Here’s a state-by-state of how Medicaid interacts with peer support services in each state.
Louisiana: Medicaid Covers Behavioral Health Peer Support Services Under MCO Plans
Louisiana is one of the many states that covers peer support services under its Medicaid program. In Louisiana, all behavioral health services, including addiction treatment services, are covered under a managed care system. Each individual MCO, or managed care organization, that administers Louisiana’s Medicaid services determines the precise limitations for peer support services, so specific rules will vary depending on which MCO your patient chooses. However, according to the KFF database, there are no copay requirements for peer support services in Louisiana, regardless of what MCO is administering care.
While not all peer support services are covered under Louisiana Medicaid, qualified providers who deliver psychosocial rehabilitation, addiction services, crisis intervention, “Assertive Community Treatment,” and community-based psychiatric support/treatment are eligible for reimbursement according to Louiana’s Behavioral Health Services Provider Manual.
For more on behavioral health business, sober living, and addiction treatment in Louisiana, see our other posts, Why Louisiana is a Great State for Opening a Sober Living Home and Opening an Addiction Treatment Center in Louisiana? Here’s What You Need to Know.
Kentucky: No Medicaid Copay for Peer Support Services
Kentucky’s Medicaid program covers all levels of care for addiction treatment patients, including assessment, psychological testing, crisis intervention, mobile crisis intervention, residential crisis stabilization, day treatment, peer support, intensive outpatient treatment, individual outpatient therapy, group outpatient therapy, and family outpatient therapy.
Peer support services do not require a copay under Kentucky’s medicaid rules.
For more on behavioral health business strategy and management in Kentucky, see How to Open a Sober Living Home in Kentucky and It’s Easy to Open an Addiction Treatment Center in Kentucky. Here’s How To Get It Done.
Oregon: OHP Covers Peer Support Services With Some Limits
Oregon’s medicaid program is called the Oregon Health Plan. Oregon Health Plan members are eligible for peer support services so long as the facility that provides the services obtains a Certificate of Approval or COA with the state. As with most state programs, Oregon medicaid will not reimburse peer support services if they are not “medically necessary” and not explicitly called for in the patient’s treatment plan. There are no copays required for medicaid patients who wish to access peer support services in Oregon, however, patients receiving care outside of an MCO are limited to 96 units of peer support services, where a unit is one 15-minute block of services. Patients who receive services through an MCO are subject to MCO-established limitations that vary depending on individual MCO rules.
For more on behavioral health business in Oregon, see: Opening a New Addiction Treatment Center in Oregon? The State Needs You Now More Than Ever.
Oklahoma: $3 Copay for Medicaid-Reimbursable Peer Support Services
Oklahoma Medicaid covers peer support services for addiction treatment patients without limits. However, Oklahoma is one of the few states that actually requires a copay for Medicaid patients who wish to access peer support services. The cost is low - only $3 - but multiple episodes of care can quickly add up for patients who are strapped for cash, creating a barrier to care for some patients who can’t afford to cover the copay.
For more on behavioral health business development, strategy, and management in Oklahoma, see: Oklahoma is Committed to Opening More Certified Addiction Treatment Centers. Here's How to Open Yours.
Connecticut: Sober Living Homes May Not Bill Medicaid for Peer Support Services
Connecticut is one of the few states that does not bill for peer support services through Medicaid. Currently, all peer support services rendered in Connecticut are funded through grants at community-based organizations. The state has made several attempts to advance reimbursement for peer support services, including tightening up regulations of peer support specialist certification, making plans to form review committees to investigate reimbursement best practices, and drafting legislation (later shot down) to begin reimbursing peer support services through Medicaid.
So, if you’re wondering if you can get peer support services reimbursed through Medicaid at your sober living home in Connecticut, unfortunately, the answer at this time is a resounding “no.” There are some politicians working to change this, however, so it is worth watching the news to see if anything comes of their efforts, but change is likely to be slow in this area.
For more on behavioral health business strategy and development in Connecticut, see: Consider These 6 Facts Before Opening a Sober Living Home in Connecticut and Connecticut is a Smart Choice for Opening Your Next Licensed Addiction Treatment Center
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