Idaho Medicaid Reimbursement Rates for Peer Support Services is Low
Idaho Medicaid covers Peer Support Services for mental health conditions, but not Substance Use Disorder specifically. The state reimburses providers $13.63 for every 15 minutes of Peer Services provided to patients. In Idaho, Peer Support Specialists are required to complete 46 training hours, 25 supervised work hours, and pass a formal exam. Peer support Specialists must have lived experience with SUD and/or recovery in order to work with clients.
For more on opportunities and entrepreneurship in the Idaho behavioral health community, see: Best Kept Secrets to Opening an Addiction Treatment Center in Idaho.
West Virginia Medicaid Covers Peer Support Services for SUD but Not Mental Health
West Virginia’s Medicaid coverage for Peer Support Services is similar to the situation in Idaho - except in West Virginia, it’s people with SUD who may access Peer Support Services, but those suffering from a mental health condition are not eligible. West Virginia reimburses providers $15.07 for each 15 minute unit of patient services delivered under the H0038 CPT code. This reimbursement rate is in-line with many other rates across the country. Like Idaho, West Virginia Medicaid requires Peer Support Specialists who have lived experience with addiction and recovery. Would-be Peer Support Specialists must complete 500 hours of work experience, 46 hours of training work hours, and 25 supervised work hours, in addition to passing an exam.
For more on Medicaid, behavioral health billing, and West Virginia business strategy, see:
Your Questions About Opening a Sober Living Home in West Virginia - Answered
Vermont’s Medicaid Coverage for Peer Support Services Likely Coming Soon
Vermont’s Medicaid coverage for Peer Support Specialist services is currently in flux. According to the KFF database, Vermont does not currently reimburse for Peer Support Services under its Medicaid program, making it one of the two states in the United States to fail to classify Peer Support Services as Medicaid-reimbursable. However, it seems very likely that this will change very shortly, thanks to legislation that Vermont passed in June 2024. Now that a certification program is in place, Vermont legislators plan on getting a state plan amendment filled with the Centers for Medicare and Medicaid Services to make Peer Support Services provided by certified providers Medicaid-reimbursable.
For more information on Medicaid billing for behavioral health in Vermont, see: Medicaid Unwinding and State Behavioral Health in South Dakota, North Dakota, Alaska, Vermont, and Wyoming.
New Hampshire’s Medicaid Reimbursement Rates Make Peer Support Services a Good Option for Sober Living Home Operators
New Hampshire’s Medicaid program reimburses at a pretty high rate for both mental health Peer Support Services and SUD Peer Support Services. Each are reimbursable at $24.94 for each 15 minute block of services billed under CPT code H0038.. New Hampshire requires all certified Peer Support Specialists to have personal lived experience relevant to the population, as well as 500 hours of work experience, 46 hours of training, and 25 hours of directly supervised work hours. As with other states in this post, there is also an exam Peer Support Specialists in New Hampshire must pass in order to achieve certification.
For more on Medicaid and behavioral health entrepreneurship in New Hampshire, see: Medicaid Unwinding and State Behavioral Health in West Virginia, Hawaii, New Hampshire, Maine, Rhode Island, and Delaware and How to Open an Addiction Treatment Center in New Hampshire.
Hawaii Medicaid Covers Peer Support Services for Addiction and Recovery
Hawaii’s Medicaid program does cover Peer Support Services for both mental health and Substance Use Disorder patients. The reimbursement rate for both - $15.19 for every 15 minutes of services rendered - is about the national average. Like virtually every other state in the US, Hawaii Medicaid uses the H0038 CPT code to represent Peer Support Services. Hawaii requires certified Peer Support Specialists to pass an exam. But their training and work experience hours requirements “vary” according to a recent report compiled by SAMHSA.
For more on sober living business development and strategy in Hawaii, see Everything You Want to Know About Opening a Sober Living Home in Hawaii.
Sober Living App Helps Sober Living Succeed
Sober Living App makes it easier - and more profitable - to operate sober living homes.
Our all-in-one app handles rent collection, admissions, property management, residents’ care coordination, community contacts, transportation details, calendars, staff, alumni and more - all from the convenience of your phone.
Claim your free trial today and see why more sober living homes prefer the Sober Living App.