MEDI-CAL PEER SUPPORT SPECIALIST | NEW UPDATED EXAM
2026/2027 | QUESTIONS AND VERIFIED SOLUTIONS
Q1. What is Medi-Cal? ANSWER California's Medicaid program
providing free or low-cost health coverage to eligible residents.
Q2. Who administers Medi-Cal? ANSWER The California Department of
Health Care Services (DHCS).
Q3. What is the Mental Health Services Act (MHSA)? ANSWER A
California law funded by Proposition 63 that expands mental health
services, including peer support.
Q4. What does "Medi-Cal managed care" mean? ANSWER Medi-Cal
benefits delivered through contracted health plans rather than fee-for-
service.
Q5. What is a County Mental Health Plan (MHP)? ANSWER A county-
operated system responsible for delivering specialty mental health
services to Medi-Cal beneficiaries.
Q6. What is the role of DHCS in peer support services? ANSWER
DHCS sets policies, reimbursement rates, and provider qualifications for
Medi-covered services.
Q7. What is an Individualized Recovery Plan (IRP)? ANSWER A
person-centered plan documenting recovery goals and services, including
peer support.
Q8. What is EPSDT? ANSWER Early and Periodic Screening, Diagnostic,
and Treatment — a Medi-Cal benefit for individuals under 21.
Q9. Are peer support services covered under Medi-Cal? ANSWER Yes,
when provided by qualified peer support specialists as part of a covered
benefit.
,Q10. What is a "peer" in the Medi-Cal context? ANSWER Someone
with lived experience of mental health challenges or substance use who is
in recovery.
Q11. What is the difference between Medi-Cal and Medicare?
ANSWER Medi-Cal is state/federal for low-income; Medicare is federal for
65+ or disabled.
Q12. What is a Medi-Cal beneficiary? ANSWER An enrolled individual
eligible to receive Medi-Cal covered services.
Q13. What is a Provider Identification Number (PIN)? ANSWER A
number assigned to providers for billing and service delivery tracking.
Q14. What is the role of the County Behavioral Health Department?
ANSWER To plan, coordinate, and oversee mental health and substance
use services in the county.
Q15. What is a "straight" Medi-Cal card? ANSWER Traditional fee-for-
service Medi-Cal not enrolled in managed care.
Q16. What is CalAIM? ANSWER California Advancing and Innovating
Medi-Cal — a transformation initiative integrating physical and behavioral
health.
17. What are Enhanced Care Management (ECM) services? ANSWER
Intense care coordination services under CalAIM for high-need
beneficiaries.
Q18. What is Community Supports under CalAIM? ANSWER Non-
clinical services like housing transition assistance and respite.
Q19. Can peer specialists bill Medi-Cal directly? ANSWER Typically
no; they bill through an enrolled provider agency.
Q20. What is a Treatment Authorization Request (TAR)? ANSWER A
request for approval of certain Medi-Cal services before delivery.
Q21. What does "medical necessity" mean? ANSWER Services must be
reasonable, necessary, and appropriate for the beneficiary's condition.
Q22. What is the 1115 Waiver? ANSWER A federal waiver allowing
California to test new approaches in Medi-Cal.
, Q23. What is the role of the Mental Health Plan in authorizing
services? ANSWER To determine medical necessity and authorize
specialty mental health services.
Q24. What is a grievance in Medi-Cal? ANSWER A complaint about
quality of care or services.
Q25. What is an appeal? ANSWER A request to reverse a denial,
reduction, or termination of services.
Q26. What is a State Hearing? ANSWER A formal hearing before an
Administrative Law Judge regarding Medi-Cal disputes.
Q27. What is the Medi-Cal Share of Cost? ANSWER The amount a
beneficiary must pay before Medi-Cal coverage begins.
Q28. What is a Managed Care Plan (MCP)? ANSWER A health plan
contracted with DHCS to provide Medi-Cal benefits.
Q29. What is the Behavioral Health Integration Incentive? ANSWER A
CalAIM initiative encouraging coordination between physical and
behavioral health.
Q30. What is the Provider Enrollment Division? ANSWER The DHCS
unit responsible for enrolling providers in Medi-Cal.
2. Peer Support Role & Scope of Practice (31–60)
Q31. What is the primary role of a Peer Support Specialist? ANSWER
To use lived experience to inspire hope and support recovery.
Q32. Can a peer specialist diagnose mental illness? ANSWER No,
diagnosis is outside the peer support scope of practice.
Q33. Can a peer specialist prescribe medication? ANSWER No, only
licensed prescribers can prescribe medication.
Q34. Can a peer specialist provide therapy? ANSWER No, therapy
requires a clinical license.
Q35. What is "lived experience"? ANSWER Personal experience
navigating mental health or substance use challenges.
Q36. What does "mutuality" mean in peer support? ANSWER A
reciprocal relationship where both parties benefit and learn.
