Connecticut’s peer recovery organizations have tried for years to get Medicaid reimbursement for their services, but now they are opposing a bill to do just that, arguing that the Department of Mental Health and Addiction Services (DMHAS) is implementing a top-down credentialing process with little input from the very workers and organizations who would be required to get the certification.
House Bill 7023 would require the Department of Social Services, which oversees Medicaid, to “provide Medicaid reimbursement to peer support specialists for such services.” A peer support specialist is defined in the legislation as someone who “may have lived experience in recovering from mental illness or substance use disorder and is certified to provide peer recovery support under a program administered by the Department of Mental Health and Addiction Services.”
The bill, introduced by the Human Services Committee, is up for a public hearing Thursday, but already peer recovery advocates and organizations are lining up against it, saying the bill lacks clarity and understanding of what a peer recovery specialist is; the state administered credentialing program is vague; that there are no protections for current peer specialists who largely work for minimum wage, and that there is no safeguarding peer organizations from grant reductions by DMHAS should they get Medicaid reimbursement.
“As seen with other Medicaid reimbursement service types, when Medicaid reimbursement is achieved by the state, previously designated grant funding is re-allocated to support other priorities of the agency,” wrote Scott Forrest, Community Bridger administrator for Advocacy Unlimited, a peer recovery organization. “Given the wage gap and lack of prioritization of peer recovery services, there is a strong probability that the peer recovery workforce will face increased productivity expectations without fair compensation.”
While much of this may be worked out through the public hearing process – the legislation is only a proposal at this point – some peer recovery specialists and organizations are concerned they are being forced into a credentialing and payment process that could ultimately hurt them more than help them.
“Without provisions for job protections, there is a high probability that currently employed specialists are at risk of job loss due to the unknown mandates for new credentialing of the peer recovery workforce being pushed through by DMHAS,” wrote Emma James Burke, recovery support specialist program administrator for Advocacy Unlimited.
Peer support specialists are those with lived experience in dealing with mental health and addiction issues and use their experience to help guide others toward recovery outside of a clinical setting. That means peer support specialists save money for the state, but without a mechanism to be reimbursed by Medicaid their pay is reliant on grants. In order to create a Medicaid reimbursement mechanism, however, there must be some agreed-upon credentialing system.
Connecticut already has training programs and certification for peer support specialists through organizations like Advocacy Unlimited and Connecticut’s Community for Addiction Recovery (CCAR). There is also certification for peer recovery through the International Certification & Reciprocity Consortium, but other certifications may only be recognized in other states.
DMHAS seeks to bring peer certification all under one roof through a single set of requirements, and a single credentialing organization – the Connecticut Certification Board, a nonprofit organization whose mission is “protecting the public through competency-based credentialing, training and promoting ethical practice by [substance use disorder] professionals,” according to their website.
“The goal is to ensure that one standardized set of Peer Principles, Core Competencies and Code of Ethics are endorsed statewide and is in alignment with what the State of Connecticut, Substance Abuse and Mental Health Services Administration, the Association for Addiction Professionals National Certified Peer Recovery Support Specialist, and other states’ best practices,” the Office of Recovery Community Affairs (ORCA), a division of DMHAS, states on its website.
ORCA announced a “newly created Certified Recovery Peer Professional credential” for “individuals trained by any of the DMHAS-approved Peer Training Organizations.” The organization has held two “grandparenting” virtual town halls to answer questions by the peer support community. However, what that certification by CCB entails – and even whether CCB is the best organization to administer certification – is where disagreement begins.
Some peer recovery organizations and advocates argue they will now be required to obtain state certification under guidelines and requirements they were not permitted to weigh in on despite being the very people and organizations who spearheaded peer recovery in Connecticut.
In 2021, the General Assembly passed a bill to create a task force to examine how to certify and pay for peer services, but some legislative leaders never made their required appointments and the task force died without ever having a meeting. DMHAS, however, moved forward on its own, creating two committees to develop a statewide certification process, culminating with the Certified Recovery Peer Professional credential.
Although some peer recovery specialists served on those committees, by and large, the peer community felt left out of the process because the task force was never allowed to do its work and was supplanted by DHMAS.
Similar bills for peer service Medicaid reimbursement failed to pass out of committee in 2023. In 2024, the peer recovery community notched a small legislative victory, getting the first peer-run respite home established in Connecticut, after a similar tug of war with the DMHAS over where such homes would be placed and how they would be run.
Some of the same nonprofit peer recovery advocates originally appointed to the task force are now critical of HB 7023 and the top-down approach by DHMAS, emailing the peer community to testify in opposition; they want the Medicaid reimbursement, but with protections, and they want the task force reconvened.
“As this bill is written today, the peer recovery workforce opposes this legislation,” Forrest writes in testimony. “However, we are open to exploring Medicaid Reimbursement in the future. Our ask is that you do not vote this bill out of committee and instead convene the Taskforce to Study Peer Services that was appointed in 2021. That taskforce was never convened.”
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All the peers and peer run organizations should come together and have ONE voice. Peer’s need to have a say however first we need to speak with each other only then can we truly move as ONE. NOTHING ABOUT US WITHOUT US. If we’re not listening and talking to each other how do, we expect others to hear us
this is the very reason that outsiders can come in
I have researched some other states that offer Peer Support Specialist training and certification free of cost to those in recovery. I have been suggesting this for years and either the State of CT is unwilling to offer grants for the training or the organizations who are presently certifying the trainings are not interested in working with scholarships. Since some of the agencies or communities are charging a fee that is cost prohibitive for many people in recovery, especially when they are just getting back on their feet, it makes me pause and wonder just what these agencies are doing for the recovery community when they are unwilling to help those in recovery get back on their feet and have the potential to really help their peers?