The Effects of State Regulations and Medicaid Plans on the Peer Support Specialist Workforce

Peer support specialists have proven to be a cost‐effective and clinically effective workforce in improving patient quality of life and symptom management, while decreasing avoidable emergency room visits and care overutilization. This study used publicly available datasets to map and type locations where peer services are provided, and determine how state policies are associated with peer support provision. We transcoded the 2018 National Survey on Substance Abuse Treatment Services (N‐SSATS) and 2018 National Mental Health Services Survey (N‐MHSS) directories, yielding a list of street addresses and characteristics for substance use disorder treatment (SUDTx) and mental health treatment (MHTx) facilities nationwide. We then pulled all state regulations for peer provider licensing/certification, service authorization, and Medicaid reimbursement from public, online repositories. Stepwise regressions associated these regulations with the proportion of SUDTx and MHTx facilities in the state offering peer services to determine what effect, if any, state policies may have on the peer workforce. Behavioral health treatment facilities offering services in 2018, specifically such facilities offering peer support services. The transcoding uncovered 9,294 MHTx facilities and 12 074 SUDTx facilities, nationwide. Approximately 25% of MHTx facilities (2311/9294) and 56% of SUDTx facilities (6806/12 074) self‐reported offering peer support services in 2018. Most counties had at least one facility offering peer services, with more densely populated counties having more of such facilities. Facilities offering peer services were more concentrated in urban hubs, like Detroit, Chicago, Los Angeles, etc., as opposed to rural or frontier areas. In MHTx facilities, peer services were included in the greatest proportion in community mental health centers (35%, 782/2194), multisetting health facilities (31%, 102/332), and residential treatment centers for adults (26%, 138/528). In SUDTx facilities, peer services were included in the greatest proportion in residential treatment (79%, 2203/2776), residential detoxification (76%, 618/817), and outpatient day treatment facilities (71%, 1145/1614). Stepwise regression found Medicaid reimbursement rates positively associated with peer service provision ( P  < .05). To be reimbursed by Medicaid, many state Medicaid plans require peers to have a state‐recognized certification. Other positively associated policies were requiring education and supervision hours for a credential ( P  < .05, each) and allowing applicants to apply college degrees toward requirements for a peer credential ( P  < .05). These policies were more common in state‐regulated credentials than more informal registrations. Transcoding the N‐MHSS and N‐SSATS datasets allowed us to map where peer services were being offered nationwide, determine the types of facilities offering peer services, and see how their provision rates varied by state. Testing regulatory data for peer credentials and state Medicaid plans against these provision rates found Medicaid reimbursement rates and certain peer credential requirements were positively associated with peer service provision. The Centers for Medicare and Medicaid Services has approved peer services for Medicare reimbursement, and states are increasingly adding peers to their lists of approved Medicaid providers. Our statistical analysis suggests that increasing the Medicaid reimbursement rate for peers and creating a state‐regulated peer credential (license or certification) could improve the rate at which MHTx and SUDTx facilities offer peer services within states. Health Resources and Services Administration.