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Reimbursement for mental health peer specialists dies in committee

As the State of Connecticut looks to bolster its mental health system following years of reduced funding and the spike in need following the COVID-19 pandemic, bills that would have allowed certified peer recovery support services to be billed through Medicaid or covered by insurance were not passed out of committee.

Peer support specialists are individuals with “lived experience” in the field of mental health and substance abuse, who use their experience to help guide others toward recovery. The legislation was strongly supported by a number of mental health and addiction recovery nonprofit organizations.

“Workforce shortages are rampant in behavioral health and throughout the healthcare industry,” wrote Dr. Jonathan Craig Allen, medical director at Rushford Behavioral Health Center in Meriden, in testimony. “Incorporating people with lived experience and specialized training into the treatment paradigm addresses this person power deficit while providing treatment teams with members who understand the culture, environment, social and economic factors (and prejudice) often faced by those seeking care.”

Currently, there are roughly 2,000 peer support specialists working in Connecticut, largely funded through grants to nonprofit organizations, but under the terms of the legislation certified peer recovery support specialists would be able to bill Medicaid directly for their services or be covered under insurance, rather than relying on grant funding.

The Department of Mental Health and Addiction Services has formed working groups to develop a unified certification process for peer specialists, which is still working toward that goal.

State lawmakers in 2021 also passed a bill to establish a task force dedicated to coming up with the best plan for reimbursing peer specialists, but that task force was never fully formed and never met, much to the disappointment of peer support nonprofit organizations that have been pushing for this change for years.

As of 2018, Connecticut was one of eleven states that did not cover peer support specialists under Medicaid, according to an Open Minds analysis of state Medicaid amendments. The analysis indicated Connecticut provides reimbursement for peer addiction services through a Medicaid waiver, but not for mental health.

The latest Medicaid bill – SB 1205 – was supported by the National Alliance for Mental Illness, the Connecticut Hospital Association, the Connecticut Community Nonprofit Alliance and the Keep the Promise Coalition – an organization formed to push back against Connecticut’s defunding of mental health services in the wake of deinstitutionalization.

However, the legislation was opposed by the Department of Social Services (DSS) and, interestingly, the Connecticut Community for Addiction Recovery (CCAR), which trains, certifies and employs peer support specialists in the area of substance of abuse.

DSS Commissioner Andrea Barton Reeves testified that Medicaid reimbursement is already available through some Medicaid waivers, particularly for recovery coaches in substance abuse disorder (SUD) residential treatment programs, and under Medicaid’s Mental Health waiver. “Given the recent expansion in coverage through the SUD waiver and the other mechanisms in place for reimbursement, DSS does not support this bill, which would require the Department to amend the Medicaid state plan.”

Multiple representatives of CCAR argued the bill process for Medicaid would place an undue burden on them and said being part of the Medicaid system could affect their recovery model by placing restrictive parameters on their services.

“Our Coaches’ main value is their lived experience and this bill may have unintended negative consequences that could prevent an individual the ability to be identified as a Medicaid provider,” wrote Kevin Shuler, program manager for CCAR. “Programs like ours are best sustained financially through Grant Funding. The potential restrictive parameters imposed by Medicaid would drastically affect our ability to consistently mobilize and do the right thing by the people we serve.”

Jordan Fairchild of the Keep the Promise Coalition addressed DSS’s concerns directly in his testimony, saying the Medicaid waivers “apply only to a limited group of people.”

“In the case of the Mental Health waiver, this program is specifically for people who are at risk of institutionalization or placement in a nursing home,” Fairchild wrote. “Neither waiver program provides coverage for all Medicaid enrollees, which is the purpose of this bill.”

Jefferey Santo, a peer recovery support specialist, and executive director for Recovery Innovations for Pursuing Peer Leadership and Empowerment (RIPPLE), wrote that he was “angry” over CCAR’s lack of support.

“The problem with peer support is that we are not a traditional form of treatment or care; we don’t fit in their box. Peers tend to go outside the established status quo, which scares some people,” Santo wrote. “If we genuinely want to change the current trends we see in our state and nation, we need to do more and I believe that peers will lead the way.”

Senate Bill 1205 was not the only peer support bill to not pass out of committee. Another senate bill – SB 976 – which would have required private insurance plans to reimburse for certified peer support services, part of a larger bill that would have required private health insurers to cover a much wider range of services, including bariatric surgery.

And while SB 976 was supported by many of the same mental health advocacy organizations that supported Medicaid reimbursement, it was opposed by business and insurance associations who said the expanded services would simply increase the cost of insurance at a time when prices were already escalating.

“The sheer volume of mandates under consideration creates a volatility in the system that is not conducive to efficient, stable and predictable insurance market,” wrote Susan Halpin of the Connecticut Association of Health Plans. 

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Marc E. Fitch, Senior Investigative Reporter

Marc E. Fitch

Marc worked as an investigative reporter for Yankee Institute and was a 2014 Robert Novak Journalism Fellow. He previously worked in the field of mental health is the author of several books and novels, along with numerous freelance reporting jobs and publications. Marc has a Master of Fine Arts degree from Western Connecticut State University.

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