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150 UNDERSTANDING MEDICAID HOME AND COMMUNITY SERVICES: A PRIMERMinnesota's Single Point of Entry SystemThe state of Minnesota provides several home and community benefits (e.g., personal assistance) that cutacross target population lines, along with specialized services keyed to the needs of particular target populations.In Minnesota, delivery of human services is organized around county human service agencies. Theseagencies are designated the single point of entry to all types of services—including public assistance, socialservices, health, and long-term services. Thus, anyone in Minnesota who needs publicly funded services cangain access to them through the county human service agency. This structure enables the individual (or family)to access the full range of services and supports Minnesota makes available, including home and communityservices. With respect to long-term services, counties manage intake, assessment, preadmission screening, andservice authorization.Minnesota's system is especially well positioned to tie together state and local programs. In its larger counties,specialty branches are also commonly found within the human services agency to meet the needs of specifictarget populations (e.g., people with developmental disabilities). One reason why Minnesota is organized in thisfashion is that counties themselves are required to provide a portion of the funding for various services. In addition,many Minnesota counties provide a significant amount of local tax dollars, over and above required statematching requirements, to underwrite human services.service systems along target population linesinclude: (a) it ensures that the specific needs ofeach target group are addressed in an expert,focused, and unified fashion; (b) it provides forthe coordination of multiple Federal, state, local,private, and third-party funding streams that areespecially relevant to meeting the needs of the targetpopulation; (c) it facilitates optimal use of theservice delivery systems associated with differenttarget populations, some of which are very largeand complex in their own right and, thus, requirededicated management and oversight; and (d) itfits well with long-standing service systems.Disadvantages often cited with respect to organizingsystems along target population lines include:(a) duplication of administrative structures; (b)overspecialization of services; (c) difficulties incoordinating the delivery of specialized serviceswith services and benefits applicable to a widerange of target populations; and (d) difficulties inhaving their specific needs met for populationsthat do not have a designated service deliveryagency in their state.Advantages cited in support of the single structuremodel include: (a) it avoids individuals andfamilies having to figure out which of many systemsmight best meet their needs; (b) individualswith disabilities have many needs that cross disabilitycategory lines and can be best addressedthrough a unified service system; (c) individualsand families can be afforded better access to awider range of services than are available withinmore narrowly defined specialized systemsorganized around particular target populations;and (d) integrated systems are more economical tooperate from an administrative cost standpoint,because they avoid duplicative organizationalstructures. Frequently cited disadvantages of suchsystems include: (a) they can be especially complexto administer; and (b) the specialized needsof specific target populations may be neglected.Federal policy leaves it to each state to determinehow best to organize its home and communityservice delivery system(s), as evidenced by thedisparate organizational structures presently inplace. The main Federal policy requirements inthis arena are two: a state must administer its programuniformly across the state (unless a waiverof statewideness has been approved); and Medicaidservices must fall under the authority of asingle state agency that is responsible for ensuringthe Medicaid state plan is being followed.Federal policy does dictate that HCBS waiver programsbe structured along target population lines.However, this policy does not dictate that a stateestablish a distinct, separate point of entry servicedelivery system for each HCBS waiver program.Nor does it prevent a state from designing HCBSwaiver programs that define and offer benefits