North Dakota Peer Support & Medicaid Guide

North Dakota has a formal statewide peer support system spanning mental health, substance use recovery, brain injury, family peer support, Medicaid 1915(i) services, Community Connect, justice-related recovery programs, and other community behavioral health services.

The state’s primary credential is the Certified Peer Support Specialist, commonly abbreviated CPSS.

North Dakota recognizes two levels of certification:

Certified Peer Support Specialist I
Certified Peer Support Specialist II

A CPSS I has completed state-approved peer support training and the certification process. A CPSS II has completed CPSS I requirements, provided at least 1,500 hours of direct peer support service, and completed peer support supervisor training. A CPSS II may supervise a CPSS I. (Health and Human Services North Dakota)

North Dakota’s peer definition is broader than in many states. The state recognizes lived experience involving:

Mental health conditions
Substance use disorders
Brain injury
Combinations of these conditions

It also recognizes a pathway for parents or primary caregivers with lived experience navigating behavioral health or related systems on behalf of a child. (Health and Human Services North Dakota)

North Dakota Medicaid covers Peer Support through its 1915(i) Behavioral Health Services and Supports program. Adult Peer Support uses H0038, while Family Peer Support uses H0038 with modifier UK. Both are reimbursed in 15-minute units under current 2026 guidance. (Health and Human Services North Dakota)

North Dakota Peer Support Quick Facts

Category	North Dakota overview
State Medicaid program	North Dakota Medicaid
State behavioral health authority	North Dakota Health and Human Services
Primary peer credential	Certified Peer Support Specialist
Certification levels	CPSS I and CPSS II
Lived experience	Required
Mental health pathway	Yes
Substance use pathway	Yes
Brain injury pathway	Yes
Parent/caregiver pathway	Yes
State-approved peer training	Required
CPSS II experience	1,500 direct service hours
CPSS II supervisor training	Required
CPSS II supervision authority	May supervise CPSS I
Medicaid peer coverage	Yes
Medicaid program	1915(i) Behavioral Health Services and Supports
Adult Peer Support age	18+
Family Peer Support age	Participant ages 0-17
Adult peer code	H0038
Family peer code	H0038 UK
Billing unit	15 minutes
Community Connect peer support	Yes
Brain Injury endorsement	Available
Military Peer Support endorsement	Available
Last reviewed	August 2026

What Is Peer Support in North Dakota?

North Dakota describes a peer support specialist as someone with lived experience of recovery from a:

Mental health condition
Substance use disorder
Brain injury
Combination of these conditions

who provides behavioral health services and support to people experiencing similar challenges. (Health and Human Services North Dakota)

Through shared understanding and mutual empowerment, peer specialists help people become and remain engaged in recovery.

North Dakota emphasizes that peer support goes beyond reducing symptoms. It supports:

Recovery
Community
Wellness
Self-determination
Quality of life
Social connection
Engagement with services
Personal growth

The state notes that peer support can improve quality of life, social functioning, whole health, service engagement, and satisfaction while reducing hospitalizations and healthcare costs. (Health and Human Services North Dakota)

Who Can Be a Peer Support Specialist?

North Dakota recognizes more than one lived-experience pathway.

A peer support specialist may be someone who:

Personally identifies as being in recovery from a mental health disorder
Personally identifies as being in recovery from a substance use disorder
Has lived experience with traumatic brain injury
Has a combination of these experiences

The state also recognizes family members with lived experience supporting someone with mental health, substance use, or brain injury needs. (Health and Human Services North Dakota)

This makes North Dakota’s peer workforce broader than systems that limit certification only to personal behavioral health recovery.

Certified Peer Support Specialist I

A Certified Peer Support Specialist I, or CPSS I, is the foundational North Dakota credential.

The state defines a CPSS I as a peer specialist who has:

Completed Division-approved peer support training
Completed the state certification process

(Health and Human Services North Dakota)

A CPSS I can provide peer support within applicable programs and employment settings, subject to service-specific workforce, supervision, Medicaid, and employer requirements.

Certified Peer Support Specialist II

A Certified Peer Support Specialist II, or CPSS II, is the more advanced North Dakota credential.

