Minnesota, like other states, faces challenges in overseeing the delivery and quality of home-based services. With that in mind, we focused our evaluation on the "integrity" of personal care services by addressing the following questions:

• Who uses PCA, and how does its use vary around the state? Have sufficient steps been taken to ensure a consistent, sound process for assessing potential service recipients?
• Has the state taken sufficient steps to prevent fraud, abuse, and other types of improper payments for PCA services?
• Does the state have effective ways of ensuring the quality of PCA services and protecting recipients from harm?

We examined personal care services paid for by publicly funded health care programs, primarily Medical Assistance. These included services the state paid for on a "fee-for-service" basis, as well as those paid for through the state's payments to managed care organizations. We devoted more of our analysis to fee-for-service care because (1) it accounts for a significant majority of the state's PCA expenditures and (2) the state collects more data on services fund through fee-for-service than services funded through managed care (abstract from: p. 1 of report).