, YES technology first state 68.75%

“Technology First initiatives are aimed at creating systemic infrastructure changes to promote people with IDD’s access to technology, including through resource allocation. Yet… we found only a few differences in allocation of technology between states that have committed to Technology First and those that have yet to do so. While this does not mean that there is no value in Technology First initiatives – certainly anything that expands people with IDD’s access to technology is beneficial and will likely improve the quality of life of people with IDD – it appears these initiatives have yet to truly impact resource allocation when it comes to HCBS… we hope that states and advocates can utilize the information from this study to improve their resource allocation and HCBS programs, including when it comes to technology. After all, technology is a social determinant of health, improving people with IDD’s health, community integration, and quality of life” (Friedman, 2023, pp. 9-13).

This article is a summary of the following journal manuscript: Friedman, C. (2023). Technology first: The impact on technology availability for people with intellectual and developmental disabilities. Journal of Applied Research in Intellectual Disabilities, 36(6), 1251-1263.