Peer Support Specialist Credentialing in States With Medicaid Coverage of Peer Support Services for Substance Use...

State Medicaid programs have widely adopted coverage of services delivered by credentialed peer support specialists (PSSs), but no comprehensive analysis of state variations in credentialing requirements exists. State-level variation is important because it affects care delivery as well as PSS workforce development and mobility across states. This study aimed to characterize PSS credentialing requirements in 40 states with Medicaid coverage of peer support services for substance use disorder in 2024.

State PSS credentialing requirements were identified with a structured systematic search protocol. Information was abstracted and summarized for 10 credentialing components: minimum age for certification, lived experience with substance use, criminal background check, minimum education level, minimum training hours, prior work experience, examination, certification validity period, continuing education, and certification fees.

State PSS credentialing requirements varied considerably. Most states required lived experience with substance use (95%), a high school diploma or equivalent (85%), and an examination (95%). Fifty-five percent required a minimum age for certification, and 33% required a background check. Training requirements ranged from 30 to 80 hours, and prior work experience requirements ranged from 40 to 1,000 hours. Certification validity periods ranged from 1 to 4 years, and continuing education requirements ranged from 8 to 40 hours. States listed up to four separate certification costs, including a recertification fee ranging from $15 to $200.

Although states included some common credentialing requirements, such as training and examination, considerable cross-state variation was found, highlighting the need for greater evaluation of credentialing models, improved transparency in requirements, and harmonization across states.