Colorado ABA Finder
A kitchen table with an open folder of paperwork and a child's toy carIllustration

Does Health First Colorado, Colorado Medicaid, cover ABA therapy for autism and behavioral health?

Yes. Health First Colorado covers ABA and other behavioral therapy for children when it is medically necessary, the provider files a prior authorization first, and your child does not need an autism diagnosis to qualify.

The short version

  • The benefit is called Pediatric Behavioral Therapies. It sits inside EPSDT, the children's benefit, for members age 20 and under.
  • Every course of therapy needs a prior authorization request (PAR) before it starts. The provider assesses your child, writes the plan and files it. You do not.
  • An approved PAR is good for up to six months. Then the provider files a new one.
  • No autism diagnosis is required. The state's page says so in plain words.
  • Children on a Medicaid waiver can use it too. If you earn too much for Medicaid and your child has a disability, the Children's Buy-In Program may get you in, with a monthly premium of $0 to $120.

What the state says, word for word

On the question of a diagnosis: "Does my child have to have a diagnosis of Autism to qualify for the services? No. Behavioral therapy is available to all children currently eligible for Health First Colorado when the service is medically necessary." The page adds that the state has criteria for what qualifies.

On the prior authorization: "All behavioral therapies will need to be authorized prior to the start of treatment. The contracted Medicaid provider will assess your child, put together a treatment plan, and submit a Prior Authorization Request (PAR) to the Department's Utilization Management (UM) vendor to review for medical necessity."

On how long it lasts: "An approved PAR is valid for up to six (6) months, after which a new PAR must be completed and submitted."

On waivers: "Can I access the services if my child is on an HCBS Waiver? Yes. All EPSDT services are available to all children receiving Health First Colorado."

Who is on the list, and what the list means

The state publishes a list of contracted providers and says it adds to it every week. On 18 October 2026 it held 186 providers: 77 home based, 70 center and home based, 19 center based, and 20 with a name and a phone number only.

Being on the list means a provider is enrolled with Health First Colorado for this benefit. It does not mean the provider has an opening, takes your child's age, or works in your town. That is what this site adds: each provider's own site, read and quoted, city by city.

The provider types behind the list

The billing manual says organizations enroll as Provider Type 83, Behavioral Therapy Clinic, and the therapists who work under them as Provider Type 84, Behavioral Therapist, affiliated with a Type 83. The manual also says that from December 1, 2026, prior authorization reviews use InterQual criteria instead of the state's own. Ask your provider whether that changes the paperwork for a renewal that falls after that date.

What the therapy costs you

Usually nothing. Health First Colorado pays the provider directly. The July 2026 fee schedule pays $17.20 per 15 minutes for CPT code 97153, the main ABA code, down from $18.17 a year earlier. Providers have said in public that the rate is hard to live on, which is one reason waitlists exist.

“The reality is many providers are already barely keeping their doors open”

Will Martin, co-chair of the Colorado Association for Behavior Analysis Public Policy Committee. Outside voice, not part of this site. CBS Colorado, 18 November 2025.

If the request is denied

One trap: if the review vendor asks the provider for documents and does not receive them within four business days, the request is denied for lack of information. Answer the provider's calls during that window.

  1. Before a denial, the doctor who requested the PAR gets a peer-to-peer call with the reviewer. Many requests are fixed here.
  2. The provider can ask for a reconsideration, with documents that were missing the first time, or file a new request.
  3. You can appeal in writing. The state's page says the Letter of Appeal must be received by the Office of Administrative Courts no later than 30 calendar days from the date on your denial letter. You can ask for a phone hearing.

What else Colorado Medicaid covers around ABA: behavioral health, developmental and primary care

ABA sits inside EPSDT, the children's benefit, and it's rarely the only service a child uses. The same benefit covers medically necessary developmental screening with your primary care provider, speech-language and occupational therapy, and mental health services through the regional accountable entity (RAE) for your county. Each of the ten city pages on this site names that RAE.

That matters for the order of calls. A pediatrician's developmental note, a speech evaluation or a school report all help the ABA provider show medical necessity in the prior authorization request. You don't need them to start, but they shorten the paperwork.

Health First Colorado coverage vs. private insurance plans for ABA therapy

Many Colorado children have a parent's employer plan first and Health First Colorado second. The commercial plan pays first and Medicaid can pick up what it leaves. Colorado's autism insurance mandate for state-regulated plans dates from SB 09-244 and was widened by SB 15-015, which removed age and dollar caps. We haven't yet read the statute text itself, so that line comes from Autism Speaks' summary, not the law.

Self-funded employer plans follow federal rules instead of Colorado's, so the mandate may not reach them. TRICARE's ABA program is different again and requires an autism diagnosis. If your family holds TRICARE or an employer plan alongside Health First Colorado, say so on the first call so the provider bills in the right order.

How to check your own coverage in Colorado

The first thing worth confirming is that the child is enrolled in Health First Colorado today, not only approved once. Eligibility is reviewed, and a lapsed enrollment stops the prior authorization cold. The second is that the provider is enrolled with Health First Colorado for pediatric behavioral therapies; every provider on this site is on the state's own list, so that part is done.

It also helps to know who the RAE is for your county, because that's who answers plan questions, and to keep the member line handy. If the family earns too much for Medicaid, the Children's Buy-In Program is the next question, along with which premium band you'd fall in.

Find a provider in your city

Denver, Colorado Springs, Aurora, Fort Collins, Lakewood, Boulder, Pueblo, Greeley, Longmont, Thornton, or the whole state list with filters.

Questions about ABA therapy coverage in Colorado

Does Health First Colorado cover ABA therapy for autism?

Yes, when it is medically necessary and the provider's prior authorization request is approved. The same benefit also covers behavioral therapy for children without an autism diagnosis.

How many hours of ABA will Medicaid approve?

The state does not publish a number. The reviewer approves hours based on the plan the provider submits and the criteria for medical necessity. The approval covers up to six months at a time.

Can I get ABA at school with Medicaid?

The benefit can be delivered at school, but the school district decides whether an outside provider may come into the building. Chalkbeat found Denver Public Schools granted three of 28 requests in the 2023-24 school year while Jeffco, Douglas County and Cherry Creek granted all of theirs. Ask your provider how it handles your district.

Who do I call with a coverage question?

The Health First Colorado Member Contact Center at 1-800-221-3943, or State Relay 711. For the benefit itself, the state gives HCPF_EPSDT@state.co.us.

Sources

Every quote on this page was matched word for word against the source on 18 October 2026.