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Can recovery coaches bill Texas Medicaid?

Yes, through an employer. Since January 1, 2019, Texas Medicaid has paid for peer specialist services (billed as H0038) for adults 21 and older with a mental health or substance use condition, when peer support is part of their recovery plan. But a peer specialist doesn't enroll and bill Medicaid on their own:

• You work for a Medicaid-enrolled provider. That includes behavioral health practices and clinics, chemical dependency treatment facilities, local mental health and behavioral health authorities, federally qualified health centers and rural health clinics, and, since March 2021, opioid treatment programs. A provider that isn't enrolled can contract with one that is.
• You're supervised. Your supervisor is a qualified credentialed counselor (an LCDC, for example), a licensed practitioner of the healing arts, or another qualified professional overseen by one, and holds a peer specialist supervisor certification. Supervision is at least weekly during your initial certification and at least monthly after that.
• You can start during your internship. A newly certified peer specialist can give billable services during the 250-hour supervised internship at their job, finished within six months.
• There's a limit. Medicaid pays for 104 units (15 minutes each) of peer support in a rolling six months, and more when medical necessity is documented.

So the Medicaid route is a job or a contract with a program. Coaching in your own private practice is paid by your clients or their families. If you run a program and want to add peer services, Cima Consulting can get the program enrolled and credentialed with the Medicaid plans (see Texas Medicaid credentialing).

Other ways coaches get paid

• Private clients. Charge by the session or by the month, and post the price on your listing. If you're certified under Texas law, the No Surprises Act's Good Faith Estimate rule may apply to your self-pay clients. Giving one costs nothing, and our free tool makes it in a few minutes.
• Programs and organizations. Treatment programs, recovery community organizations, clinics and health systems hire peer specialists, and grant-funded programs pay for peer support too.

Never take money for referrals

Recovery coaches get asked to "send people" to programs, sometimes for cash, free rent or a "marketing fee". Don't. Paying or taking money for patient referrals is illegal under the Texas Patient Solicitation Act. When the referral is to a treatment program, recovery home or lab, it can also be a federal crime under the Eliminating Kickbacks in Recovery Act (EKRA), whoever pays for the care. Pay for the coaching you actually do, by the hour or as a salary, is how it should work. Pay that goes up with how many people you send somewhere is the line you don't cross. Find Care is never paid per referral either.