{"id":32061,"date":"2023-10-04T16:36:26","date_gmt":"2023-10-04T16:36:26","guid":{"rendered":"https:\/\/caseyfamilyv2.wpengine.com\/peer-support-medicaid\/"},"modified":"2026-03-24T22:08:31","modified_gmt":"2026-03-24T22:08:31","slug":"apoyo-de-pares-de-medicaid","status":"publish","type":"post","link":"https:\/\/www.casey.org\/es\/peer-support-medicaid\/","title":{"rendered":"\u00bfC\u00f3mo se puede financiar el apoyo entre j\u00f3venes a trav\u00e9s de Medicaid?"},"content":{"rendered":"
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A growing number of states are investing in peer support services for youth in foster care and those transitioning to adulthood. Support from a trained peer can help bridge trust, cultural, and language gaps between young people and the adults who serve them. It also helps facilitate youth engagement with services. Peer support has proven effective<\/a> at inspiring hope and may offer a resource to youth reluctant to engage with more traditional clinical services. Medicaid can be a critical funding stream for peer support, both for young people currently involved in the child welfare system and those at risk who have co-occurring behavioral health concerns.<\/p>\n

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Peer support as defined by CMS<\/h3>\n

\u201cThe terms \u2018peer supporter,\u2019 \u2018peer worker,\u2019 and \u2018peer specialist\u2019 are interchangeably used to describe a person with lived\/living experience, either directly or through a current\/former dependent, involving a problematic mental health and\/or substance use condition(s), and who supports other people experiencing similar challenges in a wide range of non-clinical activities including advocacy, navigation and linkage to resources, sharing of experience, social support, community and relationship building, group facilitation, skill building, mentoring, goal setting, and more. Across the U.S., various other terms such as recovery coach, mentor, peer provider, or peer navigator are used to describe peer workers.\u201d\u00a0<\/em><\/p>\n

Source:<\/strong> Substance Abuse and Mental Health Services Administration National Model Standards for Peer Support Certification<\/a>.<\/p>\n<\/div>\n \n \n \n <\/div>\n<\/div>\n\n\n

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The Centers for Medicare and Medicaid Services (CMS) have considered youth peer support a Medicaid-eligible service since 2013<\/a>. As of April 2020, 33 states<\/a> included peer support for parents and\/or youth in their Medicaid state plan amendments or through a Medicaid waiver. Of those, 17 specify youth peer support.<\/p>\n

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This brief covers why Medicaid-funded youth peer support is a promising complement to child welfare services, how Medicaid can be used to fund peer support, and what questions can help guide child welfare administrators as they learn more about the possibilities in their own state.1<\/sup><\/a>\u00a0For more information about youth peer mentor services, including benefits and staffing considerations, see the Casey Family Programs brief: What are some considerations for employing and supporting youth peer mentors in child welfare?<\/em><\/a><\/p>\n

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Medicaid-funded peer support is a good fit for youth involved in child welfare <\/strong><\/h2>\n

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Child protection agencies working in silos lack adequate funding flexibility to provide children and families with the full range of services needed to support child safety and family well-being, and promote youth development. Federal policy reforms such as the Family First Prevention Services Act<\/a> are steps in the right direction, and can be leveraged alongside \u2014 and blended and braided with \u2014 Medicaid to offer greater opportunities for funding of upstream services and prevention strategies<\/a>.<\/p>\n

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The child welfare and Medicaid systems share a common interest in the health and well-being of children. Many children at risk of child welfare system involvement, including all children and youth in foster care, are entitled to Medicaid coverage.2<\/sup><\/a> Many of the same factors affect both child maltreatment risk and adverse health outcomes, including income and housing stability. The emphasis on social determinants of health<\/a> in recent Medicaid policy provides even more opportunity for upstream services to prevent child welfare system involvement.<\/p>\n

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Some states have been successful in funding peer support services using both Medicaid and traditional child welfare funding streams such as Title IV-E, which serves as the primary funding source of child welfare services, and Title IV-B, which provides additional (yet modest) funds for states to explore flexible approaches for maltreatment prevention and keeping families safely together. While Title IV-E and Medicaid are both uncapped entitlement funding for eligible children, they require matching state and\/or local funds, and the percentage of state spending that can be matched by federal funds varies by program, from state to state, and from year to year.3<\/sup><\/a> Peer support services essentially must compete with other child welfare and Medicaid funding priorities, which is one of many reasons why it makes sense for state child welfare and Medicaid agencies to collaborate to maximize available dollars. It is especially important to maximize Medicaid funding because it is an entitlement and the largest funder of behavioral health services in the country.<\/p>\n

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An increase in Medicaid-eligible peer support would expand the behavioral health provider workforce at a time when clinicians are in high demand and short supply. Since peer mentor positions have fewer formal education and experience requirements, these roles are more accessible to a broader range of individuals, including people with lived experience in the child welfare system and those who have been historically disadvantaged, such as people of color and LGBTQ+ people. This, in turn, increases youth access to mental health support from people who have similar backgrounds and share common experiences.<\/p>\n

