Introduction:
Peer support services have emerged as a vital component in both mental health (MH) and substance use disorder (SUD) treatment, providing individuals with lived experiences the opportunity to support others in their recovery journeys. However, despite their effectiveness, peer support certification and Medicaid reimbursement for these services vary widely across states, leading to significant gaps in access and coverage. This report outlines a recent initiative to identify and address these gaps, highlighting a multi-step approach that involved analyzing existing state policies, contacting state representatives, and following up on the next steps for integrating peer support services more comprehensively.
Process
As part of an initiative to address gaps in certification and Medicaid reimbursement for mental health (MH) and substance use disorder (SUD) peer support services, outreach was conducted to 12 states. These efforts began with an analysis of state policies to identify where gaps existed, followed by direct contact with state representatives via email on September 24, 2024. The outreach aimed to raise awareness of these gaps and request information on potential efforts to close them.
Step 1: The Policy Center compiled a list of states and conducted an analysis to determine where gaps for certification and reimbursement existed in each state. We published a report in July 2024 outlining these gaps. Gaps in Peer Support Reimbursement and Certification in the United States.
| State | MH Certification | SUD Certification |
|---|---|---|
| Hawaii | Yes | No |
| New Hampshire | Yes | Yes |
| South Dakota | No | No |
| State | MH Medicaid Reimbursement | SUD Medicaid Reimbursement |
|---|---|---|
| Connecticut | Yes | No |
| District of Columbia | Yes | No |
| Hawaii | Yes | No |
| Maine | Yes | No |
| Maryland | No | Yes |
| Massachusetts | Yes | Yes |
| New Hampshire | No | Yes |
| New Jersey | No | Yes |
| Ohio | No | Yes |
| Pennsylvania | Yes | No |
| South Dakota | No | No |
| Vermont | No | No |
Step 2: In September, 2024 we contacted the Medicaid State Directors of each state through email with a letter requesting insight and updates about whether/how the state may be addressing the specific gap(s) in the state. We requested a deadline for reply by October 4th, 2024. Responses were received from six states: Connecticut, Hawaii, Massachusetts, New Hampshire, Maryland, and Vermont.
The responses varied in detail:
| State | Contact |
|---|---|
| Connecticut | “We do not have peer or Community Health Worker reimbursement as a separate and distinct reimbursement service at this time. That being said, within our substance use disorder residential treatment per diem reimbursement model, we considered peer based services and staff and providers can certainly hire peer staff within that reimbursement model. Additionally, within our maternity bundle rate, we considered the cost of Community Health Workers as part of the reimbursement model/bundle.” |
| Hawaii | “The peer support specialist certification program is with the Department of Health, unrelated to Medicaid. Finally, currently there is a Peer Support Specialist workgroup, and any such issues will be discussed there, and not back to your organization directly.” *Policy Center Note: SB 3094 establishes a temporary peer support specialist working group within the Office of Wellness and Resilience (OWR) to enhance the role and effectiveness of peer support specialists in Hawaii. This passed in 2024 and we anticipate tracking the staffing and progress of this taskforce. |
| Massachusetts | “Thank you for your outreach and the opportunity to respond to the important matter of peer support for mental health and substance use disorder treatment. We would like to correct your assessment of Massachusetts reimbursement for peer support specialists for substance use treatment. Massachusetts Medicaid (MassHealth) began paying for “Peer Recovery Coaches” in July 1, 2018. A Peer Recovery Coach is “an individual currently in recovery who has lived experience with substance use or other addictive disorders and/or co-occurring mental health disorders and has been trained to help their peers with a similar experience to gain hope, explore recovery, and achieve life goals (division of medical assistance 130 cmr 418.000: substance use disorder treatment services). All Peer Recovery Coaches must be credentialed as a Certified Addiction Recovery Coach (CARC) through 1) The Massachusetts Board of Substance Abuse Counselor Certification; or 2) another licensure or certification process as determined by the Executive Office of Health and Human Services. Peer Recovery Coach services are billable using code H2016 HM- Comprehensive community support program, per diem (Enrolled Client Day). Thank you for your attention to this important topic, and please do not hesitate to reach out with any questions.” |
| New Hampshire | “There is a MH peer certification process in NH (not through the NH licensing board but through DHHS) and we are working to establish peer-specific Medicaid rates through our efforts under 1115. Today, certified MH peers are able to bill Medicaid FSS when employed by a CMHC.)” |
| Maryland | Peer Reimbursement Coverage Response Letter – Policy Center for Maternal Mental Health.docx (4).pdf |
| Vermont | “This work is in process. We have a planned launch of 7/1/25.” |
Step 3: After receiving no response from the following states, we sent a follow-up email request for information on October 8th, 2024. We received responses from both Pennsylvania and South Dakota.
