What Colorado Parents Need to Know About ABA Insurance

If your child has been diagnosed with autism spectrum disorder in Colorado, you’re in a strong position when it comes to insurance coverage for ABA therapy. Colorado has one of the more comprehensive autism insurance mandates in the country, and between Medicaid, commercial plans, and TRICARE, most families find a path to coverage. In fact, roughly 79% of families we work with pay $0 out of pocket for ABA services.

This guide breaks down every major coverage option available to Colorado families so you can spend less time on hold with insurance companies and more time focused on your child.

Colorado’s Autism Insurance Mandate (SB 09-244)

Colorado passed Senate Bill 09-244, which requires commercial health insurance plans to cover the diagnosis and treatment of autism spectrum disorder, including ABA therapy. Here’s what you need to know about the mandate:

• Annual cap: $34,000 per year for ABA therapy services
• Age limit: Originally capped at age 19, but a 2019 amendment removed the age restriction entirely
• Applies to: All state-regulated commercial health insurance plans, including individual and group policies

The $34,000 annual cap is generally sufficient for most treatment plans, especially as children progress and their hours gradually reduce. If your child needs intensive services early on, your BCBA will work with you to maximize coverage within this framework.

Health First Colorado (Medicaid) Coverage

Colorado Medicaid, known as Health First Colorado, provides robust ABA therapy coverage through the state’s Regional Accountable Entities (RAEs). This is often the most comprehensive option available because Medicaid does not impose the same dollar caps as commercial insurance.

How RAEs Work

Colorado’s Medicaid system is organized into seven regional zones, each managed by a RAE. Your RAE coordinates behavioral health services, including ABA therapy. When you’re approved for services, the RAE connects you with in-network providers in your area.

What’s Covered

Under Medicaid’s Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit, children under 21 are entitled to medically necessary services without annual dollar caps. This means your child can receive the full number of recommended hours without worrying about hitting a coverage limit.

If your child qualifies for Health First Colorado, this is often the best coverage path. Learn more about the insurance plans we accept and how we can help verify your benefits.

TRICARE Coverage for Military Families

Colorado has a significant military presence, and TRICARE provides strong ABA therapy coverage for military dependents. Key installations in the state include:

• Fort Carson (Colorado Springs)
• Peterson Space Force Base (Colorado Springs)
• Schriever Space Force Base (Colorado Springs)
• United States Air Force Academy (Colorado Springs)
• Buckley Space Force Base (Aurora)

TRICARE ABA Benefits

TRICARE covers ABA therapy as a medically necessary treatment for autism. There are no annual dollar caps, and coverage continues as long as treatment is deemed medically necessary through periodic reviews. You’ll need a referral and prior authorization, but the process is well-established for ABA services.

If you’re a military family stationed in Colorado, reach out to our team and we can walk you through the TRICARE authorization process step by step.

Commercial Insurance Coverage

Most major commercial carriers in Colorado cover ABA therapy under the state mandate. Here are the carriers we see most often:

Anthem Blue Cross Blue Shield

Anthem is one of the largest carriers in Colorado and covers ABA therapy under both individual and group plans. Pre-authorization is typically required, and Anthem uses medical necessity criteria to determine approved hours.

UnitedHealthcare (UHC)

UHC plans in Colorado cover ABA therapy with prior authorization. They use Optum behavioral health for claims management, so your provider will coordinate directly with Optum for approvals.

Cigna

Cigna covers ABA therapy services and typically requires a comprehensive diagnostic evaluation and treatment plan before authorizing services.

Aetna

Aetna plans in Colorado cover ABA therapy. Authorization timelines can vary, so it’s helpful to start the process early.

Kaiser Permanente

Kaiser operates as an integrated system in Colorado. If you have Kaiser, ABA services are typically provided through their network, which can mean a more streamlined referral process but fewer provider choices.

Not sure if your plan covers ABA? Check our insurance page to see if your carrier is listed, or contact us for a free benefits check.

Understanding Your Coverage: Key Steps

Navigating insurance for ABA therapy can feel overwhelming, but it doesn’t have to be. Here’s a straightforward process:

1. Get a formal diagnosis. You’ll need a documented autism spectrum disorder diagnosis from a qualified professional. This is the foundation for any insurance claim.
2. Contact your insurance company. Ask specifically about ABA therapy coverage, including any pre-authorization requirements, annual caps, and in-network providers.
3. Work with your provider. A good ABA provider will handle much of the insurance coordination for you, including submitting treatment plans and managing authorizations.
4. Keep records. Save copies of all communications, authorizations, and Explanation of Benefits (EOB) statements.

What If Your Claim Is Denied?

Insurance denials happen, but they’re not the end of the road. Colorado law gives you the right to appeal, and many denials are overturned on appeal. Common reasons for initial denials include incomplete documentation, missing pre-authorization, or questions about medical necessity. Your ABA provider should be able to help you navigate the appeals process.

Treetop’s Colorado Services

Treetop provides ABA therapy across Colorado through both center-based and in-home service models. We accept most major insurance plans and handle the insurance verification process for you. Our team knows the ins and outs of Colorado’s insurance landscape and can help you understand your specific benefits before services begin.

Visit our Colorado locations page to find services near you.

Get Started Today

You shouldn’t have to become an insurance expert just to get your child the support they need. Our team at Treetop is ready to help you verify your benefits, navigate the authorization process, and get started with ABA therapy as quickly as possible. Contact us today for a free consultation and benefits check.