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In 2007, the Center for Medicare and Medicaid Services wrote “The experiences of peer support providers, as consumers of mental health services, can be an important component in delivery of effective treatment.” After years of peer advocacy, in 2017 Texas passed HB 1486, directing development of a peer support Medicaid benefit, effective 2019. Prior to HB 1486, funding for peer support services was patchwork. Peers might be identified as a different type of provider (e.g., qualified mental health professional [QMPH]) or provide non-peer services (e.g., medication management) in order to qualify for traditional reimbursement. HB 1486 presented the opportunity to expand peer services across the state. However, excitement for the benefit was tempered by the relatively low rate of reimbursement, which offered less incentive for organizations to utilize the benefit.
Researchers sought to assess the effect of HB 1486 via change in peer service provision over time. Research questions included: which provider types offered peer services; in what regions of the state were they provided; and was level of care (LOC) related to their receipt.
Medicaid encounters data for years 2016 through 2020 were examined. Variables included peer service codes (individual, group, and re-entry), provider codes (peer, QMHP, and paraprofessional), region/location codes, and LOC assignment. Statistical analyses were conducted in SPSS v26. Mapping analyses were conducted using ArcGis.
Results
Trends over time: From 2016 to 2020, provision of peer support services increased each year. The greatest increase was seen after implementation of the benefit. At the same time, the type of provider of peer services narrowed; QMHPs and paraprofessionals delivered 98% and 70% fewer peer services, respectively. Across the peer support codes, peer providers accounted for 94.3% of service provision. This suggests organizations may have shifted to appropriately identifying the type of professional providing peer services, given they were now eligible for reimbursement.
Regional trends: Of the 40 Texas Local Mental Health Authorities (LMHAs), only 20 used one or more peer support codes. This shows regional differences in the provision of peer support services, and that there are additional opportunities for people to benefit from peer support.
LOC Trends: Individuals assigned a higher LOC were more peer support than individuals assigned a lower LOC.
Conclusions and Recommendations
Both the increase in peer support services and the narrowing of the types of providers suggest the new Medicaid benefit had an impact. However, there are still many areas where the benefit has not been utilized. It may be beneficial to survey LMHAs to better understand why they are or are not utilizing the benefit. The LOC analysis also revealed opportunities and areas for peer services to expand.
In light of the findings of this research, peer advocacy, and available state general revenue for Medicaid match, the reimbursement rate for peer services increased effective March 2022. Therefore, additional research to determine the effect of the rate increase is necessary.