To qualify, the worker must:

First meet all CPSS I requirements
Complete at least 1,500 hours of direct service as a peer support specialist
Complete peer support supervisor training

A CPSS II may serve as a supervisor for a CPSS I. (Health and Human Services North Dakota)

This creates a formal peer career ladder:

Peer training → CPSS I → direct service experience → supervisor training → CPSS II

For organizations employing multiple peer staff, this makes workforce hour tracking and supervisor qualification particularly important.

Person in Recovery Pathway

North Dakota’s certification system explicitly asks applicants to identify whether they are applying as:

A person in recovery
A parent or primary caregiver

For the personal recovery pathway, applicants identify lived experience involving:

Mental health
Substance use
Brain injury
Any combination of these conditions

(Health and Human Services North Dakota)

Applicants should use the current North Dakota HHS certification materials because specific eligibility, recommendation, fee, and documentation requirements may change.

Parent and Primary Caregiver Pathway

North Dakota also recognizes peer professionals whose lived expertise comes from being a parent or primary caregiver.

Parent and caregiver peers have lived experience navigating child- or youth-serving systems on behalf of children with:

Social needs
Emotional needs
Developmental needs
Health needs
Behavioral healthcare needs

North Dakota offers a dedicated Parent and Caregiver Peer Support Training pathway. Current training is five days total, divided into a three-day foundational training followed by two additional training days. (Health and Human Services North Dakota)

This pathway is especially relevant to Medicaid Family Peer Support.

North Dakota Peer Support Training

North Dakota HHS maintains state-approved peer support training.

Current training opportunities include:

General Peer Support Specialist training
Parent and Caregiver Peer Support training
Supervisor training
Brain Injury Peer Support endorsement
Military Peer Support endorsement
Continuing education opportunities

(Health and Human Services North Dakota)

Organizations and prospective peers should verify that a training remains state-approved before relying on it for certification.

Peer Support Supervisor Training

Supervisor training is especially important in North Dakota because completion of peer support supervisor training is one of the requirements for becoming a CPSS II. (Health and Human Services North Dakota)

North Dakota also offers dedicated peer support supervision training opportunities.

Current HHS training materials indicate that certain peer supervision trainings are approved for continuing education and meet state criteria for North Dakota peer support supervision. (Health and Human Services North Dakota)

Organizations should distinguish between:

Administrative supervision
Peer-specific supervision
Medicaid-required oversight
Clinical consultation

Brain Injury Peer Support

North Dakota explicitly includes brain injury within its peer support framework.

A peer may qualify based on lived experience of a brain injury, and the state also offers a Brain Injury Peer Support Endorsement. (Health and Human Services North Dakota)

This is relatively distinctive nationally.

Brain injury peer support may help participants with:

Community reintegration
Identity changes
Daily living
Social connection
Behavioral health needs
Recovery
Resource navigation
Self-advocacy

Organizations should verify endorsement requirements through the current North Dakota Brain Injury Network and HHS resources.

Military Peer Support

North Dakota also offers a Military Peer Support Endorsement.

The state notes that military service can have long-term impacts on veterans, military family members, and caregivers and that peer specialists can provide an intentional space for veterans to connect with people who understand military experience. (Health and Human Services North Dakota)

Military peer services may support:

Veterans
Service members
Military families
Caregivers
People transitioning out of military service
Veterans navigating behavioral health systems

Mental Health Peer Support

Mental health recovery is a major part of North Dakota’s peer support system.

Peer specialists may support people experiencing:

Serious mental illness
Mood disorders
Trauma
Psychosis
Anxiety
Other behavioral health challenges

Peer support may involve:

Recovery mentoring
Wellness support
Self-advocacy
Community integration
Goal setting
Treatment engagement
Natural supports
Housing and employment navigation
Coping skills
Community resources

Substance Use Peer Support

North Dakota’s peer credential also explicitly recognizes substance use disorder recovery.

Peers may support people experiencing:

Opioid use disorder
Alcohol use disorder
Stimulant use disorder
Other substance use disorders
Co-occurring conditions

Substance use peer support may include:

Recovery coaching
Treatment engagement
Recovery planning
Recovery capital development
Mutual support
Resource navigation
Community connection
Harm reduction
Housing
Employment
Recovery maintenance

Recovery Talk

North Dakota offers Recovery Talk, a free peer support service focused on addiction recovery.

