For The Peers Who Are Ready to Run Something
Natasha Faruqui, Tim Balow, and Ishan Shah at Peerakeet
By now, there is a version of the peer specialist career path that most people in the field recognize. You get certified, you get hired by an organization, a recovery community center, a behavioral health agency, a hospital system, or a health plan. You do the work, and if things go well, maybe you move into a senior peer role, or a supervisor position, or program coordination. Professional advancement is relatively limited in the field of peer services today. What is worth noting is that this path exists because the infrastructure for anything else has, historically, not existed.
But some are looking for something with more responsibility and growth, peers who have both the certification and the years of experience. They have real relationships in their communities, a clear sense of what they want to build, and the drive to build it. What they do not have is a way to get from that point to running an actual organization, with real documentation, real compliance infrastructure, and real payer pathways, without spending years figuring out a system that was not designed for them to navigate independently.
Peerakeet Practice is built to close this gap.
The Structural Problem With Peer-Led Ownership
Peer-run organizations are not a new idea.
A 2012 national survey identified 380 entities meeting the criteria for a peer-run organization across the United States, and that was more than a decade ago, before the field expanded significantly (Ostrow & Leaf, 2014). Organizations led by people with lived experience have long delivered services with a level of trust, credibility, and authenticity that traditional systems often struggle to replicate. They reach people who are easily missed by mainstream care. They are built closer to the communities they serve.
At the same time, existing provider organizations have played an essential role in bringing peer services into the mainstream. Recovery community organizations, behavioral health agencies, hospitals, health plans, and community programs have created jobs, supervision structures, service lines, and funding pathways that helped professionalize the field.
That work matters.
The next step is not to replace those organizations. It is to expand what is possible for the peers who are ready to build alongside them.
Medicaid has become one of the most important stable funding pathways for peer services as grant funding remains unpredictable. But Medicaid does not usually pay individual peer specialists directly. It pays enrolled provider organizations (MACPAC, 2019). That means the path to reimbursement, for most peers, runs through an organization that carries the compliance responsibility, manages documentation, bills the payer, receives the reimbursement, and pays the peer a wage.
That model works, and it will continue to be central to the field.
But it should not be the only model available.
A national survey found that many peer-run organizations were hesitant to pursue Medicaid reimbursement, citing administrative burden, compliance requirements, and documentation standards as barriers that felt difficult to manage without dedicated infrastructure (Ostrow et al., 2017). That hesitation is rational. Starting a Medicaid-ready provider organization is not just a matter of forming an LLC and opening a laptop.
It means navigating entity formation, state-specific peer certification rules, supervision requirements, HIPAA-compliant documentation, consent workflows, audit trails, service definitions, payer expectations, and provider enrollment processes before the first billable service is ever delivered.
In most states, those rules are not written in one simple place. They are spread across Medicaid manuals, agency guidance, certification boards, state plan amendments, provider bulletins, and policy documents that change over time (CMS, 2024).
For a peer with certification, experience, and a vision, that landscape is not just confusing.
It can become a full-time job before the real work even begins.
What the Money Looks Like
The economics show why ownership infrastructure matters.
Across states that report individual Medicaid reimbursement rates for peer support, the median rate is $15.08 per 15-minute unit of service, ranging from $7.83 in Mississippi to $21.90 in Missouri (NRI, 2023). At the national median, four 15-minute units represent roughly $60 in gross Medicaid revenue for one hour of documented peer support.
Now compare that to what many peer specialists earn as employees. The average peer support specialist wage in Texas is approximately $18.37 per hour (ZipRecruiter, 2025). In Ohio, Indeed reports a statewide average of approximately $19.03 per hour for certified peer specialists as of 2026 (Indeed, 2026).
That comparison is not meant to criticize provider organizations.
Organizations have real costs and real responsibilities. They provide supervision, compliance oversight, billing infrastructure, insurance, training, administration, participant acquisition, reporting, and program management. In many cases, they also absorb financial risk that individual peers should not be expected to carry on their own.
But the comparison does show why ownership can matter for experienced peers who are ready for that responsibility.
When a peer specialist owns the organization delivering the service, more of the value created by that work can stay close to the person and community doing the work. The infrastructure still has to exist. The responsibilities do not disappear. The difference is that the infrastructure can support peer ownership instead of making ownership inaccessible.
