Can 'True' Peer Services Operate in a Medicaid and Managed Care Environment?

NYAPRS Note: Thanks to the leadership of the Georgia Mental Health Consumer Network (GMHCN) dating back to 1999, Medicaid funding has helped advance the work and careers of peer specialists across our nation. Yet there’s plenty of controversy about whether ‘true’ peer services can exist in a Medicaid and managed care environment. Come learn about how this has been playing out in Georgia, Tennessee and New Mexico from Sherry Jenkins-Tucker of the Georgia Mental Health Consumer Network, Anthony Fox of the Tennessee Mental Health Consumers’ Association and the Star Center’s Elise Padilla at NYAPRS’ Annual Conference, which will be held only 3 weeks from now, at the Honor’s Haven Resort in Ellenville, NY. See program and registration details at www.nyaprs.org.

Georgia Provides a Model for Medicaid Reimbursement of Peer Support Specialists

By Clayton Velicer, MPH  Peers for Progress  October 31, 2013

In October, the US Department of Health and Human Services opened up the insurance marketplace allowing individuals to purchase health coverage as part of the implementation of the Affordable Care Act (ACA). With the start of the enrollment period, we are highlighting some recent policy developments in peer support and explore what ACA implementation means for peer support.

Last month, the Pew Charitable Trust published an article in praise of Georgia’s Peer Specialist program which provides Medicaid reimbursement for mental health peer support specialists. Under the ACA, an estimated 8 million people will enroll in Medicaid next year, many of whom will have untreated mental illnesses.

….Georgia became the first state to provide Medicaid reimbursement for peer specialists in 1999. The success of Georgia’s program was evaluated in a 2006 study conducted by the Georgia Department of Behavioral Health & Developmental Disabilities that compared consumers using certified peer specialists against standard care. The study that found individuals using the peer specialists showed reduced symptoms/behaviors, increased skills, and improved ability to access resources and to meet their own needs. The study also reported that the use of the peer specialists cost Georgia on average $997 per year compared to $6,491 for in day treatment. Additional information about the Georgia Peer Specialist program can be found here.

As a result of the success of the Peer Specialist program in George and other states, in 2007 the Centers for Medicare and Medicaid Services circulated a memo to state Medicaid Directors promoting the use of peer support specialists:

Peer support services are an evidence-based mental health model of care which consists of a qualified peer support provider who assists individuals with their recovery from mental illness and substance use disorders. CMS recognizes that the experiences of peer support providers, as consumers of mental health and substance use services, can be an important component in a State’s delivery of effective treatment. CMS is reaffirming its commitment to State flexibility, increased innovation, consumer choice, self-direction, recovery, and consumer protection through approval of these services.

Since this statement, the adoption of peer support specialists as part of comprehensive treatment for mental health has continued to increase in popularity as reflected in the growing number of states that offer Medicaid reimbursement for services. A Pew infographic shows that 31 states now reimburse peer support specialists through Medicaid.

Finally, in addition to the use of peer support specialists, the success of peer support programs in Georgia has also allowed the state to expand the use of peer support into other areas of healthcare. In 2012, the state received CMS approval to expand peer support services into Whole Health Coaches.

These coaches will have the goals of promoting recovery, wellness and healthy lifestyles, reducing identifiable behavioral health and physical health risks, and increasing healthy behaviors intended to prevent disease onset. As more Americans obtain access to healthcare and become eligible for Medicaid-reimbursed services, we encourage our readers to share resources and thoughts on the use of peer support services in mental health as well as prevention and management of chronic disease.

http://peersforprogress.org/pfp_blog/georgia-providing-a-model-for-implementing-peer-support-specialists/