Peer Support and Medicaid Reimbursement: A Guide

Peer support has emerged as a transformative force in recovery services, enabling individuals with lived experience of mental health or substance use challenges to guide others through their recovery journey. Across the United States, Medicaid has recognized the importance of these services by providing reimbursement, allowing certified peer support specialists to receive financial compensation. This comprehensive guide will explore how to become a certified peer support specialist, Medicaid reimbursement processes, and grant funding opportunities for expanding peer support services. Additionally, we’ll demonstrate how organizations and peer support specialists can utilize One Step to streamline their work and track client outcomes effectively.

1. What is Peer Support and What Does a Peer Support Specialist Do?

Peer support is a unique, strengths-based approach where individuals who have experienced similar struggles offer their support to others. This model emphasizes shared understanding, mutual respect, and empowerment. The role of a peer support specialist is to help individuals in recovery set goals, navigate challenges, and find the motivation and resilience to stay on their recovery path.

A peer support specialist’s duties can vary but typically include:

• One-on-One Support: Regular check-ins with clients to monitor their well-being, offer encouragement, and help them develop personalized recovery plans.
• Goal Setting: Assisting clients in setting realistic, achievable goals, such as securing housing, finding employment, or rebuilding relationships.
• Support Groups: Facilitating peer-led support groups where participants share experiences, offer advice, and provide emotional support.
• Crisis Intervention: In some cases, peer support specialists help clients de-escalate crises and connect them with appropriate clinical resources.

This form of support can significantly improve recovery outcomes, as clients often respond better to someone who understands their journey firsthand. The sense of trust and connection fosters a more open, collaborative relationship, which is crucial in long-term recovery efforts.

2. What Are the Requirements to Offer Peer Support?

Each state’s requirements for becoming a peer support specialist vary, but there are some common elements across the country. Generally, candidates must meet the following criteria:

• Lived Experience: Candidates must have personal experience in mental health or substance use recovery. This experience is central to the peer-to-peer model, as it allows the specialist to offer empathetic and authentic support.
  • Certified Recovery Peer Specialist (CRPS) for Florida
  • SAMHSA:  National Model Standards for Peer Support Certification, Pg. 6
• Sustained Recovery: Most states require candidates to be in sustained recovery for a specific period, typically one to two years. This ensures that the specialist has a stable foundation from which to help others.
  • National Certified Peer Recovery Support Specialist (NCPRSS)
• Training and Certification: Candidates must complete state-approved training programs, which often range from 40 to 80 hours. These programs cover topics such as ethics, boundaries, effective communication, and crisis management.
  • SAMHSA Training Requirements
• Code of Conduct and Ethics: Peer support specialists must adhere to a professional code of ethics, which outlines appropriate boundaries and confidentiality standards. This ensures that the peer relationship remains respectful, supportive, and non-judgmental.
  • NAADAC: NCPRSS Code of Ethics
  • N.A.P.S: National Practice Guidelines
  • CFPS Code of Ethics

Each state has its own certification process, so it’s essential to check with your state’s governing body to understand the specific criteria and requirements. For example, Georgia and New York have rigorous certification processes that include exams, supervised hours, and continuing education.

Many states also require background checks, which is important to consider when preparing to apply for certification. Those who have been through the criminal justice system should look into their state’s regulations, as some states provide pathways for individuals with criminal records to become certified. 

3. How Can You Get Credentialed as a Peer Support Specialist?

The path to becoming credentialed as a peer support specialist generally involves the following steps:

1. Complete a State-Approved Training Program: Start by enrolling in a training program approved by your state’s Medicaid agency. These programs typically range from 40 to 80 hours and cover key topics like the recovery process, peer support values, and professional ethics. Some training may be offered online, while others require in-person participation.
   Example: In California, peer support specialists must complete 80 hours of training through an approved provider such as the California Association of Peer Support Specialists (CAPSS). The curriculum includes modules on trauma-informed care, motivational interviewing, and cultural competency.
2. Pass the Certification Exam: After completing training, you will need to pass a certification exam. This exam tests your knowledge of core competencies, such as active listening, boundary-setting, crisis intervention, and ethical decision-making.
3. Apply for State Certification: Submit your exam results, proof of completed training, and any other required documentation (e.g., proof of recovery status) to your state’s certification board. In some cases, you may also need to provide references or a letter from a clinical supervisor.
4. Meet Continuing Education Requirements: Once certified, peer support specialists must fulfill continuing education requirements to maintain their credentials. This ensures that specialists stay updated on best practices, emerging trends, and new approaches to supporting clients.

