States’ Use of Peers in the Mental Health Crisis Continuum
August 30, 2022/ by Rebekah Falkner, Jodi Manz, and Mia Antezzo
As states continue to build out mental health crisis systems following the implementation of 988 and the opportunity to receive an enhanced Medicaid match under the American Rescue Plan Act (ARPA) for mobile crisis services, considerations for how to leverage limited behavioral health workforce are at the forefront. States are expanding opportunities for peers – non-licensed individuals with lived mental health or substance use disorder (SUD) experience – to support components of mental health crisis services. Leveraging this lived experience, peer services offer states a certified workforce that can provide navigation and other services across a complex system.
States are taking different approaches to incentivize the integration of Medicaid coverage for peer services in behavioral health. Specifically, states have expanded opportunities to leverage peers as part of a core continuum of crisis services that includes crisis call centers, mobile mental health teams, and facility-based care. As states take steps to enhance crisis services, including peer services along this continuum can be a workforce strategy to expand capacity.
Call center staff – which can include peers – answer calls or texts from individuals in mental health crisis and provide telephonic intervention. Peers can serve as staff on these lines but can also serve as connectors via peer-run warmlines. In New Mexico, the state’s peer-to-peer warmline works in conjunction with the New Mexico Crisis Access Line. Staff triages calls, offering an option to be connected to either a peer or a clinician, and connects them accordingly.
In order to be eligible for the enhanced Medicaid match for crisis services in ARPA, mobile teams must be composed of at least one licensed clinician and one other mental health worker, which can be a peer. The enhanced match provides an incentive for states to expand these services, and peers as a workforce bring not only lived experience but are able to be trained and certified quickly. Peers are, in fact, noted in the enabling statutory language as an option for inclusion on these teams, and many states are already taking this approach. Minnesota Medicaid, for example, covers peers as members of mobile teams, allowing them to bill for services that help to stabilize individuals in crisis in the community.
When an individual is assessed to need a higher level of care, crisis stabilization and receiving facilities are able to provide inpatient or 23-hour care. Michigan allows billing for peers serving Medicaid recipients as members of care teams within crisis stabilization units. Peers in these settings can provide supportive services, including necessary transition and recovery-oriented care. Virginia has also designed an additional community stabilization crisis benefit to ensure post-crisis follow up care, services that may include those delivered by peers.
This chart highlights the policy components of these four states’ approaches to including peers in providing services across the crisis continuum.
Acknowledgements: This blog and chart were supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award under the National Organizations of State and Local Officials (NOSLO) cooperative agreement totaling $836,859.00. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the U.S. Government. For more information, please visit HRSA.gov. The authors would like to thank state leaders working with NASHP on enhancing mental health crisis services in rural areas for their thoughtful discussion on this topic.
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