Barriers or Bridges?: State-Level Certification and the Politics of Peer Recovery Work

As peer recovery workers (PRWs) become increasingly integrated into behavioral health systems, certification has emerged as a mechanism for legitimizing lived experience and enabling Medicaid reimbursement. However, certification policies vary widely, reflecting divergent values and priorities that shape access to the profession.

A reflexive thematic analysis of state-level certification policies for PRWs across all 50 U.S. states and Washington, D.C. was performed.

Five key themes were derived: The Value of Peer Support in Multidisciplinary Teams, Work Experience Prior to Certification, Cultural Sensitivity, Exclusionary Language, and Structural Barriers to Inclusion. Although many policies affirm the importance of lived experience and recovery-oriented care, others impose restrictive requirements, such as abstinence-only definitions of recovery, vague moral character clauses, and excessive pre-certification work hours. These requirements may disproportionately exclude marginalized individuals and deter otherwise qualified applicants.

Findings highlight how policy language not only governs access to certification but also signals broader societal attitudes toward recovery, legitimacy, and professional worth. Recommendations include revising exclusionary criteria, increasing transparency in evaluation, and involving PRWs in policy development. By aligning certification standards with the values of equity and inclusion, states can better support a diverse and sustainable peer workforce.