The Michigan Department of Health and Human Services (MDHHS) released a proposed policy July 27 to establish Medicaid coverage and reimbursement for hospital-based peer recovery coach (PRC) services. The policy would allow hospitals to directly bill for PRC services delivered to Medicaid beneficiaries ages 18 and older with a substance use disorder (SUD) or co-occurring SUD. Covered services could be provided in outpatient hospital or emergency department settings and include peer recovery support, discharge planning assistance, care coordination, treatment and recovery navigation and linkage to community-based resources.
The proposed policy aligns closely with recommendations from the MHA and member hospitals and represents a significant step toward sustainable funding for hospital-based PRC programs. The MHA encourages hospitals to review the proposed policy and consider submitting comments to MDHHS by Aug. 31.
If approved by the Centers for Medicare & Medicaid Services, reimbursement will begin Oct. 1, 2026.
Members with questions may contact Kelsey Ostergren at the MHA.
Phone: (517) 703-8601
Fax: (517) 703-0628
