Texas CASA Champion Bill Spotlight: Expanding Medicaid Coverage for Peer Support Services for Older Youth

Now that the 87th Texas Legislature is well underway, let’s explore some of the legislation we’re championing this session. Today, we’re featuring HB 1413/SB 662.


Author: Rep. Romero, Jr.
Companion: SB 662
About: Bill History Bill Summary

Directs the Peer Support Stakeholder Workgroup at HHSC to adopt rules to allow for expanding Medicaid coverage for peer support services to youth who are 14 years old or older. Peer support is when someone with lived experience gives assistance to help someone with mental illness or a substance use disorder to help them achieve long-term recovery.

Status: Filed as of 3/2/2021


As many CASA volunteers and child welfare advocates know, youth in foster care are at high risk for behavioral health and substance use issues. In fact, prevalence rates for alcohol abuse, drug abuse and drug dependency are two to five times higher for youth in foster care than their peers who are not in foster care. Youth whose parents also struggled with mental illness or substance use themselves are even more vulnerable. Similar to trauma, mental health and substance use patterns can be intergenerational. This is even more true for families having previous involvement in the child protection system.

Youth who age out of foster care are eligible for Medicaid coverage up to age 26. They are automatically enrolled after exiting care at 18, but must renew their coverage with the state annually. During this time, it is critical that these young adults continue meeting with their doctor and following their treatment plan, as this is when they are at the highest risk of developing or exhibiting signs of substance use.

A number of states have approved peer support services for youth as a Medicaid-covered service, including Georgia, Kentucky, Massachusetts, Mississippi, Oklahoma and Oregon. Here in Texas, however, Medicaid coverage covers the cost of seeing a therapist or psychiatrist, but it does not currently cover mental health peer support specialists for youth between the ages of 14-21. This leaves youth in Texas ineligible for these services at the time when many of them need them most.

What are peer support services, & why would these services benefit youth & young adults in the foster care system?

The Substance Abuse and Mental Health Services Administration defines peer support services as “mutual support — including the sharing of experiential knowledge, and skills, and social learning.” In other words, someone who has lived experience with a mental illness or a substance use disorder is trained and certified to help someone else who is going through the same thing achieve long-term recovery.

Peer support providers must be trained, certified and hired within certain mental health service settings in order to deliver services. They work from the perspective of having lived experience of mental illness or substance use to promote recovery and resilience to others navigating the recovery process.

Peer support specialists are cost-effective, evidence-based, relationship-focused, voluntary and trauma-informed. In addition, peer support providers can serve as a bridge between systems to support young adults in their transition to adulthood, while also providing improved treatment outcomes.

Perhaps most importantly, they can offer a sense of community, something that the youth and young adults we serve can often suffer without. People as young as 18 can certify as peer support specialists, and as we know, young people are more likely to form a positive, trusting relationship with people similar to them, who can understand what they are going through and can meet them where they are.

How would this legislation help?

Simply put, HB 1413 and its companion bill SB 622 would direct the Health and Human Services Commission to allow youth ages 14-21 access to peer support services under Medicaid. As mental health parity remains a leading priority for the Legislature, Texas CASA is hopeful to see this legislation pass to increase the diversity of mental health services for older youth in Texas.

Interested in CASA’s legislative advocacy?

You can keep up with this legislation, as well as the status of other bills that would improve the child welfare system for youth and their families, on our Bill Tracker. If you’re interested in joining or starting a Legislative Advocacy Team (LAT) at your local CASA program, you can learn more on our website.