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Since the cost of peer-provided services is lower than for clinical services, peer services can help broaden access to supports. In some cases, agencies are stretching their service dollars by using peer mentors as paraprofessional members of multidisciplinary teams supervised by a clinician.<\/p>\n

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In 2022, CMS urged states<\/a> to \u201cavoid requiring a behavioral health diagnosis for the provision of Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services.\u201d As a result, states can determine what services are medically necessary and the threshold to qualify for peer-provided services in some states may be lower than for more expensive and specialized clinical supports, and a diagnosis may not always be required. This may make supports accessible to more young people, including those who have experienced trauma but may not have a clinically diagnosed behavioral health condition. Shifting eligibility away from a diagnosis focus and toward the experiences of young people helps center the impacts of issues such as racism and poverty, and recognizes the importance of wellness and well-being<\/a>.<\/p>\n

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How Medicaid can be used to fund peer support<\/strong><\/h2>\n

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Medicaid is a joint federal and state program. States are required to cover a federally determined set of minimum benefits and then have considerable leeway to cover additional services, eligibility, reimbursement, and provider requirements. There are multiple ways that states can fund youth and young adult peer support under Medicaid:<\/p>\n

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  1. Name youth peer support as a<\/strong> billable service via state plan amendment<\/strong>. State plans can be amended to add services and make other changes with CMS approval. States may include peer support under other service titles\/descriptions such as “community support,” “case management,” or “resource development.”<\/li>\n<\/ol>\n
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      Examples<\/strong>: Youth MOVE NEXT<\/a> in Glenn County, Calif., hires and trains youth peer mentors between age 16 and 25, with the mission to build a robust pool of young peer mentors who share lived experience with the youth they serve. Youth peer support is billed under the state\u2019s rehabilitation option<\/a> as a part of the California State Plan. In Maine<\/a>, peer support is not reimbursed as a specific service, but peers are included as part of the treatment team for some covered behavioral health benefits.<\/p>\n

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      1. Include youth peer support in a<\/strong> state waiver<\/strong><\/a>. Some states use 1915(c) Home and Community-Based Waivers to fund family and youth peer support programs. Following CMS approval, these waivers allow Medicaid to pay for services not covered in the state plan or not typically eligible for reimbursement, for the purpose of testing new models of service delivery and payment.<\/li>\n<\/ol>\n

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        Example<\/strong>: From 2012 to 2017, Georgia funded youth peer services<\/a> on a limited basis through the Community\u2010Based Alternatives for Youth program that originally was funded through the 1915(c) Alternatives to Psychiatric Residential Treatment Demonstration Waiver. In 2017, Certified Peer Support-Youth (as well as Certified Peer Support-Parent) became Medicaid billable services under a Medicaid Rehabilitation Option State Plan Amendment<\/a>.<\/p>\n

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        1. Fund integrated care models (ICMs).<\/strong> These state care delivery and payment models reward coordinated, high-quality care and may be used to reimburse partnerships with community-based organizations that provide peer support. To implement ICMs within Medicaid programs, states may seek to explore new initiatives or enhance existing efforts under a Medicaid state plan, or they may use demonstration or waiver authority.<\/li>\n
        2. Fund peer services for youth and young adults using Medicaid administrative funds<\/strong>, <\/strong>which allow states to reimburse community-based organizations for activities related to coordination of peer support for eligible recipients. This approach may be less complicated but typically yields a lower reimbursement rate.<\/li>\n
        3. Include peer support in <\/strong>CHIP Health Service Initiatives<\/strong><\/a>, <\/strong>defined as activities that protect the public health, protect the health of individuals, improve or promote a state’s capacity to deliver public health services, or strengthen the human and material resources necessary to accomplish public health goals relating to improving the health of children eligible for CHIP and Medicaid. This approach may allow states to include peer support activities to help improve the health of low-income children.<\/li>\n
        4. Leverage <\/strong>managed care organization plans through 1115 or 1915(b) waivers<\/strong><\/a>, which allow states to implement specific managed care plan procurement and contracting strategies to incentivize care coordination across medical and nonmedical contexts, including to address social determinants of health. States have discretion as to which populations and services fall under a managed care system, and the perspectives of those with lived experience should be consulted in that process, which opens up the opportunity for states to prioritize peer supports.<\/li>\n<\/ol>\n

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          Example:<\/strong> Peer support behavioral health services in Louisiana<\/a> are covered through managed care, and the managed care organizations themselves are allowed to establish specific authorization parameters, including provision of peer support.4<\/sup><\/a><\/p>\n

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          Questions to consider<\/strong><\/h2>\n

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          The following questions can serve as a guide for child welfare leaders interested in the possibilities for leveraging Medicaid funding in their state.<\/p>\n