For many Colorado families, figuring out insurance coverage for ABA therapy can feel confusing. You may hear that Colorado has an autism insurance mandate, but still wonder what that actually means for your child, your plan, and your out-of-pocket costs.
The good news is that many Colorado insurance plans are required to cover medically necessary autism treatment, including Applied Behavior Analysis, or ABA therapy. However, coverage can depend on the type of insurance plan you have.
At Best Buds ABA, we know how overwhelming insurance questions can feel, especially when you are trying to get support started for your child. Here are the most important things Colorado families should know.
Colorado Has an Autism Insurance Mandate
Colorado requires many state-regulated health insurance plans to cover the assessment, diagnosis, and treatment of autism spectrum disorder. This can include ABA therapy when it is considered medically necessary.
Colorado’s autism insurance law began with Senate Bill 09-244, which became effective in 2010. It was later strengthened by Senate Bill 15-015, which became effective in 2017 and helped remove previous age and dollar limits for covered autism services.
In simple terms, if your child has an autism diagnosis and your plan is subject to Colorado’s autism insurance requirements, your insurance may be required to cover medically necessary ABA therapy.
The Type of Insurance Plan Matters
Even though Colorado has strong autism insurance protections, not every plan follows the same rules.
In general, the mandate applies to many fully insured, state-regulated plans. These may include certain individual plans, small group plans, marketplace plans, and employer plans that are regulated by the state of Colorado.
However, some employers use self-funded or self-insured plans. These plans are often governed by federal ERISA rules, which means Colorado’s state insurance mandate may not apply in the same way. Some self-funded plans still cover ABA therapy, but coverage depends on the specific plan.
A helpful first step is to call the number on your insurance card and ask:
“Is my plan fully insured or self-funded?”
That one question can help you better understand which coverage rules may apply.
What ABA Coverage May Include
When ABA therapy is covered, insurance may help pay for services such as:
- An initial behavioral assessment
- A personalized treatment plan
- One-on-one ABA therapy sessions
- Parent or caregiver training
- Ongoing supervision and progress updates
Most insurance plans will require documentation before approving ABA therapy. This may include an autism diagnosis, a recommendation for ABA therapy, and a treatment plan showing that services are medically necessary.
Does Health First Colorado Cover ABA Therapy?
Health First Colorado, Colorado’s Medicaid program, may cover pediatric behavioral therapies for eligible children when services meet medical necessity requirements. According to Colorado’s Department of Health Care Policy & Financing, behavioral therapies must be authorized before treatment starts. A contracted Medicaid provider typically completes an assessment, creates a treatment plan, and submits a Prior Authorization Request for review.
If your child has both private insurance and Medicaid, private insurance may need to be billed first before Medicaid helps with remaining eligible costs.
Prior Authorization
Even when ABA therapy is covered, families should expect an approval process before therapy begins. This is called prior authorization.
During this step, the insurance company reviews your child’s diagnosis, assessment, recommended therapy hours, and treatment goals. Approval is usually needed before services can begin or continue.
If coverage is denied, or if fewer hours are approved than recommended, families may have the right to appeal the decision.
Insurance can be one of the most stressful parts of starting therapy, but you do not have to figure it out alone.
Best Buds ABA provides ABA therapy services for children and families in Colorado and Nevada. Our team can help families better understand their ABA therapy options, verify benefits, and guide them through the next steps so children can begin receiving meaningful support.
Have questions about ABA therapy coverage in Colorado? Contact Best Buds ABA today to learn how our team can help your family get started.
Sources:
Autism Speaks: Colorado State-Regulated Insurance Coverage
Colorado Department of Health Care Policy & Financing: Pediatric Behavioral Therapies
Colorado HCPF: Pediatric Behavioral Therapies Information for Providers
Colorado HCPF: Pediatric Behavioral Therapies Billing Manual