If your child has been diagnosed with autism or another developmental disability including Down syndrome or global developmental delay, and your family is enrolled in Colorado Medicaid — known as Health First Colorado — you may have more coverage than you realize. ABA therapy is a covered benefit under Medicaid for children, and for many families, it can significantly reduce or eliminate out-of-pocket costs for treatment.
This guide walks you through how Medicaid coverage for ABA therapy works in Colorado, what the enrollment process looks like, and how to connect with a provider who accepts Health First Colorado.
What Is Health First Colorado?
Health First Colorado is Colorado’s Medicaid program, administered by the Colorado Department of Health Care Policy and Financing (HCPF). It provides health coverage to low-income individuals and families, including children with disabilities.
If your child is enrolled in Health First Colorado, they have access to a broad range of medical and therapeutic services — including applied behavior analysis (ABA) therapy for autism.
Does Colorado Medicaid Cover ABA Therapy?
Yes. ABA therapy is a covered benefit under Health First Colorado for children under 21 with an autism spectrum disorder (ASD) diagnosis.
This coverage is guaranteed at the federal level through a provision called EPSDT — Early and Periodic Screening, Diagnostic, and Treatment. Under EPSDT, Medicaid must cover any service that is medically necessary for a child under 21, even if that service isn’t explicitly listed in the state’s benefit plan. Because ABA therapy is considered medically necessary treatment for autism, it falls squarely within EPSDT protections.
In plain terms: if your child has an autism diagnosis and is under 21, Health First Colorado cannot deny coverage for ABA therapy on the basis that it isn’t a covered benefit.
Who Qualifies for ABA Therapy Through Medicaid?
To access ABA therapy through Health First Colorado, your child generally needs to meet the following criteria:
- Enrolled in Health First Colorado — your child must be an active Medicaid beneficiary.
- Autism spectrum disorder diagnosis — a formal diagnosis from a licensed psychologist, developmental pediatrician, or similar qualified professional.
- Medical necessity determination — a BCBA (Board Certified Behavior Analyst) conducts an assessment and documents that ABA therapy is clinically appropriate for your child.
- Under age 21 — EPSDT protections apply through age 20.
If your child meets these criteria, coverage should be available regardless of income level, as long as they are actively enrolled in the program.
What Does Coverage Actually Include?
Health First Colorado coverage for ABA therapy can include:
- Initial functional behavior assessment (FBA) — the evaluation used to determine your child’s needs and build a treatment plan
- Direct therapy hours — one-on-one ABA sessions with a Registered Behavior Technician (RBT) supervised by a BCBA
- Supervision and care coordination — time your BCBA spends overseeing your child’s program
- Parent training — sessions where caregivers learn strategies to support their child at home
The number of approved hours varies based on your child’s individual needs as documented in the assessment. There is no fixed statewide cap on hours — coverage is driven by what is deemed medically necessary for your specific child.
How the Authorization Process Works
ABA therapy under Medicaid requires prior authorization before services begin. Here’s how the process typically unfolds:
Step 1: Get a diagnosis If your child hasn’t been formally diagnosed with autism or another developmental disability yet, that’s the starting point. A licensed psychologist or developmental specialist completes a comprehensive evaluation and provides a written diagnosis.
Step 2: Find a Medicaid-enrolled ABA provider Not all ABA providers accept Medicaid. You’ll need to find a provider who is credentialed with Health First Colorado. This is an important first step — your provider will guide much of the authorization process.
Step 3: Complete an initial assessment A board certified behavior analyst (BCBA) from your provider will conduct a functional behavior assessment to evaluate your child’s strengths, needs, and areas of focus. This assessment forms the clinical foundation for the authorization request.
Step 4: Submit for prior authorization Your provider submits the assessment results and a treatment plan to Health First Colorado (or your child’s managed care organization, if applicable). The plan outlines recommended therapy hours and goals.
