AB 2138 adds two sections to California’s Welfare and Institutions Code to make peer support specialists a required, integrated member of enhanced care management (ECM) teams under Medi‑Cal. The bill directs the Department of Health Care Services to require each ECM provider to maintain an interdisciplinary care team that includes at least one peer support specialist who is accessible to ECM members and who performs outreach, care‑planning support, warm handoffs, and culturally responsive, trauma‑informed peer services.
The bill also restricts the use of criminal background checks as a sole or primary basis to disqualify someone from serving as a peer support specialist, while preserving the department’s authority to comply with federal screening mandates and setting‑specific safety rules. Implementation is conditional on obtaining any needed federal approvals and on federal financial participation being available, and the department must reflect the requirement in contracts, guidance, and monitoring systems.
At a Glance
What It Does
AB 2138 creates statutory requirements that ECM providers include at least one peer support specialist on their interdisciplinary teams, lists core peer functions, and permits multiple staffing models (employment, contracting, shared staffing, or CBO partnerships). It also bars categorical disqualification of peers based solely on criminal background checks, subject to federal law and setting‑specific mandates.
Who It Affects
Directly affects ECM providers contracted by Medi‑Cal managed care plans, Medi‑Cal managed care plans themselves (contracts and monitoring), peer support specialists and potential hires, and community‑based organizations that supply peer personnel. It also imposes administrative tasks on the Department of Health Care Services to revise contracts, guidance, and compliance mechanisms.
Why It Matters
The statute elevates peer support from an optional service to a required component of ECM operations, changing hiring, contracting, and supervision practices across the Medi‑Cal managed care system. It creates a standardized expectation for peer roles while navigating federal screening rules, which has implications for workforce supply, program costs, and member engagement strategies.
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What This Bill Actually Does
AB 2138 writes into state law two linked changes: a prohibition on automatically disqualifying peer support specialists because of criminal history (with defined exceptions), and a requirement that every ECM provider include at least one peer support specialist integrated into day‑to‑day ECM delivery. The bill uses existing statutory references for definitions (for example, the term “peer support specialist” as already defined in state law) and places the new duties within the CalAIM/ECM framework.
Rather than prescribing a single employment model, it allows flexibility in how providers meet the requirement — direct hire, contract, shared staffing, or partnership with community organizations — provided the peer is meaningfully accessible to members.
The peer’s role is described by example rather than exhaustive scope: outreach and engagement (including hard‑to‑engage members), assistance with self‑advocacy and navigation across behavioral health, substance use, housing and social services, participation in care planning and transitions after crises or inpatient episodes, and delivery of culturally responsive, trauma‑informed support grounded in lived experience. The bill expressly preserves the department’s authority to set clinical, documentation, supervision, and quality standards for ECM so that peers work within established safety and documentation systems.On background screening, the bill disallows disqualification based solely or primarily on criminal background checks for peer roles, but it carves out multiple limits: the prohibition yields where federal law requires specific screening to secure federal financial participation; where setting‑specific rules (for example, schools or certain facilities) mandate checks for all staff; and where supervisors adopt individualized safety and suitability policies that consider rehabilitation and relevance to job duties.
Finally, the statute is explicitly conditional: the department must obtain any necessary federal approvals and ensure federal financial participation is available before it implements the background‑screening limitation, and the department must incorporate the new team requirement into managed‑care contracts, guidance, and monitoring practices.
The Five Things You Need to Know
The bill adds Section 14045.195 creating a statutory bar on disqualifying a peer support specialist solely or primarily because of a criminal background or fingerprint check, while allowing consideration of criminal history as part of overall fitness.
Section 14184.2051 requires each ECM provider to maintain an interdisciplinary care team that includes at least one peer support specialist who is integrated into ECM service delivery and available to members.
The statute enumerates peer functions — outreach and engagement, supporting self‑advocacy and navigation, assisting with care planning and warm handoffs after inpatient or crisis episodes, and providing culturally responsive, trauma‑informed relationship‑based support.
The department may permit any combination of staffing models (employment, contracting, shared staffing, or community‑based partnerships) to meet the peer requirement, so long as accessibility and meaningful integration are maintained.
Both the background‑screening restriction and the team requirement are subject to the department obtaining necessary federal approvals and to the availability of federal financial participation; the bill requires DHCS to update contracts, guidance, and monitoring accordingly.
Section-by-Section Breakdown
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Why peers belong in ECM and the Legislature’s goals
This prefatory section explains the policy rationale: ECM serves populations with complex clinical and social needs (serious mental illness, SUD, justice involvement, homelessness) and peer specialists improve engagement and outcomes. The Legislature frames the change as strengthening whole‑person care, removing barriers that exclude qualified peers, and ensuring expansion occurs in ways consistent with federal Medicaid rules and safety requirements.
