Developing the Peer Workforce

Recognizing that individuals with the lived experience of mental health conditions have valuable insights into what makes recovery possible, the behavioral health workforce is expanding to include peer specialists. A growing base of evidence affirms peer specialists’ effectiveness in facilitating wellness and improved outcomes. Studies show that utilizing peer specialists as part of a care team can lead to reduced hospitalizations, reduced use of crisis services, improved symptoms, larger social support networks, and improved quality of life, as well as strengthening the recovery of the people providing the services. i

Based on positive outcomes resulting from use of peer support services, in 2007, the Centers for Medicare and Medicaid Services (CMS) issued guidelines for states wanting to bill for peer support services, proclaiming them "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 abuse disorders." ii

DBSA strongly supports federal and state policies to expand and strengthen the peer workforce. Current federal law gives states the option to adopt peer specialists as providers under their state Medicaid plans but does not require that they do so. In turn, peer specialist training and certification requirements are determined on a state-by-state basis. Approximately 26 states currently fund peer specialist services through Medicaid. In addition, in 2012, President Obama issued an Executive Order that mandated the hiring of 800 new Veteran peer specialists to work in VA facilities and improve access to mental health services for Veterans.

There are numerous opportunities for advocates to get involved in expanding and strengthening peer support services. DBSA encourages you to visit your state’s Medicaid website to learn whether peer support services are already covered by Medicaid in your state.

If peer support services are not covered in your state, you can:

  • Develop a coalition of mental health and social services providers to support the inclusion of peer support services in the state plan.
  • Reach out to key contacts in your state Medicaid department or state legislature to urge the addition of peer support services to your state plan.
  • Work with state officials to develop a state plan amendment or Medicaid waiver that adds peers to the state plan and outlines requirements on training, certification, qualifications, accountability, data collection, and roles/responsibilities for peers.

If peer support services are covered in your state, you can:

  • Become a certified peer specialist.
  • Assess the adequacy of currently covered peer support services. Are they available to all consumers who need them? Are there limitations on the settings in which peer services can be provided? Are peer specialists fully integrated as part of the care team? What requirements for accountability, data collection, and quality review are in place, and do any changes need to be made? Are there potential opportunities for expanding the role of peers that are not currently covered in the Medicaid state plan? Are peers an integral part of the design, implementation, and evaluation of peer support services?
  • Advocate for high-quality state peer specialist training and certification. Is the training/certification process adequate to ensure effective services? Is continuing education readily available and accessible for peer specialists? Is DBSA’s nationally-known training recognized by your state’s certifying body?
  • Engage in state-level advocacy to make improvements or expansions to peer support services through Medicaid.

Ongoing advocacy is also important at the federal level to expand upon both the sources of funding and the Medicaid state plan authority that are available to states in utilizing peer support services. Currently, states may adopt peer services in the following ways: under the Medicaid rehabilitation option; as a Medicaid state plan waiver, which requires a demonstration that costs for the waiver service(s) and population(s) will be comparable to those under the regular Medicaid plan; or through block-grant funded programs. Additional flexible funding sources are needed to grow the recovery and whole health outcomes peer support services can deliver.

There are not currently any bills before Congress exclusively devoted to expanding federal funding for peer services. However, the Excellence in Mental Health Act—a bill to require enhanced Medicaid funding for services provided by community behavioral health organizations that meet certain federal standards—includes a requirement that these centers offer peer and family support services.




i. Eiken, S., & Campbell, J. (2008). Medicaid coverage of peer support for people with mental illness: Available research and state example. Published by Thomson Reuters Healthcare. Retrieved from:

ii. Center for Medicare and Medicaid Services, State Medicaid Director Letter #07-011. August 15, 2007.