Case management services in Missouri’s Division of Developmental Disabilities underwent a shift from a state structure to a regional structure. Within this structure, 12 regions each serve approximately 12–15 counties. Each region has a technical assistance (TA) position designed to support each of the designated priority work areas. These include self-determination, family supports, individual supports and services, Employment First, and accessible housing. When the change from a state to regional structure occurred, administrators had to look for staff who could support those priorities. In addition, they created a central technical assistance staff person to act as the state content expert in each priority area. This person provides technical assistance to the regional technical assistance providers. For example, the central Employment First TA staff person acts as an ongoing resource to all of the regional Employment First TA providers across the state.