Does My Colorado Insurance Have to Cover ABA? Understanding the State Mandate

Open enrollment paperwork. Explanation of Benefits forms. Prior authorization requests. Insurance coverage for ABA therapy shouldn't require a law degree — but for many Colorado families, figuring out whether their plan is legally required to cover their child's therapy can feel exactly that complicated.

Here's the short version: Yes, Colorado has one of the strongest autism insurance mandates in the country — but whether it applies to your specific plan depends entirely on the type of plan you have. Knowing the difference is the first thing that unlocks everything else.

Here's the direct answer: Colorado insurance law requires most state-regulated health insurance plans to cover ABA therapy for autism at no age cap and no dollar limit. The mandate was first established by Senate Bill 09-244 (effective July 1, 2010) and strengthened by Senate Bill 15-015 (effective January 1, 2017), which removed all previous age and financial caps. However, self-funded employer plans governed by federal ERISA law are exempt from state mandates entirely. Colorado Medicaid (Health First Colorado) provides its own separate ABA coverage pathway for eligible families. Understanding which category your plan falls into determines exactly what protections apply to your family.

The Law: Colorado's ABA Insurance Mandate, Explained

Colorado's autism insurance reform didn't happen overnight. It came in two significant legislative steps.

Step One: Senate Bill 09-244 (2010)

In 2009, Colorado enacted Senate Bill 09-244, which took effect July 1, 2010. This law required state-regulated private health insurance plans to cover ABA therapy services for individuals with autism spectrum disorder under the age of 19.

This was a major step for Colorado families — but the original law carried limitations, including an age cap at 19 and certain dollar restrictions.

Step Two: Senate Bill 15-015 (2017)

In 2015, Colorado passed Senate Bill 15-015, which took effect January 1, 2017. This law removed the age cap and all dollar limits that had existed under the original mandate. As a result, Colorado now has no age restrictions and no annual dollar caps on ABA coverage under the state mandate.

This places Colorado among a small group of states — alongside California, Maryland, Massachusetts, and New York — that offer the broadest coverage protections nationally, with neither age caps nor annual dollar limits.

The mandate is codified in Colorado Revised Statutes Section 10-16-104, which requires covered health benefit plans to include services for the treatment of autism spectrum disorders, including ABA, when medically necessary.

What the Colorado ABA Insurance Mandate Actually Requires

For plans subject to the state mandate, covered services must include:

• ABA therapy sessions — provided by qualified autism services providers (BCBAs, licensed behavior analysts, or supervised registered behavior technicians) when medically necessary
• Behavioral assessments — evaluations conducted by a BCBA to establish eligibility and develop treatment plans
• Parent/caregiver training — coaching and training for parents as part of the behavioral treatment plan
• Diagnostic services — assessments determining an autism spectrum disorder diagnosis
• Medications (if covered under the health benefit plan as part of autism treatment)

The law codifies that covered ABA services cannot be denied on the assertion that they are "experimental" or "investigational." Medically necessary ABA therapy must be covered when determined appropriate by a qualified provider.

The Big Exception: Why Your Plan Might Not Be Covered

Here is where many Colorado families hit a wall — and understanding this exception is just as important as knowing the mandate itself.

Fully Insured Plans vs. Self-Funded Plans: A Critical Distinction

Colorado's state mandate applies only to fully insured plans. These are the plans where an employer or individual purchases coverage directly from an insurance company, and the insurer bears the financial risk. Fully insured plans are regulated by Colorado state law — which means they must follow the autism insurance mandate.

Self-funded (self-insured) employer plans are exempt. Many large employers operate self-funded plans, where the company itself pays the claims directly and typically contracts with an insurance company only to administer the plan. These plans are governed by the federal Employee Retirement Income Security Act (ERISA), not state law. ERISA preempts state insurance mandates — meaning Colorado's ABA coverage requirement does not apply to them.