The service allows people to connect with trained peer support specialists with lived experience through phone or text and is offered through North Dakota HHS. (Health and Human Services North Dakota)

Recovery Talk illustrates that North Dakota peer support exists beyond Medicaid-billed encounters.

Programs should distinguish between:

Community peer support
State-funded peer programs
Medicaid 1915(i) Peer Support
Other contract-funded services

Community Connect

North Dakota’s Community Connect program provides community-based behavioral health services to adults with mental health or substance use disorders affecting multiple areas of life.

Current eligibility includes:

Age 18 or older
North Dakota residency
Mental health or substance use disorder diagnosis
Functional impact across domains such as housing, employment, parenting, physical health, or community connection

Community Connect services include:

Care coordination
Peer Support
Recovery Services

(Health and Human Services North Dakota)

Peer Support within Community Connect is described as support from a person with similar lived experience who provides hope, support, and advocacy. (Health and Human Services North Dakota)

Free Through Recovery

North Dakota also operates Free Through Recovery, a community-based initiative for people involved with the criminal justice system.

The state’s community supports infrastructure describes Free Through Recovery as improving access to effective community-based services for people in the justice system. (Health and Human Services North Dakota)

Peers may be particularly valuable in:

Reentry
Recovery
Community stabilization
Justice-system navigation
Treatment engagement
Housing
Employment
Social connection

Program-specific peer qualifications and funding requirements should be reviewed separately.

Is Peer Support Covered by North Dakota Medicaid?

Yes.

North Dakota Medicaid covers Peer Support through the 1915(i) Behavioral Health Services and Supports program. (Health and Human Services North Dakota)

1915(i) is designed to help qualifying Medicaid members with behavioral health conditions live successfully in their homes and communities.

The service array includes:

Peer Support
Family Peer Support
Housing Support
Supported Employment
Supported Education
Non-Medical Transportation
Benefits Planning
Respite
Other community-based supports

(Health and Human Services North Dakota)

Adult 1915(i) Peer Support

North Dakota’s 1915(i) Peer Support service is available to eligible participants age 18 and older. (Health and Human Services North Dakota)

The state describes the service as support from trained and certified individuals with lived experience as recipients of behavioral health services.

The purpose is to promote:

Hope
Self-determination
Recovery skills
Long-term behavioral health recovery
Community living

(Health and Human Services North Dakota)

Medicaid Peer Support Code

Current April 2026 North Dakota Medicaid guidance identifies:

H0038

for 1915(i) Peer Support.

The service is reimbursed using a 15-minute rate. (Health and Human Services North Dakota)

Medicaid 15-Minute Billing Rule

North Dakota Medicaid uses the standard timed-service rounding methodology for 1915(i) Peer Support.

Current 2026 policy identifies:

1 unit: 8 through 22 minutes
2 units: 23 through 37 minutes
3 units: 38 through 52 minutes
4 units: 53 through 67 minutes
5 units: 68 through 82 minutes
6 units: 83 through 97 minutes
7 units: 98 through 112 minutes
8 units: 113 through 127 minutes

The pattern continues for longer services. Providers should not bill services lasting less than eight minutes. (Health and Human Services North Dakota)

2026 Therap Billing Requirement

A significant North Dakota Medicaid operational change took effect in 2026.

Current 1915(i) policy states that, beginning January 1, 2026, claims for services rendered on or after that date are submitted through the Therap billing module. (Health and Human Services North Dakota)

Organizations providing 1915(i) Peer Support should therefore account for both:

Their internal peer documentation workflow
North Dakota’s required Therap billing workflow

Family Peer Support

North Dakota Medicaid also covers Family Peer Support through 1915(i).

Family Peer Support is designed for caregivers of enrolled children and adolescents.

