July 2026 Top of Mind

Medicaid members now have coverage for Peer Recovery Support Services

Medicaid members in Wisconsin have a new option to support their recovery from behavioral health conditions – ForwardHealth now covers peer recovery support (PRS) services as a non-clinical complement to clinical treatment. PRS can be offered for date(s) of service on or after April 1, 2026. Here’s what you need to know:

What are Peer Recovery Support Services?

They are non-clinical services that help support and maintain recovery for Medicaid members who are experiencing mental health and/or substance use challenges. Supportive peers use their own lived experiences to offer informational, emotional, social and practical help as part of a member’s care plan. The services do not duplicate or replace clinical treatment or case management.

Who qualifies to use PRS services?

PRS services are available to members of all ages enrolled in Wisconsin Medicaid, BadgerCare Plus, Medicaid SSI HMO, Family Care, Family Care Partnership, or Program of All-Inclusive Care for the Elderly (PACE).

ForwardHealth does not require prior authorization for PRS services. There are two ways PRS can become part of a member’s treatment:

• A behavioral health provider can include PRS services in a member’s plan of care.
• A qualified prescriber acting within their legal scope of practice, such as a physician, physician assistant or nurse practitioner, can order or prescribe PRS services.

Who can deliver PRS services?

There are two elements to how PRS services are delivered to Medicaid members:

• Peer recovery coaches provide PRS services through their employment with a PRS provider agency, and under the direction and supervision of qualified professionals.
• PRS provider agencies must be enrolled in Wisconsin Medicaid to be reimbursed for services the peer recovery coaches deliver.

Need more information?

Review the ForwardHealth New Coverage for Peer Recovery Support Services guide for detailed information about requirements, roles and responsibilities for peer recovery coaches and provider agencies: covered services, individual vs. group services, Medicaid enrollment, claims and reimbursement, and support resources.

For additional support regarding Peer Recovery Coach services or questions about contracting to serve UnitedHealthcare Community Plan of Wisconsin members, please call Optum Behavioral Health Provider Services at 1-877-614-0484, 7 am – 7 pm CT, Monday – Friday.