Does Insurance Cover ABA Therapy in Colorado?
Find out if your Colorado plan covers ABA and exactly what to ask before you call an agency.
How Colorado's autism mandate works
Colorado requires state-regulated health plans to cover autism treatment, including ABA. That mandate applies to fully insured plans, which are the ones you buy through the individual marketplace or get from a smaller employer that buys a state-regulated policy.
But a large employer often self-funds its health plan. That means the employer pays claims directly, and the plan is governed by federal ERISA law, not state rules. A self-funded plan is not legally bound by Colorado's autism mandate, though many choose to cover ABA anyway.
That is why two families at the same company can get different answers. One may have a fully insured plan with mandated coverage, the other a self-funded plan with no legal requirement. The only way to know is to check your specific plan.
The exact question to ask HR
Before you call an ABA agency, get the facts from your employer. Ask HR one precise question: 'Is our health plan fully insured or self-funded?'
If it is fully insured, Colorado's mandate applies, and your plan must cover medically necessary ABA. If it is self-funded, the mandate does not apply, but the plan may still cover ABA voluntarily.
Then call the customer service number on your insurance card and ask: 'Does my plan cover applied behavior analysis for autism? Are there any visit limits, age limits, or dollar caps?' Write down the date, the representative's name, and their answer.
What prior authorization requires
Most plans require prior authorization before ABA starts. That means your provider sends a treatment plan to the insurer, and the insurer approves it before sessions begin.
The treatment plan typically includes a diagnosis of autism, a prescription or referral from a doctor, and a detailed behavior plan with goals. Your ABA agency usually handles the paperwork, but you need to make sure the diagnosis is current and the referral is in place.
Ask your insurer how long the authorization takes and whether it needs to be renewed. Many plans require a new authorization every six or twelve months.
What to do if you get a denial
If your plan denies ABA, you have the right to appeal. Start by reading the denial letter carefully. It will state the reason and the deadline to appeal, which is often 180 days.
File an internal appeal with your insurer first. Include a letter from your child's doctor explaining why ABA is medically necessary. If the internal appeal fails, you can request an external review by an independent third party.
Colorado has a consumer assistance program that can help you with appeals. Call the Colorado Division of Insurance or visit their website for free help. Do not give up after one denial; many appeals succeed.
Health First Colorado for eligible families
If your income qualifies, Health First Colorado (Colorado's Medicaid program) covers medically necessary ABA for children under 21. This is through the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit.
To apply, go to the Colorado PEAK website or call the county human services office. You will need proof of income, residency, and your child's diagnosis.
Once enrolled, you will be assigned to a managed care plan. The plan name is on your member card. Call that plan to find ABA providers in their network.
Where ABA providers are located
Colorado has a wide network of ABA agencies. We list agencies across many counties, so you are likely to find one near you.
The largest concentrations are in El Paso County, Denver County, and Arapahoe County. Even in rural counties, there are often options, though you may need to travel or ask about telehealth.
Colorado listings right now
932 ABA agencies across 40 Colorado counties.