Reviewed by a Board Certified Behavior Analyst (BCBA) at Achieve ABA Therapy Group · Updated June 2026
Colorado has one of the more protective autism insurance laws in the country, with no age caps and no dollar caps on covered, state-regulated plans. That is genuinely good news for families, but the protection only helps when you know how to claim it.
Many parents I work with are surprised to learn the mandate does not reach every plan. In this article, I’ll explain more about autism insurance coverage in Colorado in plain terms: who the state mandate covers, how Medicaid and military benefits can help, what you might pay out of pocket, and the steps to move from a diagnosis to approved ABA therapy.
Understanding Autism Insurance Coverage in Colorado
Colorado has had a strong autism insurance law on the books for more than a decade. Knowing what it requires, and where its limits sit, gives you a realistic place to start.
What the State Mandate Requires
Colorado’s autism mandate began with Senate Bill 09-244, which took effect on July 1, 2010 and is now part of state law as C.R.S. 10-16-104. In 2015, Senate Bill 15-015 strengthened it by removing all age and dollar caps, effective January 1, 2017. That detail is a meaningful one for families, because many states still limit coverage by a child’s age or cap the yearly dollar amount, and Colorado no longer does either.
The law requires covered plans to pay for the assessment, diagnosis, and treatment of autism spectrum disorder, including ABA. It also requires that this coverage be no less favorable than the coverage your plan provides for physical illness.
How Parity Protections Strengthen Your Coverage
That last point connects to a broader protection called mental health parity. Federal and Colorado parity laws require many plans to treat behavioral health benefits on roughly equal footing with medical and surgical benefits.
In practice, that means a plan generally cannot apply tougher visit limits, higher copays, or stricter authorization hurdles to your child’s ABA than it would to a comparable physical health service. Parity does not guarantee unlimited care, but it gives families real leverage when a limit looks unfair.
The Question That Decides Your Rights: Plan Type
Here is the part that catches most parents off guard. The state mandate does not apply to every insurance plan in Colorado. Whether it applies to you depends on whether your plan is state-regulated or self-funded. Sorting that out first will save you a great deal of confusion down the line.
State-Regulated Plans vs. Self-Funded (ERISA) Plans
These two categories follow different rulebooks. One answers to Colorado law, and the other answers to federal law.
State-Regulated (Fully Insured) Plans
If your employer buys coverage from an insurance company, or you purchased a plan through Connect for Health Colorado, the state marketplace, your plan is most likely state-regulated. These plans are overseen by the Colorado Division of Insurance and are bound by the state autism mandate. For your family, that means ABA for a child with an autism diagnosis is a covered benefit when it is medically necessary.
Self-Funded / ERISA Plans
Many large employers pay employee medical claims from their own funds rather than buying insurance. These self-funded plans are governed by a federal law known as ERISA, and state mandates generally do not apply to them. Some self-funded employers choose to cover ABA anyway, and many do, but Colorado law does not require it. If you work for a large national company, a school district, or another big employer, there is a good chance your plan falls into this group.
How to Tell Which One You Have
- Read your plan documents, including your Summary Plan Description and the information on your insurance card.
- Look for a state regulation reference. State-regulated plans often cite Colorado insurance rules, while self-funded plans usually do not.
- Ask your HR or benefits team directly: is our health plan fully insured or self-funded?
- Contact the Colorado Division of Insurance, part of the Department of Regulatory Agencies, if you are still unsure.
Coverage Paths Beyond Private Insurance
Private insurance is only one route to ABA. For many Colorado families, public programs and military benefits fill important gaps, and sometimes they work alongside a private plan.
Health First Colorado (Medicaid) and EPSDT
Health First Colorado, the state’s Medicaid program, may cover ABA for eligible children under 21. This runs through a benefit called EPSDT, which stands for Early and Periodic Screening, Diagnostic, and Treatment, and it requires Medicaid to cover medically necessary services a child needs, including behavioral therapy, when the criteria are met.