That is the shift Peerakeet Practice is designed to make possible.
What Peerakeet Practice Does
Peerakeet Practice is built on the simple premise that the structure that makes an organization viable should not require years of institutional knowledge to access, but instead be built into the platform from day one.
The setup process runs through three stages. The first is organizational foundation: entity structure, certification on file, and the program structure your state expects. The second is supervision and compliance: the supervisory pathway that most states require for billable peer services, documentation standards, and consent workflows built to hold up under audit. The third is service delivery and payer readiness: documentation that produces records payers can trust, and a clear view of what is left to achieve provider enrollment.
All 50 states are mapped for peer support rules, supervision requirements, and payer pathways. The state-specific requirements that are typically scattered across agency websites and policy manuals are finally tracked in one place, updated as rules change, and surfaced at the moment they become relevant to where a peer is in the setup process. The target is launch readiness in 30 to 90 days, depending on starting point and state.
What stands out is that the practice remains firmly in the peer's hands. The organization, certifications, contracts, and payer relationships are all established in a way that supports their ownership and leadership. Peerakeet is the software the organization runs on, not a management company, not the provider of record, not a payer, not a franchisor. The peer who goes through this process comes out the other side owning their work.
Why This Matters Now
The field is at an inflection point.
Medicaid coverage for peer services has expanded to 47 states and the District of Columbia (Kaiser Family Foundation, 2023). The reimbursement infrastructure for peer support is more developed than it has ever been. Across the country, behavioral health systems are looking for ways to extend care, improve engagement, support recovery, and reach people who are not well served by traditional models alone.
Existing organizations will continue to be essential to that future. Many peers will want to work inside strong programs, and many programs will continue to build excellent peer services within larger systems of care.
But the next stage of peer support should also make room for another path.
Experienced peers should be able to build organizations of their own, partner with existing systems, serve their communities, and participate in the reimbursement infrastructure the field has worked so hard to create.
The peer workforce now numbers over 100,000 people in the United States. Many have the experience, trust, relationships, and readiness to run something of their own. What they need is not permission. They need infrastructure.
They need a way to move from certification to ownership.
They need a way to build organizations that are compliant, sustainable, payer-ready, and still grounded in the lived experience that makes peer support powerful in the first place.
That is what Peerakeet Practice exists to support.
For the peers who are ready to run something, the path should not be hidden behind state manuals, payer rules, and operational complexity.
It should be buildable.
References
Bureau of Labor Statistics, U.S. Department of Labor. (2024). Occupational employment and wage statistics: Substance abuse, behavioral disorder, and mental health counselors. https://www.bls.gov/oes/current/oes211018.htm
Centers for Medicare & Medicaid Services. (2024). Frequently asked questions on Medicaid and CHIP peer support services. https://www.medicaid.gov/federal-policy-guidance/downloads/faq06052024.pdf
Kaiser Family Foundation. (2023). Medicaid behavioral health services: Peer support services. https://www.kff.org/data-collections/medicaid-behavioral-health-services/
Medicaid and CHIP Payment and Access Commission. (2019). Recovery support services for Medicaid beneficiaries with a substance use disorder. https://www.macpac.gov/wp-content/uploads/2019/07/Recovery-Support-Services-for-Medicaid-Beneficiaries-with-a-Substance-Use-Disorder.pdf
Ostrow, L., & Leaf, P. J. (2014). Improving capacity to monitor and support sustainability of mental health peer-run organizations. Psychiatric Services, 65(2), 239–241. https://doi.org/10.1176/appi.ps.201300187
Indeed. (2026). Certified peer specialist salary in Ohio. https://www.indeed.com/career/certified-peer-specialist/salaries/OH
National Research Institute. (2023). Use of peer specialists in state behavioral health service settings. https://nri-inc.org/media/ve5b3e5e/use-of-peer-specialists-in-state-bh-service-settings-2023.pdf
Ostrow, L., Steinwachs, D., Leaf, P. J., & Naeger, S. (2017). Medicaid reimbursement of mental health peer-run organizations: Results of a national survey. Administration and Policy in Mental Health and Mental Health Services Research, 44(4), 501–511. https://doi.org/10.1007/s10488-015-0675-4
ZipRecruiter. (2025). Peer support specialist salary in Texas. https://www.ziprecruiter.com/Salaries/Peer-Support-Specialist-Salary--in-Texas