The state describes the service as being delivered by trained and certified Peer Support Specialists with lived experience as a parent or primary caregiver who has navigated child-serving systems for children with social, emotional, developmental, health, or behavioral healthcare needs. (Health and Human Services North Dakota)

Family Peer Support serves participants ages 0 through 17. (Health and Human Services North Dakota)

Family Peer Support Billing

Current April 2026 North Dakota Medicaid policy identifies:

H0038 with modifier UK

for 1915(i) Family Peer Support.

The service is reimbursed in 15-minute units. (Health and Human Services North Dakota)

The same timed-service methodology applies, including the minimum eight-minute threshold for one billable unit. (Health and Human Services North Dakota)

Adult Peer Support vs. Family Peer Support

Area	Adult Peer Support	Family Peer Support
Medicaid program	1915(i)	1915(i)
Participant age	18+	0-17
Primary recipient	Adult Medicaid member	Caregiver/family supporting enrolled child
Worker lived experience	Behavioral health recovery	Parent/caregiver navigation experience
Code	H0038	H0038
Modifier	None under current manual	UK
Unit	15 minutes	15 minutes
Person-centered plan	Required	Required

(Health and Human Services North Dakota)

1915(i) Person-Centered Plan of Care

Every person receiving 1915(i) services has a care coordinator.

The care coordinator works with the member to develop a person-centered plan of care and choose services and providers aligned with the member’s goals. (Health and Human Services North Dakota)

Peer Support should therefore connect to the member’s person-centered goals.

A Medicaid peer note should make it possible to understand:

Which goal was addressed
What peer support was provided
How the participant engaged
Progress or barriers
What follow-up is planned

1915(i) Eligibility

Peer Support through 1915(i) is not automatically available to every North Dakota Medicaid member.

Members must:

Apply for 1915(i)
Complete an assessment or screening
Meet program eligibility requirements
Develop a person-centered plan of care

(Health and Human Services North Dakota)

Organizations should verify 1915(i) enrollment before assuming an encounter is reimbursable.

Medicaid Expansion Peer Support

North Dakota expanded access to covered peer support for Medicaid Expansion members beginning January 1, 2023.

The state announced that certified peer support specialists could provide covered recovery and wellness support for eligible Medicaid Expansion members through the applicable program structure. (Health and Human Services North Dakota)

Providers should verify the current 2026 managed care and Medicaid requirements applicable to Expansion members.

Scope of Practice

North Dakota peer support specialists provide recovery-oriented services based on lived experience.

Depending on the program, appropriate activities may include:

Sharing relevant lived experience
Recovery mentoring
Self-advocacy
Goal setting
Coping skill development
Resource navigation
Natural support development
Community connection
Recovery planning
Treatment engagement
Wellness
Family support
Brain injury support
Military peer support
Justice and reentry support
Community integration

Activities Generally Outside Peer Scope

Unless separately licensed and authorized under another professional role, peer support specialists generally should not:

Diagnose behavioral health conditions
Conduct psychotherapy
Prescribe medication
Provide medical advice as licensed professionals
Perform clinical assessments requiring licensure
Make involuntary treatment decisions
Independently modify clinical treatment
Represent themselves as licensed clinicians
Determine Medicaid eligibility
Provide legal advice

Peers may participate alongside clinical professionals without becoming clinicians themselves.

Peer Supervision

North Dakota’s two-level certification structure makes peer-specific supervision especially important.

A CPSS II may supervise a CPSS I. (Health and Human Services North Dakota)

Peer supervision may address:

Use of lived experience
Ethics
Boundaries
Recovery orientation
Mutuality
Role fidelity
Documentation
Difficult interactions
Staff wellness
Professional development
Community resources
Crisis escalation

Organizations should also distinguish peer supervision from administrative management and clinical consultation.

Documentation for North Dakota Peer Support

A strong peer support note may include:

Participant identifier
Date
Start time
End time
Duration
Location
Modality
Peer specialist
CPSS level
Recovery or person-centered goal
Peer intervention
Relevant use of lived experience
Skills addressed
Resource navigation
Natural supports
Participant response
Progress
Follow-up
Connection to the person-centered plan
Signature or attestation

For 1915(i) services, documentation must support the Medicaid service billed.