- South Dakota
- District of Columbia
- Maine
- New Jersey
- Ohio
- Pennsylvania
| State | Response |
|---|---|
| Pennsylvania | “I’ve copied Kendra Snuffer, Chief of Staff for the Office of Mental Health and Substance Abuse Services to address your questions.” *Policy Center Note: Follow-up with Kendra Snuffler has been conducted, and we await additional feedback. |
| South Dakota | “South Dakota Medicaid is currently exploring state plan coverage for peer support services in conjunction with the Division of Behavioral Health.” |
Summary of Findings on Peer Support Certification and Medicaid Reimbursement Efforts
Our report, Gaps in Peer Support Reimbursement and Certification in the United States – Policy Center for Maternal Mental Health has been updated to reflect important developments regarding peer support certification and Medicaid reimbursement for mental health (MH) and substance use disorder (SUD) services. The following is a comprehensive summary of the progress made across states and the ongoing need for advocacy and inquiry:
States with Corrected Assessments
One state has provided corrected assessments, confirming that gaps in peer support certification and Medicaid reimbursement have already been addressed:
- Massachusetts: Peer certification and Medicaid reimbursement processes are in place for both MH and SUD services.
- New Hampshire: There is a certification process in place through the Dept of Health and Human Services. The Medicaid agency is working to establish peer-specific Medicaid rates through our efforts under the 1115 waiver. Today, certified MH peers are able to bill Medicaid FSS when employed by a CMHC community mental health center.
States with Plans to Address Gaps
Three states have acknowledged the existing gaps and are working to address them. We will continue to monitor these developments and report on progress:
- Vermont: The state plans to fully address gaps in peer support certification and Medicaid reimbursement by July 1, 2025.
- Hawaii: A peer support specialist working group has been established under legislative guidance to address these gaps.
- South Dakota: Medicaid is exploring the possibility of adding peer support services to its state plan in collaboration with the Division of Behavioral Health.
States Requiring Further Advocacy and Inquiry
Seven states still require additional inquiry and advocacy efforts:
- Connecticut: The state certifies mental health peers through a third-party entity (Advocacy Unlimited) but has stated there is no peer or Community Health Worker reimbursement. Though the state does consider the cost of Community Health Workers as part of the maternity model/bundle, more discussions are needed to work on enhancing the reimbursement structures in place.
- Maryland: The state allocated $21 million for Fiscal Year 2025 and is leveraging additional funds through the American Rescue Plan Act. However, further discussion is needed to explore direct reimbursement of peers for mental health services.
- Pennsylvania: We have been redirected to new leadership and are continuing to address our inquiries. We plan to offer support and serve as a resource as they navigate these issues.
- District of Columbia, Maine, New Jersey, and Ohio: We are still awaiting responses from these states. To ensure progress, we will identify new contacts within these states’ respective departments and continue making additional inquiries.
In closing, this status report outlines the progress made in several states and highlights the need for sustained advocacy, particularly in states where gaps in mental health certification persist, to ensure that access to certified peer support for maternal mental health is available and reimbursable in all states.
The Policy Center will continue to track these developments and engage with states to support timely access to certified peer support services.
This report was updated on October 31, 2024 to include a new chart of current peer gaps and categorize New Hampshire’s certification status*
*To note, New Hampshire does have certification for both mental health and substance use disorder, and has been categorized as a state providing a corrected assessment. This was not noted in the original report release.