The Health First Colorado pediatric behavioral therapies benefit, administered by the Colorado Department of Health Care Policy and Financing, spells out how this works. Families who have both private insurance and Medicaid usually use private coverage first, with Medicaid helping toward remaining costs.
Medicaid Waivers for Higher-Need Children
Some children qualify for a Home and Community Based Services (HCBS) waiver, such as Colorado’s Children’s Extensive Support (CES) waiver. These waivers are designed for children with significant support needs who live at home, and they can help cover services and supports beyond what a standard plan offers, including respite for caregivers.
Eligibility is based on your child’s level of need rather than household income alone, so it is worth asking your case management agency whether your child might qualify.
TRICARE and Military Families in Colorado
Colorado is home to a large military community, with families connected to Fort Carson, Peterson and Buckley Space Force Bases, Schriever, and the Air Force Academy. For these families, TRICARE covers ABA through the Autism Care Demonstration, a program currently authorized through the end of 2028.
Active duty families generally need to enroll their child in the Exceptional Family Member Program (EFMP) and the Extended Care Health Option (ECHO) to access ABA. We work with military-connected families in the Colorado Springs and Aurora areas and can help you understand the steps involved.
What ABA Coverage Costs Your Family
Coverage rarely means zero out of pocket. Knowing the common cost terms ahead of time helps you plan and avoid surprises on your first bill.
Deductibles, Copays, and Coinsurance
A deductible is the amount you pay before your plan starts sharing costs. A copay is a flat fee for a service, and coinsurance is a percentage of the cost you pay after meeting your deductible. Because ABA is often delivered for many hours each week, these amounts can add up, so it helps to understand them before therapy begins.
Your Out-of-Pocket Maximum
Every plan that follows Affordable Care Act rules has an out-of-pocket maximum, a yearly ceiling on what you pay for covered, in-network care. Once you reach it, your plan covers 100 percent of covered services for the rest of the plan year. For families using a lot of ABA hours, this cap can offer real financial relief, and it is one of the most useful numbers to know in your plan.
Questions to Ask Before You Start
- Is my plan state-regulated or self-funded?
- Is ABA a covered benefit, and is prior authorization required?
- What is my deductible, copay, or coinsurance for ABA, and what is my out-of-pocket maximum?
- Is my chosen provider in network, and are there any visit or hour limits?
- What documentation does the plan need to approve services?
Getting Your Child’s ABA Therapy Approved
Coverage on paper is one thing. Turning it into approved sessions takes a few concrete steps, and knowing them ahead of time keeps the process moving.
Diagnosis and Medical Necessity
In most cases, ABA approval starts with a formal autism spectrum disorder diagnosis from a qualified provider, such as a developmental pediatrician, psychologist, or neurologist. From there, a BCBA, the Board Certified Behavior Analyst who designs and oversees ABA programs, completes an assessment and documents medical necessity, which is the clinical reason your child needs the service.
If you want a refresher on the people involved, our guide to RBT vs BCBA roles explains who does what.
Prior Authorization, Step by Step
Most plans require prior authorization before therapy begins, which means the insurer reviews and approves the treatment plan first. In my experience, the requests that move fastest are the ones with complete paperwork: the diagnostic report, the assessment, and a clear plan of care. We handle these submissions for the families we serve so the documentation is right the first time. If you are new to the approach itself, our plain-language ABA guide is a helpful starting point.
Timelines You Can Expect in Colorado
For state-regulated plans, Colorado sets clear timeframes. When your provider requests prior authorization, the insurer generally must decide within 15 days. For a claim on care already received, the decision generally comes within 30 days, unless the plan requests more time. Knowing these windows helps you follow up at the right moment instead of waiting in the dark.
What to Do If Your Claim Is Denied
A denial feels discouraging, but it is often just one step in a longer conversation. Colorado gives families a clear, layered appeal process, and many denials are overturned with the right documentation.
Start With an Internal Appeal
Your first move is a first-level internal appeal, where you ask the insurer to review its decision again. In Colorado, you generally have 180 days from the denial to request this review. Your denial letter should explain the reason, which tells you what to address. Your provider can supply additional records to support medical necessity.
