State Medicaid Program Reimburses for Physical Health and Wellness Services Provided by Mental Health Peers, Leading to Anecdotal Reports of Improved Outcomes | AHRQ Innovations Exchange
Policy Innovation Profile
State Medicaid Program Reimburses for Physical Health and Wellness Services Provided by Mental Health Peers, Leading to Anecdotal Reports of Improved Outcomes
Problem AddressedMental illness is common (particularly among low-income populations) and often leads to physical health problems and death. Certified peer specialist (CPS) services—support and education provided by peers who are also in recovery from mental and behavioral health conditions—have been shown to be effective, but payers often do not cover such services; when they do, coverage tends to be limited to mental and behavioral health services and does not extend to physical health and wellness services.
- A common condition, especially among low-income individuals: Roughly 20 percent of adults in the United States have a mental disorder, and approximately 5 percent have a serious mental illness.1Approximately one-fifth of individuals with mental illness also have a co-occurring substance dependence or abuse disorder,1and many also have low socioeconomic status.2
- Increased risk of physical health problems and death: Persons with mental illness are more likely than others to suffer from physical health problems, including chronic diseases such as diabetes, cardiovascular disease, diabetes, obesity, asthma, epilepsy, and cancer.3 As a result, the life expectancy of those with serious mental illness is roughly 25 years less than that of the average individual.3,4
- Unrealized potential of CPS services: Since 2000, a growing body of scientific research has found that CPS services improve mental and physical health outcomes.5 For example, the Health and Recovery Peer (HARP) program (a six-session intervention based on Stanford University’s Chronic Disease Model that helps individuals with serious mental illness manage their chronic illnesses) helped patients achieve greater improvements in patient activation, physical health-related quality of life, physical activity, and medication adherence than similar patients receiving usual care.6 In spite of this evidence, most payers do not cover CPS services, particularly those related to physical health and wellness.