For a detailed breakdown of each state’s requirements, visit Peer Recovery Now’s Certification Database.

4. How Do You Get Reimbursement from Medicaid?

Navigating Medicaid reimbursement can seem complex, but understanding the key steps will help ensure you receive compensation for your services. Peer support specialists must typically:

1. Ensure Peer Support Services are Covered by Medicaid: Verify that your state includes peer support services in its Medicaid plan by checking SAMHSA’s Medicaid Behavioral Health Services page or visit Peer Recovery Now – State Requirements
2. Work for a Medicaid-Enrolled Organization: After certification, find employment with an organization that is Medicaid enrolled to bill for services. The National Association of State Mental Health Program Directors (NASMHPD) provides resources to locate these organizations.
3. Document All Services Provided in Each Session: Keep accurate records of each session, including dates, duration, and activities for reimbursement purposes. Refer to the SAMHSA Guidelines for Peer Support Documentation for best practices.
4. Research Billing Codes: Familiarize yourself with billing codes like CPT and HCPCS, which vary by state. Typically you’ll be using codes that either apply to substance use only or substance use and mental health. In California there is a code for both: H0025. While in Massachusetts there is a different code for each: H0046 for mental Health and H2016 for substance use.
   An overview of these codes can be found:
   1.  American Medical Association’s (AMA) Behavioral health coding guide
   2. SAMHSA: Medicaid Billing Codes and Code Modifiers Utilized by the States, Pg. 38
   3. SAMHSA: Medicaid Reimbursement for Peer Support Services A Detailed Analysis of Rates, Processes, and Procedures, Pg. 5
5. Understand Managed Care Organization Networks: If Medicaid is administered by managed care organizations (MCOs), work within those networks. More information on MCOs is available through the [National Association of Medicaid Directors (NAMD)](https://www.medicaiddirectors.org).

5. How Much Do You Get Reimbursed?

Reimbursement rates for peer support services vary widely depending on the state, the provider, and the setting in which services are provided. On average, reimbursement rates fall between $15 and $50 per hour. However, states may have tiered reimbursement systems based on the complexity of the services provided or the geographic area.

For example:

Reimbursement rates for peer support services vary widely depending on the state, the provider, and the setting in which services are provided. On average, reimbursement rates fall between $15 and $50 per hour. However, states may have tiered reimbursement systems based on the complexity of the services provided or the geographic area.

For example:

• In Arizona, Medicaid reimburses peer support services at an average rate of $35 per hour.
• In Pennsylvania, rates can range from $25 to $40 per hour, depending on whether the service is delivered in an outpatient setting or as part of an intensive recovery program.

It’s important to consult your state’s Medicaid office for the most up-to-date reimbursement rates. You can explore current rates and reimbursement processes in the Peer Recovery Now’s Medicaid Reimbursement Report.

6. Grant Funding Opportunities for Peer Support Specialists

In addition to Medicaid reimbursement, there are numerous grant funding opportunities available to peer support specialists and organizations. Grants can provide the financial backing necessary to expand services, invest in training, or cover operational costs. Some grants are state-specific, while others are available nationally.

Key places to explore for funding:

• Substance Abuse and Mental Health Services Administration (SAMHSA): SAMHSA offers federal grants to support peer recovery programs, especially those targeting underserved populations. Programs like the Community Mental Health Services Block Grant (MHBG) provide funding specifically for expanding peer support services.
• Faces & Voices of Recovery: This organization offers grants for peer recovery services, particularly for community-based recovery organizations. Their goal is to help organizations scale their impact while maintaining client-centered care.
• Local and State Government Grants: Many states have grant programs focused on expanding behavioral health services. Check with your state’s department of health or mental health services office to explore available opportunities.

Grants can also be an excellent way to fund technology enhancements that improve service delivery. By incorporating applications like One Step Software, organizations can demonstrate their commitment to using innovative tools to track client progress and outcomes.

Using One Step to Enhance Your Peer Support Services

As a peer support specialist or organization offering peer support, having the right tools can make all the difference. One Step’s client recovery app is designed to help you:

• Track Client Progress: Set goals with clients and use the app to monitor their progress in real-time.
• Send Reminders: Use the Agenda feature in the app to remind clients about appointments, meetings, or other key recovery milestones.
• Document Client Interactions: Use digital forms and notes to keep a detailed log of your sessions with clients, including their challenges, progress, and goals. One Step Software provides online form templates for efficiency. This documentation is critical for Medicaid reimbursement.

By integrating One Step into your workflow, you can streamline communication, ensure compliance with Medicaid documentation standards, and help clients stay on track with their recovery goals.