Step 5: Receive authorization and begin services Once approved, your child can begin ABA therapy. Authorizations are typically granted for a set period — often six months to a year — and must be renewed with updated documentation.
Managed Care vs. Fee-for-Service Medicaid
One thing that confuses many families is that not all Medicaid enrollees have the same plan structure. In Colorado, some children are enrolled in fee-for-service Medicaid, where claims go directly to the state. Others are enrolled in a managed care organization (MCO), such as:
- Colorado Access
- Denver Health Medicaid Choice
- Rocky Mountain Health Plans
- Anthem HealthKeepers Plus
If your child is in a managed care plan, your provider will submit authorization requests to the MCO rather than directly to HCPF. The coverage rules remain the same — EPSDT protections still apply — but the process may differ slightly depending on the plan.
Your provider should be familiar with which MCO your child is enrolled in and how to navigate that specific authorization process.
What If Authorization Is Denied?
Medicaid denials happen, but they are not final. If your child’s ABA therapy authorization is denied or the approved hours feel insufficient, you have the right to appeal.
A few things to know:
- Request the denial in writing — you’re entitled to a written explanation of why coverage was denied.
- Ask your provider to help — your BCBA can submit additional clinical documentation to support the appeal.
- File a state fair hearing — if an internal appeal doesn’t resolve the issue, you can request a formal hearing through the Colorado Office of Administrative Courts.
- Contact Colorado Medicaid directly — HCPF has a member contact line and can help clarify coverage questions.
If you believe your child’s medically necessary services are being wrongly denied, you also have the option to contact a disability rights organization or patient advocate for support.
Can ABA Therapy Be Covered by Both Medicaid and Private Insurance?
Yes — and this is an important point for families who have both. If your child is covered by a private health plan through an employer or the marketplace, and also enrolled in Medicaid, both plans may contribute to the cost of services.
In most cases, private insurance is billed first (“primary payer”), and Medicaid picks up remaining costs second (“secondary payer”). This coordination of benefits can result in very little to no out-of-pocket cost for families.
Talk to your ABA provider about how they handle dual coverage — a good billing team will manage this coordination on your behalf.
Finding an ABA Provider That Accepts Health First Colorado
Not every ABA agency in Colorado accepts Medicaid, which is why it’s worth asking upfront. When you reach out to a provider, ask specifically:
- Are you credentialed with Health First Colorado?
- Do you accept my child’s specific managed care plan?
- Can you help us with the prior authorization process?
At OGBC, we accept Health First Colorado and work directly with families to navigate the authorization process from start to finish. We handle the assessment, documentation, and coordination with your plan so that families can focus on what matters most — getting their child the support they need.
What to Expect After Services Begin
Once your child starts ABA therapy, your provider is responsible for ongoing documentation, progress monitoring, and reauthorization. You should receive regular updates on your child’s goals and how they’re progressing.
As your child develops, the treatment plan will be updated to reflect new goals and changing needs. When the authorization period ends, your BCBA will submit updated documentation to renew services for the next period.
A Note for Families New to Medicaid
If your child was recently diagnosed with autism or another developmental disability and you’re not sure whether they qualify for Medicaid, it’s worth checking — eligibility is based on income and household size, and many families who don’t expect to qualify actually do.
You can apply for Health First Colorado through PEAK (Colorado’s online benefits portal) at peak.my.omni.com, or through your local county human services office. Processing times vary, but coverage can sometimes be backdated to the date of application.
Moving Forward
A Medicaid enrollment and a diagnosis can feel like a lot to navigate at once. The good news is that the coverage exists — EPSDT ensures that — and a qualified ABA provider can walk you through the rest.
If you’re ready to explore ABA therapy for your child through Health First Colorado, OGBC is here to help. We serve families across Colorado and accept Medicaid as a covered payer. Reach out to schedule an initial consultation and we’ll help you understand exactly what your plan covers and how to get started.
We’re here when you’re ready to talk.