This is not a loophole — it is a fundamental feature of federal law. A self-funded employer plan in Denver or Aurora is not legally required by the state to cover ABA therapy, even though Colorado's mandate exists. Some self-funded employers voluntarily include ABA coverage in their benefits, but they are not required to.

How to Find Out Which Type of Plan You Have

The simplest way: check your Summary Plan Description (SPD) — the benefits document your HR department provides at enrollment. If the document says "self-funded," "self-insured," or references ERISA, state mandates do not apply.

You can also call the member services number on your insurance card and ask directly: "Is this plan fully insured or self-funded?".

For employees of small businesses, individual marketplace plans, and most small group plans, the plan is almost certainly fully insured and subject to Colorado's mandate.



For employees of large corporations and governmental entities, the plan may well be self-funded — and you'll need to confirm before assuming coverage.

Colorado Medicaid: The Second Coverage Pathway

For families who qualify based on income, Health First Colorado (Colorado's Medicaid program) provides a separate, robust pathway to ABA coverage — completely independent of the private insurance mandate.

Colorado Medicaid covers ABA therapy for children and teens up to age 21 through the EPSDT (Early and Periodic Screening, Diagnostic, and Treatment) program. Under EPSDT, there are no strict visit caps for medically necessary ABA services.

What Health First Colorado covers for ABA:

• Comprehensive BCBA behavioral assessments
• Individualized therapy sessions (delivered in-home, clinic, or school settings)
• Parent and caregiver training
• Social skills development
• Progress monitoring and treatment updates

Prior authorization is required for all ABA services under Colorado Medicaid. The ABA provider submits a Prior Authorization Request (PAR) to Acentra (Colorado's Utilization Management vendor), valid for up to six months when approved.

For families navigating Medicaid ABA coverage in Thornton, Westminster, Littleton, or Englewood, the process is the same statewide — because Health First Colorado is a state-administered program.

Important "payor of last resort" rule: If a child has both private insurance and Medicaid, private insurance must be billed first. Medicaid steps in as the secondary payer only after private insurance has responded. This coordination of benefits applies to families in Aurora, Lakewood, and across the Front Range equally.

Colorado's Children's Buy-In Program

For families that don't qualify for standard Medicaid due to income, Colorado's Children's Buy-In Program may allow access to Health First Colorado coverage at income levels up to approximately 300% of the Federal Poverty Level. This program can extend ABA coverage to families who wouldn't otherwise qualify for Medicaid.

Marketplace Plans and ACA Coverage

Health insurance plans sold through Colorado's marketplace (Connect for Health Colorado) are also required to comply with Colorado's autism insurance mandates. The Affordable Care Act (ACA) classifies behavioral health services as Essential Health Benefits — and Colorado's state mandates layer on top of federal ACA requirements.

This means families in Arvada, Denver, or anywhere in Colorado who purchase individual plans through the marketplace are protected by both federal ACA requirements and Colorado's state ABA mandate.

What "Medically Necessary" Actually Means for Your Claim

The Colorado mandate requires coverage for ABA when it is medically necessary — but insurance companies control how "medical necessity" is defined and applied to individual claims. This is where coverage problems most commonly arise.

Common reasons Colorado insurers deny ABA claims or reduce approved hours:

• Citing lack of medical necessity documentation
• Requesting additional assessment data before approving continued services
• Reducing approved hours below what the BCBA recommends

You have the right to appeal any denial. The appeal process varies by plan type:

• For fully insured plans: Disputes and appeals may be escalated to the Colorado Division of Insurance. The state insurance regulator has authority over compliance with the autism mandate.
• For self-funded ERISA plans: Appeals go through the employer's benefits administrator, not the state. External review options exist but follow federal rather than state timelines.

Key documentation that strengthens an authorization or appeal:

• Your child's formal autism diagnosis from a licensed psychologist or physician
• The BCBA's functional behavior assessment and individualized treatment plan
• Progress data from current therapy sessions
• Peer-reviewed research supporting the recommended intensity and approach.

