Does Insurance Cover ABA Therapy in Colorado? A Parent Guide

Often, yes. But “does insurance cover ABA?” really has two parts: does your plan cover it at all, and what will you still pay? The answer depends on what kind of plan you have. Here’s how it works in Colorado, in plain English.

The short answer

Colorado law requires state-regulated health plans to cover the assessment, diagnosis, and treatment of autism spectrum disorder when treatment is medically necessary. The Colorado Division of Insurance says commercial plans must meet minimum coverage requirements for autism treatment, including applied behavior analysis (ABA). Health First Colorado, the state’s Medicaid program, also covers behavioral therapies for children and youth through prior authorization.

That still leaves room for differences. Some plans aren’t covered by the state law, approvals can limit hours, and covered care can still come with a deductible or coinsurance. So the most useful next step is always to check your own plan.

What Colorado’s autism law covers

The law is Section 10-16-104 (1.4) of the Colorado Revised Statutes. A memo from the legislature’s nonpartisan research staff summarizes it: health benefit plans issued or renewed in Colorado must provide coverage to assess, diagnose, and treat autism spectrum disorder. Covered treatment includes evaluation and assessment, behavior training and management, and therapeutic care that includes applied behavior analysis. Treatment must be medically necessary.

“Medically necessary” is the key phrase you’ll hear again and again. In practice, it means a qualified clinician assesses your child, writes a treatment plan, and your plan reviews that plan before agreeing to pay for it.

The big exception: self-funded plans

Here’s the part many parents never hear. Colorado’s insurance mandates apply to fully insured plans regulated by the Division of Insurance. According to the same legislative memo, plans outside the Division’s jurisdiction are not subject to the state’s mandated benefit laws. That includes:

Self-funded employer plans, where the employer pays claims and an insurance company or administrator runs the plan
Union plans and federal employee plans
Government plans such as Medicaid and Medicare
Plans issued in other states

Many employers, especially large ones, self-fund their health plans, and your insurance card typically looks the same either way. If your coverage comes through work, ask your HR or benefits team one simple question: “Is our health plan fully insured or self-funded?” A self-funded plan can still cover ABA; it just follows its own plan documents rather than the state mandate. Your Summary Plan Description will spell out what’s included.

If your child has Health First Colorado

Health First Colorado covers ABA under its Pediatric Behavioral Therapies benefit, part of the EPSDT benefit for members age 20 and under. The state describes the process this way:

Assessment and plan. A contracted provider assesses your child, puts together a treatment plan, and submits a Prior Authorization Request (PAR).
Review. Licensed clinical reviewers check whether the requested services are medically necessary. Both you and the provider get a letter with the decision.
Approval. An approved PAR says how many hours may be provided, and it is valid for up to six months. To continue, the provider submits a new PAR.
If it’s denied. Before a denial, the requesting provider is offered a peer-to-peer conversation with the reviewer. After a denial, the provider can ask for a reconsideration, and you can file a written appeal with the Office of Administrative Courts within 30 calendar days of the notice.

Medicaid may also require additional documentation from your child’s doctor, so it helps to keep diagnosis paperwork handy.

What you might still pay

Coverage isn’t the same as free. Even mandated benefits may still come with deductibles, coinsurance, or other cost sharing. Before therapy starts, ask your plan about your deductible, your copay or coinsurance for ABA, and your out-of-pocket maximum, which caps what you pay in a plan year. Because ABA often involves regular sessions, those numbers matter. We won’t guess at your costs, because every plan is different, but we can help you understand what to ask.

Questions to ask your insurance

Is ABA therapy covered for my child’s diagnosis?
Is my plan fully insured or self-funded?
Is the provider I’m considering in network?
Do I need a referral or a diagnosis from a specific type of provider?
Is prior authorization required for the assessment, for therapy, or both?
Are there limits on hours, and how often does approval need to be renewed?
Is in-home ABA covered the same way as clinic-based ABA?

Write down the date, the name of the person you spoke with, and any reference number. It makes follow-up calls much easier.

How Attain can help

We accept Aetna, UMR, Health First Colorado (Colorado’s Medicaid program), Cigna, Blue Cross Blue Shield, and Optum. Coverage depends on your specific plan, and you don’t have to figure it out alone: we check your benefits for you before the assessment. We also offer private pay and out-of-network options. See our Insurance & Coverage page for plan-by-plan notes, or ask us about coverage.

Does Insurance Cover ABA Therapy in Colorado?