As of January 2024, Medicare began covering intensive outpatient program (IOP) services for people with mental health conditions and substance use disorders (SUD). With this expanded coverage, IOPs that meet Medicare and/or a state’s Medicaid eligibility requirements can now receive reimbursement for treating individuals dually eligible for both programs.

Yet, despite this coverage expansion filling a critical gap in care for dually eligible individuals, providers have expressed confusion about whether and how they can receive reimbursement for treating people who are enrolled in both Medicare and Medicaid. Drawing from the Center for Health Care Strategies (CHCS) brief, Expanded Medicare Coverage of Intensive Outpatient Services: Considerations for States, and from questions received by CHCS from providers in the field, this fact sheet offers answers to common questions from providers about how they can adapt their IOP services to receive reimbursement from Medicare and/or Medicaid when treating dually eligible individuals.