New Peer Support Services Benefit to Leverage Providers’ Lived Experience to Support Medi-Cal Members

Health EquityHealth WorkforceMental Health and SUDProgram Design Implementation
Written By

California’s Medicaid program (Medi-Cal) has taken significant steps in recent years to focus on whole-person approaches to care delivery that address the social drivers of health for Medi-Cal beneficiaries. Toward this end, the state has added a new benefit that enables individuals to become certified to provide and bill for delivering Peer Support Services to Medi-Cal beneficiaries.

Peer Support Programs and the Medi-Cal Peer Support Services Benefit

Peer support workers are people who have been successful with recovery from mental health challenges and/or addiction that work to help others going through similar situations. Lived experience is a key aspect of peer support, because peers have the ability to leverage shared commonalities with clients to advance their goals. Additionally, peer support programs improve outcomes for individuals with mental health and/or substance use disorders, boosting treatment engagement and decreasing rates of re-hospitalizations while lowering the overall cost of care and improving quality of life. These programs can also benefit peer support workers by providing a professional pathway that values and compensates them for their experience, skills, and knowledge of systems.The Peer Support Services Medi-Cal benefit is now available to individuals receiving services through the Medi-Cal specialty mental health and SUD delivery systems in counties that opt-in to provide Peer Support Services. Participating counties are also responsible for certifying Peer Support Specialists, a process that requires peer support workers applying for certification to receive 80 hours of training, pass a certification exam, and meet continuing education requirements. Peer Support Specialists will also soon be able to receive supplemental training in state-approved areas of specialization, allowing them to hone skills serving individuals who are without housing, are in crisis, or are justice-involved. Medi-Cal Peer Support Specialists (who often work for counties or community organizations) lead skill-building groups where clients learn coping mechanisms and problem-solving skills; provide individual coaching and engagement that helps clients navigate care transitions; and conduct other non-clinical therapeutic activities focused on promoting recovery and wellness.Coverage of Peer Support Services is also expanding the health care workforce, increasing access to services for Medi-Cal beneficiaries, and boosting community representation among care providers.  These services are also helping to address the rising need for mental health services in California and increasing the availability of culturally-specific, responsive, and timely support. And although funding for county-run peer programs and peer work has previously been available through block grants and limited claiming mechanisms in the Medi-Cal specialty mental health services system, the new Peer Support Services benefit creates a sustainable funding stream that enables long-term viability for peer programs through Medi-Cal.

How Peer Support Services Connect to Other Medi-Cal Social Supports

Although Peer Support Services are a standalone Medi-Cal benefit, they fit with other pieces of the state’s efforts to promote a whole-person approach to care delivery. The concurrent implementation of Medi-Cal coverage of Peer Support Services, Community Health Workers, Doulas,  Enhanced Care Management, and Community Supports – all of which center on local and community-based providers – are creating new opportunities for coordination and collaboration. Peer Support Specialists can play a critical role in the implementation of Medi-Cal initiatives, serving as:

Peers have a key role to play in bridging the gap between traditional health care delivery systems and the community. As California continues to focus on advancing the spectrum of physical and behavioral health services in Medi-Cal, peers are meeting beneficiaries where they are, increasing access to services, supporting recovery, and helping to strengthen the health care safety net.Aurrera Health Group is pleased to support Medi-Cal Peer Support Services implementation as part of our Medi-Cal transformation and behavioral health work with the California Department of Health Care Services. Our team provides technical assistance, policy analysis and advice, strategic planning, stakeholder engagement, and operational administration support to assist in the on-the-ground implementation of the Peer Support Services benefit and Peer Support Specialist certification programs.

Authors

Previous

Advancing Care Coordination: What’s Ahead for California’s Dual Eligible Members
Next

Increasing Access to Home and Community-Based Services: Implications of New Proposed Rules