Documentation Should Be

Accurate
Timely
Person-centered
Recovery-oriented
Strengths-based
Specific
Respectful
Relevant
Connected to participant goals
Consistent with peer scope
Consistent with Medicaid requirements when billed

Documentation Should Avoid

Unsupported diagnoses
Clinical interpretations outside peer scope
Stigmatizing language
Generic statements such as “provided peer support”
Copy-and-paste notes
Unnecessary sensitive information
Documentation of services that did not occur
Personal opinions presented as clinical facts
Language written solely to justify reimbursement

Documentation and Billing Are Not the Same Thing

A completed peer note does not automatically establish that a Medicaid claim is payable.

Payment may also depend on:

Medicaid eligibility
1915(i) enrollment
Person-centered plan
Covered service
Provider enrollment
Peer certification
Applicable age criteria
Correct code
Correct modifier
Correct timed units
Documentation
Claim submission through required systems
Timely filing
Other program requirements

Organizations should validate each component separately.

North Dakota peer programs may handle sensitive behavioral health, substance use, brain injury, and family information.

Applicable requirements may include:

HIPAA
42 CFR Part 2
North Dakota law
Medicaid requirements
HHS requirements
Organizational policies
Consent requirements

Peer workers should receive role-specific training addressing:

Information access
Documentation
Participant consent
Care-team communication
Substance use records
Family information
Youth information
Text messaging
Email
Telehealth
Social media
Crisis situations
Legal requests

Starting a Peer Support Program in North Dakota

Step 1: Define the Population

Determine whether the program serves:

Adults with mental health conditions
People with substance use disorders
People with brain injuries
People with co-occurring conditions
Children and families
Veterans
Justice-involved populations
Medicaid 1915(i) members
Other behavioral health populations

Step 2: Determine the Peer Pathway

Determine whether staff need:

CPSS I
CPSS II
Parent/Caregiver Peer Support training
Brain Injury endorsement
Military Peer Support endorsement
Another applicable specialty

Step 3: Build Credential Tracking

Track:

State-approved training
CPSS I certification
CPSS II eligibility
Direct service hours
1,500-hour threshold
Supervisor training
Endorsements
Continuing education
Certification renewal

Step 4: Establish Supervision

Determine:

Assigned supervisor
Whether the supervisor is CPSS II when required
Supervision frequency
Documentation
Ethics support
Professional development
Clinical escalation
Staff wellness

Step 5: Determine the Funding Model

Potential funding may include:

North Dakota Medicaid
1915(i)
Community Connect
Free Through Recovery
State behavioral health funding
Federal grants
Opioid settlement funds
Hospital contracts
Other grants and contracts

Step 6: Configure 1915(i) Eligibility

For Medicaid services, track:

Medicaid eligibility
1915(i) enrollment
Participant age
Person-centered plan
Care coordinator
Peer Support or Family Peer Support service
Provider enrollment

Step 7: Build the Service Workflow

Map:

Referral
Eligibility
Intake
Person-centered planning
Peer assignment
Scheduling
Service delivery
Documentation
Supervision
Follow-up
Outcomes
Billing

Step 8: Configure Medicaid Billing

For 1915(i), systems should support:

H0038
H0038 UK
15-minute units
Eight-minute minimum for one unit
Person-centered goals
Participant age
Provider eligibility
Therap billing workflow
Claim status

Step 9: Establish Role Boundaries

Develop policies covering:

Use of lived experience
Peer vs. clinical roles
Confidentiality
Dual relationships
Transportation
Gifts
Social media
Communication outside work
Crisis escalation
Staff wellness
Role drift

Step 10: Measure Outcomes

Potential outcomes include:

Engagement
Recovery goal progress
Self-advocacy
Coping skills
Community connection
Natural supports
Treatment engagement
Housing stability
Employment
Family empowerment
Recovery capital
Crisis utilization
Hospitalization
Justice-system involvement
Participant satisfaction
Peer workforce retention
Documentation timeliness
Credential progression

Common Challenges for North Dakota Peer Programs

CPSS I vs. CPSS II

North Dakota’s two-level credential structure means organizations need to know which workers can provide services and which workers may supervise others.

Tracking 1,500 Hours

The CPSS II pathway requires at least 1,500 hours of direct peer support service. (Health and Human Services North Dakota)

Programs developing supervisors should track qualifying hours continuously.