Request an External Review
If the internal appeal does not change the outcome, you can request an external review, in which an independent medical professional examines your case. You generally have four months after the first-level decision to request it, and if the reviewer finds the care medically necessary, your plan must cover it. The Colorado Division of Insurance oversees this independent review process.
File a Complaint With the Division of Insurance
If you have a state-regulated plan and believe your rights under the mandate were not honored, you can file a complaint through the Colorado Division of Insurance consumer portal. An analyst reviews the complaint, asks your insurer to respond, and investigates whether a law or regulation was violated. This option does not apply to self-funded ERISA plans, which follow a separate federal process.
How We Help Colorado Families Navigate Coverage
Understanding coverage is easier with a team that does this work every day. At Achieve ABA Therapy Group, we help families across the state turn benefits into real services for their children.
Our Services and Service Areas
- ABA therapy services, individualized to each child’s strengths and goals.
- Summer ABA therapy, to keep skills steady when school is out.
- Care across Colorado, including Denver, Aurora, Colorado Springs, Fort Collins, Lakewood, Pueblo, Thornton, Westminster, Arvada, and Boulder.
Talk to Our Team
Have questions about autism insurance coverage in Colorado? We can verify your benefits and walk you through the next steps. Call us at 720-463-9000 or contact Achieve ABA.
Frequently Asked Questions
A few questions come up in nearly every coverage conversation. Here are clear answers.
Does Colorado require insurance to cover ABA therapy?
Colorado’s autism mandate requires state-regulated health plans to cover medically necessary ABA for a child with an autism diagnosis, with no age or dollar caps. Self-funded ERISA plans are not bound by the state mandate, though some choose to cover ABA voluntarily.
Is there an age limit for autism coverage in Colorado?
For state-regulated plans, no. Colorado removed all age and dollar caps effective January 1, 2017. It is still wise to confirm the specifics with your own plan, since self-funded plans follow different rules.
How do I know if my plan is state-regulated or self-funded?
Check your plan documents or ask your HR or benefits department whether the plan is fully insured or self-funded. The Colorado Division of Insurance can also help you determine this.
Does Medicaid cover ABA in Colorado?
Health First Colorado may cover ABA for eligible children under 21 through the EPSDT benefit when it is medically necessary. Eligibility depends on factors such as household income and your child’s needs.
Does TRICARE cover ABA for military families in Colorado?
Yes. TRICARE covers ABA through the Autism Care Demonstration. Active duty families generally need to enroll their child in the Exceptional Family Member Program and the Extended Care Health Option to access services.
How long does it take to get ABA approved?
It varies by plan and how complete the paperwork is. For state-regulated plans, an insurer generally must decide a prior authorization request within 15 days. Gathering your diagnosis and assessment early is the best way to keep things moving.
Do I need a diagnosis before insurance will cover ABA?
In most cases, yes. A formal autism spectrum disorder diagnosis from a qualified provider is typically required before a plan will authorize ABA therapy.
Sources:
- https://www.medicaid.gov/medicaid/benefits/early-and-periodic-screening-diagnostic-and-treatment
- https://www.dol.gov/agencies/ebsa/about-ebsa/our-activities/resource-center/fact-sheets/final-rules-under-the-mental-health-parity-and-addiction-equity-act-mhpaea
- https://www.dol.gov/agencies/ebsa/laws-and-regulations/laws/mental-health-parity/mhpaea-enforcement-2022
- https://www.ncbi.nlm.nih.gov/books/NBK619303/
- https://www.cdc.gov/autism/treatment/index.html
- https://fpg.unc.edu/news/new-report-release-comprehensive-autism-care-demonstration-solutions-military-families
About the Author
This article was written and clinically reviewed by a Board Certified Behavior Analyst (BCBA) at Achieve ABA Therapy Group, drawing on direct experience helping Colorado families navigate insurance and begin ABA therapy. Achieve ABA Therapy Group provides individualized, evidence-based ABA therapy for children and adolescents with autism in Colorado and New Jersey.