2026/2027 | QUESTIONS AND VERIFIED SOLUTIONS
Q1. What is Medi-Cal? ANSWER California's Medicaid program
providing free or low-cost health coverage to eligible residents.
Q2. Who administers Medi-Cal? ANSWER The California Department of
Health Care Services (DHCS).
Q3. What is the Mental Health Services Act (MHSA)? ANSWER A
California law funded by Proposition 63 that expands mental health
services, including peer support.
Q4. What does "Medi-Cal managed care" mean? ANSWER Medi-Cal
benefits delivered through contracted health plans rather than fee-for-
service.
Q5. What is a County Mental Health Plan (MHP)? ANSWER A county-
operated system responsible for delivering specialty mental health
services to Medi-Cal beneficiaries.
Q6. What is the role of DHCS in peer support services? ANSWER
DHCS sets policies, reimbursement rates, and provider qualifications for
Medi-covered services.
Q7. What is an Individualized Recovery Plan (IRP)? ANSWER A
person-centered plan documenting recovery goals and services, including
peer support.
Q8. What is EPSDT? ANSWER Early and Periodic Screening, Diagnostic,
and Treatment — a Medi-Cal benefit for individuals under 21.
Q9. Are peer support services covered under Medi-Cal? ANSWER Yes,
when provided by qualified peer support specialists as part of a covered
benefit.
,Q10. What is a "peer" in the Medi-Cal context? ANSWER Someone
with lived experience of mental health challenges or substance use who is
in recovery.
Q11. What is the difference between Medi-Cal and Medicare?
ANSWER Medi-Cal is state/federal for low-income; Medicare is federal for
65+ or disabled.
Q12. What is a Medi-Cal beneficiary? ANSWER An enrolled individual
eligible to receive Medi-Cal covered services.
Q13. What is a Provider Identification Number (PIN)? ANSWER A
number assigned to providers for billing and service delivery tracking.
Q14. What is the role of the County Behavioral Health Department?
ANSWER To plan, coordinate, and oversee mental health and substance
use services in the county.
Q15. What is a "straight" Medi-Cal card? ANSWER Traditional fee-for-
service Medi-Cal not enrolled in managed care.
Q16. What is CalAIM? ANSWER California Advancing and Innovating
Medi-Cal — a transformation initiative integrating physical and behavioral
health.
17. What are Enhanced Care Management (ECM) services? ANSWER
Intense care coordination services under CalAIM for high-need
beneficiaries.
Q18. What is Community Supports under CalAIM? ANSWER Non-
clinical services like housing transition assistance and respite.
Q19. Can peer specialists bill Medi-Cal directly? ANSWER Typically
no; they bill through an enrolled provider agency.
Q20. What is a Treatment Authorization Request (TAR)? ANSWER A
request for approval of certain Medi-Cal services before delivery.
Q21. What does "medical necessity" mean? ANSWER Services must be
reasonable, necessary, and appropriate for the beneficiary's condition.
Q22. What is the 1115 Waiver? ANSWER A federal waiver allowing
California to test new approaches in Medi-Cal.
, Q23. What is the role of the Mental Health Plan in authorizing
services? ANSWER To determine medical necessity and authorize
specialty mental health services.
Q24. What is a grievance in Medi-Cal? ANSWER A complaint about
quality of care or services.
Q25. What is an appeal? ANSWER A request to reverse a denial,
reduction, or termination of services.
Q26. What is a State Hearing? ANSWER A formal hearing before an
Administrative Law Judge regarding Medi-Cal disputes.
Q27. What is the Medi-Cal Share of Cost? ANSWER The amount a
beneficiary must pay before Medi-Cal coverage begins.
Q28. What is a Managed Care Plan (MCP)? ANSWER A health plan
contracted with DHCS to provide Medi-Cal benefits.
Q29. What is the Behavioral Health Integration Incentive? ANSWER A
CalAIM initiative encouraging coordination between physical and
behavioral health.
Q30. What is the Provider Enrollment Division? ANSWER The DHCS
unit responsible for enrolling providers in Medi-Cal.
2. Peer Support Role & Scope of Practice (31–60)
Q31. What is the primary role of a Peer Support Specialist? ANSWER
To use lived experience to inspire hope and support recovery.
Q32. Can a peer specialist diagnose mental illness? ANSWER No,
diagnosis is outside the peer support scope of practice.
Q33. Can a peer specialist prescribe medication? ANSWER No, only
licensed prescribers can prescribe medication.
Q34. Can a peer specialist provide therapy? ANSWER No, therapy
requires a clinical license.
Q35. What is "lived experience"? ANSWER Personal experience
navigating mental health or substance use challenges.
Q36. What does "mutuality" mean in peer support? ANSWER A
reciprocal relationship where both parties benefit and learn.