Which Major Insurers Operate in Colorado?

The Colorado state mandate applies to all insurers offering fully insured plans in the state. Major carriers operating in Colorado — including Anthem Blue Cross Blue Shield of Colorado, Cigna, Aetna, UnitedHealthcare (Optum), and Kaiser Permanente — offer plans in the state and, for their fully insured products, must comply with the mandate.



At Inclusive ABA, we verify insurance benefits as part of the intake process — including calling your insurer, confirming ABA coverage, and checking prior authorization requirements before your child's first session. This applies for families in Denver, Aurora, Lakewood, and all the communities we serve.

A Real-World Scenario: How This Plays Out for Colorado Families

What Inclusive ABA Does for Colorado Families on Insurance

Inclusive ABA handles insurance verification and prior authorization on behalf of every family we serve — so you don't have to figure out the paperwork alone. We accept all Colorado insurance plans and work with both private insurers and Health First Colorado Medicaid.

Our intake team will:

• Verify whether your specific plan is subject to Colorado's mandate
• Confirm ABA coverage and identify any applicable deductibles, copays, or session limits
• Submit prior authorization requests through the correct channel for your plan type
• Explain exactly what to expect before your child's first session begins

We serve families across Colorado — in Denver, Aurora, Lakewood, Littleton, Arvada, Thornton, Westminster, and Englewood — with no waitlist.

Conclusion: Colorado's Mandate Is Strong — But Coverage Isn't Automatic

Colorado's ABA insurance mandate is among the most comprehensive in the United States. No age limits. No dollar caps. Coverage required for medically necessary ABA across all state-regulated plans. That's a genuinely strong legal foundation for families navigating autism care.

But coverage isn't automatic. The mandate only applies to certain plan types. Prior authorization is required. Claims can be denied. Appeals are possible. And for families on employer self-funded plans, the mandate doesn't apply at all.

The first step — understanding what type of plan you have — is the one that unlocks everything else. And you don't have to figure that out on your own.

Stop reading insurance documents alone at 11pm. Let Inclusive ABA's intake team check your benefits, explain your options, and walk you through exactly what coverage looks like for your child — before anything is submitted or started.

Talk to the Inclusive ABA team today — one call answers it all. Serving families across Colorado!.

📍 Serving Families Across Colorado

Inclusive ABA provides home-based ABA therapy throughout Colorado with no waitlist and all insurance accepted.

Frequently Asked Questions

📚 Sources

1. Autism Legal Resource Center — Colorado Autism Insurance Reform https://www.autismlegalresourcecenter.com/resources/autism-healthcare-info/ 
2. Colorado Revised Statutes § 10-16-104 — Mandatory Coverage Provisions (via Justia) https://law.justia.com/codes/colorado/title-10/health-care-coverage/article-16/part-1/section-10-16-104/ 
3. Applied Behavior Analysis Education — Autism Insurance Laws by State https://www.appliedbehavioranalysisedu.org/state-by-state-guide-to-autism-insurance-laws/ 
4. Colorado Department of Health Care Policy and Financing — Pediatric Behavioral Therapies https://hcpf.colorado.gov/pediatric-behavioral-therapies 
5. Colorado HCPF — Pediatric Behavioral Therapies: Information for Providers https://hcpf.colorado.gov/pediatric-behavioral-therapies-information-providers 
6. U.S. Department of Labor – Employee Retirement Income Security Act (ERISA) https://www.dol.gov/general/topic/retirement/erisa 
7. IRS – 401(k) resource guide - Plan participants - Summary plan description https://www.irs.gov/retirement-plans/plan-participant-employee/401k-resource-guide-plan-participants-summary-plan-description 
8. Medicaid – Early and Periodic Screening, Diagnostic, and Treatment https://www.medicaid.gov/medicaid/benefits/early-and-periodic-screening-diagnostic-and-treatment