In 2014, the Indian state revised a key program providing aids and appliances to disabled people to also include cochlear implants for children living below the poverty line. The program is remarkable in its targeting of the poorest of the poor to provide them with expensive technology made by multinational corporations and its development of new surgery and rehabilitation infrastructures throughout India. Based on interviews and participant observation with key stakeholders, this paper argues that in focusing only on “a right to hearing” and on cochlear implants as a solution for deafness, health care practitioners ignore the complex work required to maintain cochlear implant infrastructures, as well as the advocacy work done by disability activists in India and internationally to transform existing political, economic, educational, and social structures. Since cochlear implants are the “gold standard” in intervening on hearing loss and increasing numbers of countries in the Global South have started state-funded cochlear implant programs, an exploration of India’s program provides an opportunity to analyze both the importance of infrastructure and the need to combat ableism within structural competency frameworks. Disability justice is part of structural competency. Ultimately what is at stake is expanding health practitioners’ ideas of what it means to maximize potential, particularly in the face of new technological interventions around disability.