Limits on categorical disqualification for peer support specialists
This new section prohibits disqualifying a peer support specialist solely or primarily because of criminal background checks, fingerprint checks, or similar screening when such checks are conditions of employment, contracting, certification, credentialing, enrollment, or participation. It preserves the ability to consider criminal history as part of overall fitness and explicitly defers to federal law (including 42 C.F.R. §455.434) and setting‑specific federal or state screening mandates. The provision also authorizes individualized, job‑related suitability policies that assess rehabilitation and relevance.
Definitions and core ECM team requirement
This subsection defines terms (ECM, ECM provider, peer support specialist, interdisciplinary care team) and imposes the substantive obligation: as a condition of furnishing ECM, each ECM provider must have an interdisciplinary team that includes at least one peer support specialist integrated into service delivery and accessible to ECM members. The mechanics make the presence of a peer a contractual and operational requirement for providers who deliver ECM.
Enumerated peer functions and flexible staffing models
The statute lists illustrative peer functions — outreach and engagement, navigation and advocacy, care planning, transition assistance, and culturally responsive, trauma‑informed support — anchoring the role in practical activities rather than an abstract title. It then permits ECM providers to meet the requirement through various staffing approaches, including contracting or partnerships with community‑based organizations, so long as the peer role is meaningfully integrated and accessible to members.
Contracting, monitoring, and preservation of regulatory authority
DHCS must incorporate the peer requirement into managed‑care plan contracts, policies, and guidance and establish monitoring and compliance mechanisms. The section also clarifies that nothing in the new law limits the department’s authority to set clinical, documentation, quality, supervision, or other standards, or to require compliance with state and federal law — preserving typical regulatory levers to shape how peers are supervised and how their work is documented.
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Explore Healthcare in Codify Search →Who Benefits and Who Bears the Cost
Every bill creates winners and losers. Here's who stands to gain and who bears the cost.
Who Benefits
- High‑need Medi‑Cal members (those in ECM): They will have more consistent access to peers who can improve engagement, support navigation, and smooth transitions after crises, potentially reducing avoidable ED visits and hospitalizations.
- Peer support specialists with lived experience (including people with prior justice involvement): The bill reduces categorical exclusionary barriers tied to criminal history and creates more explicit employment pathways within ECM.
- Community‑based organizations (CBOs) that train or supply peers: The flexibility to meet the requirement through contracts or partnerships creates new revenue and partnership opportunities for CBOs.
- Managed care plans and health systems focused on outcomes: Plans may gain a standardized tool (peers on teams) to drive member engagement and possibly lower utilization and costs tied to crises.
Who Bears the Cost
- ECM providers and Medi‑Cal managed care plans: They will absorb hiring, contracting, supervision, training, and administrative costs to integrate peers and comply with new contract and monitoring requirements.
- Department of Health Care Services (DHCS): DHCS must revise contracts and guidance, establish monitoring and compliance systems, and pursue federal approvals — work that will require implementation capacity and possibly additional funding.
- Facilities and settings with mandatory federal background checks (e.g., certain skilled‑nursing facilities, schools): These sites will still need to follow screening mandates, complicating placement and staffing for peers and potentially increasing administrative coordination costs.
- State or local budgets if federal financial participation is unavailable: Because implementation is conditioned on FFP, failure to secure federal funding could push costs onto state or county budgets or delay roll‑out.
Key Issues
The Core Tension
The bill balances two legitimate objectives that pull in opposite directions: expanding access to peer specialists by removing categorical criminal‑history exclusions versus maintaining safety, compliance with federal screening requirements, and program integrity; resolving that tension depends on DHCS’s ability to secure federal approvals, craft nuanced guidance, and fund meaningful supervision and workforce supports.
The bill’s central operational challenge is marrying the policy goal of expanding peer access with the complex web of federal Medicaid rules and setting‑specific screening mandates. The statutory bar on categorical disqualification aims to remove exclusionary hiring practices, but the provision is explicitly subordinate to federal regulations that may require criminal‑history screening for certain services or settings.
That creates administrative complexity: DHCS must identify where federal law permits flexibility, seek waivers or approvals where necessary, and design monitoring that enforces the requirement without jeopardizing federal financial participation.
A second tension lies in workforce reality and program integrity. Requiring “at least one” peer per ECM provider is administratively simple but risks tokenism if programs do not fund sufficient FTEs, supervision, or training.
Conversely, stronger supervision and documentation requirements raise costs and may disincentivize smaller CBOs from supplying peers. The bill preserves DHCS’s authority to set clinical and supervision standards — a necessary control point — but those standards will determine whether peers operate as integrated team members or as peripheral add‑ons.
Finally, liability, credentialing variability across counties, and site‑specific safety concerns (for example, peers placed in schools or inpatient settings subject to federal checks) will require careful operational guidance to avoid placement bottlenecks.
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