Broad Lived-Experience Pathways

North Dakota recognizes mental health, substance use, brain injury, and parent/caregiver lived experience.

Organizations should match workers appropriately to the populations they serve.

Adult vs. Family Medicaid Peer Support

1915(i) uses distinct service structures for:

Adult Peer Support
Family Peer Support

Age, worker experience, code modifiers, and service recipient all matter.

1915(i) Eligibility

Not every Medicaid member qualifies automatically.

Programs need systems to verify program enrollment and person-centered plan requirements.

Therap Billing

Beginning in 2026, North Dakota requires applicable 1915(i) claims to move through Therap. (Health and Human Services North Dakota)

This may create duplicate workflow if the organization also uses another system for peer documentation and operations.

Documentation Burden

Peer specialists are primarily valuable because of their lived experience and ability to build relationships.

Poorly designed administrative workflows can reduce time available for direct support.

Rural Access

North Dakota’s geography creates challenges involving:

Travel
Workforce shortages
Community resources
Supervision
Training access
Service availability

Mobile and virtual workflows may be particularly useful when permitted.

Role Drift

Peers may gradually be assigned:

Generic case management
Administrative work
Transportation
Compliance monitoring
Clinical tasks

Organizations should protect the distinct lived-experience role.

Frequently Asked Questions

What is North Dakota’s primary peer credential?

The Certified Peer Support Specialist, or CPSS.

How many CPSS levels does North Dakota have?

Two:

CPSS I
CPSS II

(Health and Human Services North Dakota)

What is a CPSS I?

A peer who has completed Division-approved training and the North Dakota certification process. (Health and Human Services North Dakota)

What is a CPSS II?

A CPSS I who has completed at least 1,500 hours of direct peer service and peer support supervisor training. (Health and Human Services North Dakota)

Can a CPSS II supervise CPSS I workers?

Yes. (Health and Human Services North Dakota)

Does North Dakota recognize mental health lived experience?

Yes.

Does North Dakota recognize substance use recovery?

Yes.

Does North Dakota recognize brain injury lived experience?

Yes. (Health and Human Services North Dakota)

Does North Dakota recognize parent or caregiver peers?

Yes.

The state maintains a parent and primary caregiver pathway and dedicated Parent and Caregiver Peer Support training. (Health and Human Services North Dakota)

Does North Dakota Medicaid cover peer support?

Yes.

Peer Support is included in the Medicaid 1915(i) Behavioral Health Services and Supports program. (Health and Human Services North Dakota)

What age is adult Medicaid Peer Support available for?

Age 18 and older under 1915(i). (Health and Human Services North Dakota)

What age is Family Peer Support available for?

For caregivers of enrolled participants ages 0 through 17. (Health and Human Services North Dakota)

What is the minimum time for one billable unit?

At least 8 minutes under current 2026 policy. (Health and Human Services North Dakota)

Does 1915(i) require a person-centered plan?

Yes.

Every 1915(i) member has a care coordinator who works with them to develop a person-centered plan of care. (Health and Human Services North Dakota)

Do all Medicaid members automatically receive 1915(i) Peer Support?

No.

Members must separately apply and qualify for the 1915(i) program. (Health and Human Services North Dakota)

Does North Dakota have peer support for justice-involved populations?

Yes.

Free Through Recovery is designed to improve access to community-based behavioral health services for people involved in the criminal justice system. (Health and Human Services North Dakota)

Does North Dakota have a peer recovery phone or text service?

Yes.

Recovery Talk provides free peer support by phone and text for people seeking addiction recovery support. (Health and Human Services North Dakota)

Does North Dakota have a brain injury peer endorsement?

Yes. (Health and Human Services North Dakota)

Does North Dakota have a military peer endorsement?

Yes. (Health and Human Services North Dakota)

Are peer support specialists clinicians?

No.

Peer support is a lived-experience behavioral health support role and does not itself constitute professional clinical licensure.

Official North Dakota Peer Support Resources

North Dakota Peer Support

Official North Dakota HHS resource explaining peer support, lived-experience pathways, the role of Peer Support Specialists, and statewide peer support resources.