Improve Medicare coverage of peer support specialists

Peer support specialists are formally trained providers who offer peer support, using their lived experience with a mental health or substance use disorder (MH/SUD) to promote recovery in other individuals. Peer support specialists are cost-effective and provide critical support that helps individuals build stronger support systems, engage with treatment, and manage both MH//SUD and physical health conditions. Increasing utilization of peer support specialists (including through telehealth) is a critical way to alleviate shortages of MH/SUD professionals, particularly in rural and other underserved areas. More than half of U.S. counties lack any MH/SUD professionals. By helping individuals get the support and care they need, peer support specialists help prevent costly negative outcomes, including disability, hospitalization, incarceration, and even homelessness.[1] Indeed, research has shown that peer support services were associated with 2.9 fewer hospital admissions each year, and Medicaid programs saved an average of over $2,000 per month.[2]

While the Veterans Administration and a majority of state Medicaid programs have recognized the value of peer support specialists and cover these services, Medicare lags behind.[3] This is particularly problematic given that older adults are the least likely to receive needed mental health services; only 80 percent of older adults needing care receive it.[1] Congress took initial steps in 2022 when it passed legislation allowing Medicare billing of peer support services as part of mobile crisis interventions and integrated care.[4] However, many settings are still not allowed to bill peer support services, including important settings such as Community Mental Health Centers, Rural Health Centers, Federally Qualified Health Centers, and Community-Based Organizations. Congress should pass legislation ensuring full coverage of peer support services in Medicare.