This report details and analyzes the initiatives undertaken by five states (California, Maryland, Nebraska, New Jersey, and Utah) to extend the availability of personal assistance services (PAS) to people with disabilities through existing Medicaid State Plan Options (SPO). It also discusses Iowa's extensive study of whether to add a Personal Care SPO, including specific service recommendations; Iowa ultimately decided that the cost was too high to offer the service. Background information is provided on the Ticket to Work and Work Incentives Improvement Act of 1999 (TWWIIA) and the Medicaid Infrastructure Grants (MIG), which have enabled some states to expand their coverage of PAS, including workplace PAS. In particular, the report describes the mechanism of Medicaid Personal Care SPOs and presents figures on costs and rate of participation in Personal Care SPOs nationwide and for specific states, including Alaska, Arkansas, California, Massachusetts, Michigan, Missouri, New Mexico, and New York. In addition, the report describes states' attempts to control the cost of Personal Care SPOs, with examples from the following states: Alaska, Arkansas, California, District of Columbia, Idaho, Kansas, Maine, Missouri, Nebraska, New Hampshire, North Carolina, Rhode Island, South Dakota, and West Virginia. The report recommends future research on utilization of Personal Care SPOs by Medicaid Buy-In participants, including costs and specific services utilized and needed for work as well as at home.