California Pursues Addition of Peer Support Specialist Services to List of Med-Cal-Covered Behavioral Health Services
California is preparing to launch a momentous new benefit for individuals and families enrolled in Medi-Cal and are receiving treatment for mental health and substance use disorders (SUD). The state is developing a Medi-Cal certification program for peer support specialists that will allow qualified “peers” – people with lived experience – to provide services to consumers within the Drug Medi-Cal Organized Delivery System, Specialty Mental Health Services, and Drug Medi-Cal programs. The change is the result of years of advocacy for Medi-Cal coverage of peer support specialist services led by peer-run organizations, behavioral health professionals, and other stakeholders. Their work culminated in the passage of Senate Bill (SB) 803 (Beall, Chapter 150, Statutes of 2020) in September 2020, which allows the Department of Health Care Services (DHCS) to develop and implement a Medi-Cal certification program for peer support specialists.
Who are peer support specialists?
Peer support specialists are people who have experience navigating SUD or mental health diagnoses and services either themselves, or as the parent or family member of a consumer. These individuals have been successful in their own recovery process and can therefore, play a role in helping others experiencing similar situations. Research suggests that incorporating peer support into mental health and substance abuse treatment can improve outcomes for individuals and their families. In recovery from SUD, peer support providers can diminish the possibility of relapse. The peer-to-peer relationship is one that works through mutual empowerment and shared understanding to help individuals stay engaged in their recovery process, and to be as successful as possible. Peer support services encompass many different activities, including:
- Educational groups
- Relapse prevention
- Coaching
- Supporting linkages to community resources
- Education services
Peer support specialists are a valuable component of behavioral health treatment programs as they can help expand access to care and increase equity in treatment settings. Currently, there are many peer support specialists providing services in California funded through alternate sources such as federal block grants and the Mental Health Services Act. However, these services are not currently eligible for federal reimbursement through the Medi-Cal program. That will soon change, as the state plans to launch the peer support specialist certification program in early 2022.
Community engagement is a top priority
Since the passage of SB 803 last fall, Aurrera Health Group has assisted DHCS in hosting a variety of stakeholder engagement forums, including two public listening sessions attended by over 900 individuals from a variety of backgrounds including county partners, behavioral health providers, and current peer support specialists. The state also maintains a public website where interested parties can stay up to date on current happenings as well as submit feedback on various aspects of the peer support specialist certification program prior to program launch. As the state continues to work on finalizing peer support specialist policies, such as the Medi-Cal Code of Ethics for Peer Support Specialists in California, the website will be updated with the most recent information.Additionally, DHCS has and will continue to engage with specific stakeholder groups outlined in SB 803, including the County Behavioral Health Directors Association, the California Behavioral Health Planning Council, and the peers who are already doing this work throughout the state.
Next steps
Aurrera Health Group will continue to support DHCS in developing and implementing the Medi-Cal peer support specialist certification program. Part of Aurrera Health’s role is to analyze the work being done by other states to integrate peer support specialists into their Medicaid programs over the past 10 years. Our Behavioral Health Policy team looks forward to assisting the state in issuing guidance and technical assistance opportunities for counties once the certification program and policies are finalized.