Medicaid-covered peer support services: state variation and impact on substance use treatment

• In Event: Medicaid and SUD

Abstract

Objective: To characterize delivery of peer support services (PSS) for Medicaid beneficiaries with substance use disorder (SUD) in the 41 U.S. states where Medicaid covers these services. PSS are non-clinical services delivered by a credentialed peer specialist with lived experience of SUD and training in recovery coaching. As of 2025, 41 state Medicaid programs have adopted PSS as a strategy to improve SUD treatment engagement and reduce overdose and other adverse outcomes, outpacing coverage of PSS by Medicare or commercial payers, which remains rare. This study characterizes the volume of Medicaid-covered PSS delivered from 2018-2021, mode of delivery (in-person, telehealth), characteristics of PSS recipients, and the settings and treatment phases in which Medicaid beneficiaries with SUD engage in PSS.  

Methods: Retrospective cross-sectional study using Medicaid claims data from the Centers for Medicare and Medicaid (CMS) Transformed Medicaid Statistical Information System Analytic File (TAF). The sample included Medicaid beneficiaries aged 18-64 with a SUD diagnosis in the 41 U.S. states where Medicaid covers PSS for adults.  

Results: State Medicaid programs covering PSS increased from 26 in 2018 to 38 in 2021. In 2021, 96,622 Medicaid beneficiaries aged 18-64 with a SUD diagnosis received any PSS, increasing to 157,189 in 2021. PSS volume varied by state, ranging from 171 in Wyoming to 27,747 PSS in Arizona in 2021. Across states, in 2021, 29.5% of PSS users had at least one telehealth-delivered PSS, relative to 4% in 2018. Beneficiaries with SUD and co-morbid mental illness had 27% higher odds of receiving a telehealth-PSS relative to an in-person PSS, and those with rural residence had 20% higher odds (p<0.05). 48% of PSS users were male and mean age was 40.5 years. Over the entire 2018-2021 study period, 87% of PSS were delivered in specialty SUD outpatient programs: 34% in programs using 12-step facilitation, 26% in opioid treatment programs, and 27% in other types of programs. PSS initiation occurred across a range of SUD treatment phases: 38% of beneficiaries received their first PSS prior to starting SUD treatment, 11% concurrent with a new SUD diagnosis, 6% at SUD treatment initiation, and 7% and 38% during SUD treatment engagement or retention phases.  

Conclusions: Use of Medicaid-covered PSS for SUD is growing, and a third of PSS is delivered via telehealth. PSS were predominantly delivered by specialty SUD outpatient programs and PSS initiation occurred across the phases of SUD treatment episodes, with the majority occurring either prior to SUD treatment initiation – suggesting PSS may support entry into SUD treatment – or during the retention phase.  Variation in PSS volume across states covering these services suggests a need to understand how state PSS credentialling, telehealth, and other policies impact PSS delivery.

Author

• Beth McGinty, Cornell University
  Presenting Author