Let’s get the answer to the question posed in the title of this post addressed right away: yes!
Medicaid absolutely covers Peer Support Services in Maine, Montana, Rhode Island, Delaware, and Wyoming.
There are a few states remaining as of this writing that do not cover Peer Support Services under their Medicaid program in the United States, but these states are, thankfully, no longer among them.
Want more details about the coverage limitations, exclusions, and reimbursement rates you’ll encounter in each of these states? Read on for more information as we cover the details state-by-state.
Maine Medicaid AKA MaineCare Only Covers Peer Support Services for Mental Health, not Substance Use Disorder
Maine’s Medicaid program, called MaineCare, does cover Peer Support Services, but only for mental health conditions and not for behavioral health conditions in general or Substance Use Disorder, specifically. A report compiled by the SAMHSA-affiliated Peer Recovery Center of Excellence provides more details on this limitation. While many SUD patients and sober living home residents are dual diagnosis patients, this may pose some problems for organizations that serve patients without a dual diagnosis.
There’s another caveat that may represent a deal-breaker for sober living home operators in Maine who may be interested in adding Peer Support Services to their resident services, too. The reimbursement rates for Peer Support Services are pretty low in Maine compared to the rates you’ll find in other state Medicaid programs. You’ll find that, for every 15 minutes of services delivered under the H0038 CPT code - the nearly universal code for Peer Support Services - Maine’s Medicaid program will reimburse only $11.88.
For more on behavioral health organization management and strategy in Maine, see:
FAQ About How to Open an Sober Living Home in Maine
Montana Medicaid Covers Peer Support Services for Mental Health and Addiction Recovery
Montana Medicaid covers Peer Support Services for both mental health conditions as well as behavioral health conditions, including Substance Use Disorder. There is no copay for Medicaid patients to access these programs.
Montana Medicaid uses CPT code H0038 for any and all Peer Support Services, regardless of whether those services are addressing mental or behavioral health conditions. If the service is addressing both types of diagnoses, as is the case with dual diagnosis patients, the modifier “HH” is added to the H0038 CPT code. Montana’s current reimbursement rate for H0038, representing, of course, 15 minutes of services, is $14.01 as of 2024. If you click the link above that reads “Peer Support Services,” you'll see a lower reimbursement rate cited, but that represents an older rate dating to 2019. The $14.01 reimbursement rate is slightly below the national average, but only by a dollar or so.
Peer Support Specialists who provide Medicaid-reimbursable services in Montana must have lived experience in mental health and/or behavioral health recovery, they must complete 40 hours of training services and they must pass a certifying exam.
Want more information on behavioral health business strategy in Montana? See:
How to Open a Sober Living Home in Montana
Contingency Management May be Coming to an Addiction Treatment Center Near You
Rhode Island Medicaid Requires Peer Support Specialists to Meet Common Certification Standards
Rhode Island Medicaid does reimburse for Peer Support Services, both for mental health and behavioral health clients. The reimbursement rate is $13.50 for either type of service. There is no copay for patients to access these services. Certification requirements for Peer Support Specialists in Rhode Island include: mandatory lived experience, of course, as well as 500 work experience hours, 46 training work hours, 25 supervised work hours, as well as a written exam.
For more on Rhode Island addiction treatment and behavioral health business development, see:
Thinking of Opening a Sober Living Home in Rhode Island?
Rhode Island is the Perfect State for Opening an Addiction Treatment Center. Here's Why.
Delaware Medicaid Has Integrated Coverage for Mental and Behavioral Health Peer Support Services
Delaware Medicaid has “integrated” coverage for Peer Support Services for mental health and behavioral health patients. The reimbursement rate for Peer Support Services is $14.75 for every 15 minutes of services, regardless of whether those services are for mental health, behavioral health, or both. The certification requirements for Peer Support Specialists in Delaware is fairly standard. You’ll find that would-be specialists must have lived experience, plus 500 hours of work experience, 46 hours of training, 25 hours of supervised work, and they must also pass a written exam.
Read more about Delaware Medicaid, behavioral health business management, and organizational strategy here:
FAQ About Opening a Sober Living Home in Delaware
Wyoming Medicaid Has Some of the Lowest Reimbursement Rates for Peer Support Services in the Country
Wyoming Medicaid does cover Peer Support Services but the state has some of the worst reimbursement rates in the country. While Peer Support Specialists receive the same standard training and certification requirements you’ll find in most states - 500 hours of work experience, 46 hours of training, 25 hours of supervised work, plus a written exam - they’re only entitled to $9.00 of Medicaid reimbursement for every 15 minutes of service. There is no copay for patients.
For more on Wyoming sober living and addiction treatment business planning and strategy, see:
5 Things to Consider When Opening a Sober Living Home in Wyoming
How to Get an Addiction Treatment Center Licensed in Your State—PART 2
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