How Health First Colorado (Medicaid) Covers ABA Therapy — and How to Get Started

A diagnosis arrives. The pediatrician recommends ABA therapy. Then the question hits: How do we pay for this?

For families enrolled in Health First Colorado — the state's Medicaid program — the answer is better than most people realize. Colorado Medicaid covers ABA therapy as a medically necessary service for eligible children and adolescents. No dollar cap. No age limit within the under-21 window. No co-pay under EPSDT for qualifying members.

The process has steps. But those steps are navigable — especially with an ABA provider who handles the paperwork on your behalf.

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 free or low-cost health coverage to qualifying Colorado children, adults, and families.

As of January 2025, children from households with incomes up to 265% of the Federal Poverty Level (approximately $85,519 per year for a family of four in 2025) are eligible for Health First Colorado or Child Health Plan Plus (CHP+), regardless of immigration status (Connect for Health Colorado).

There is no open enrollment period. Families can apply year-round through:

• Colorado PEAK (colorado.gov/PEAK) — the state's online eligibility portal
• Connect for Health Colorado — which screens for Medicaid and CHP+ eligibility alongside private coverage options
• Local county Department of Human Services offices — for in-person assistance

Health First Colorado covers ABA therapy under the Pediatric Behavioral Therapies (PBT) benefit — a structured program with specific eligibility criteria, authorization requirements, and covered services (Colorado HCPF — Pediatric Behavioral Therapies Billing Manual).

Does Health First Colorado Cover ABA Therapy?

Yes. ABA therapy is a covered benefit under Health First Colorado through the federal EPSDT mandate.

EPSDT — Early and Periodic Screening, Diagnostic, and Treatment — is a federal requirement embedded in Medicaid law that ensures children under 21 receive all medically necessary services, even if the state's standard Medicaid plan does not otherwise cover them.

EPSDT is why Health First Colorado's ABA coverage has no hard cap on hours — if a BCBA determines a child needs 30 hours per week of ABA therapy and it meets medical necessity criteria, those hours can be authorized (Colorado HCPF — EPSDT).

Under EPSDT, Health First Colorado covers a full range of ABA-related services, including:

• Comprehensive behavioral assessments — the initial BCBA evaluation that establishes the child's current skill levels, behavioral challenges, and treatment needs
• Individualized ABA therapy sessions — direct 1:1 therapy delivered by a Registered Behavior Technician (RBT) under BCBA supervision
• Treatment plan development — the BCBA-written individualized program that guides all therapy goals and interventions
• BCBA supervision — ongoing clinical oversight of the RBT and treatment plan, typically provided through regular observation and supervision sessions
• Parent and caregiver training — structured sessions that teach families to implement ABA strategies at home, extending the impact of therapy into daily routines
• Telehealth ABA sessions — Colorado Medicaid covers telehealth delivery of ABA, which is particularly valuable for families in suburban and smaller Colorado cities who have fewer nearby in-person providers

Who Qualifies for Health First Colorado ABA Therapy?

To access ABA therapy coverage through Health First Colorado, a member must meet the following criteria:

1. Age: Under 21 years old. Medicaid coverage for ABA therapy in Colorado applies to children and adolescents up to age 21. For older teens (typically ages 17–20), prior authorization review is more rigorous and may require additional documentation of medical necessity (Alpaca Health — Health First Colorado ABA Coverage).

2. Diagnosis: A formal diagnosis of Autism Spectrum Disorder (ASD) — or a related developmental disability — from a licensed healthcare provider (psychologist, developmental pediatrician, or equivalent). Health First Colorado's PBT benefit does not require a specific diagnosis under EPSDT; behavioral therapy can be covered for medically necessary behavioral health needs even without an ASD diagnosis specifically. However, for ABA therapy, an ASD diagnosis is the standard pathway.

3. Medical Necessity: A licensed BCBA conducts a behavioral assessment and determines that ABA therapy is medically necessary — meaning it addresses specific skill deficits or behavioral challenges that impact the child's development and daily functioning. This is documented in the assessment tool submitted with the prior authorization request. Colorado does not mandate a single assessment tool, giving BCBAs flexibility in how they document needs (Colorado HCPF — PBT Provider Information).

4. Health First Colorado Enrollment: The child must be actively enrolled in Health First Colorado. Coverage is verified before services begin.

The Three Coverage Pathways: Which One Applies to Your Family?

Not every Colorado family qualifies for standard Health First Colorado. But there are three pathways families can explore:

Pathway 1: Standard Health First Colorado

For families whose income falls below 138% of the Federal Poverty Level (approximately $44,367 for a family of four in 2025). Children under 19 with household income up to 265% FPL are also eligible. Application through PEAK or Connect for Health Colorado (Health First Colorado).

Pathway 2: Child Health Plan Plus (CHP+)

For families who earn too much for standard Medicaid but cannot afford private insurance. Household income must fall between 147% and 260% of the Federal Poverty Level. CHP+ covers ABA therapy similarly to Health First Colorado, with some differences in cost-sharing. Children only — adults in the household are not covered under CHP+ (Colorado Medicaid Eligibility Calculator).

Pathway 3: Children with Disabilities Buy-In Program

This is the least-known pathway — and one of the most valuable for families of autistic children who earn above standard Medicaid limits.

The Health First Colorado Buy-In Program for Children with Disabilities allows families to "buy into" full Medicaid coverage for a child with a qualifying disability by paying a monthly income-based premium. Eligibility extends to families with incomes up to 300% of the Federal Poverty Level. Autism Spectrum Disorder is a qualifying disability under Social Security Administration listings.

For families in Denver, Aurora, Thornton, and across Colorado who believe they earn "too much" for Medicaid, this Buy-In program is frequently the pathway that makes full Medicaid ABA coverage accessible (Colorado HCPF — Buy-In Program).

How Prior Authorization Works for Health First Colorado ABA

All ABA therapy services under Health First Colorado require prior authorization (PAR) before services can begin. This is a non-negotiable step — services provided without an approved PAR are not reimbursable and families cannot be billed for them.

The PAR process in Colorado works as follows:

Step 1: Provider Enrollment The ABA provider must be enrolled with Health First Colorado under Provider Type 83 (Behavioral Therapy Group) and Provider Type 84 (Behavioral Therapy Individual). Inclusive ABA is enrolled and credentialed with Health First Colorado (Colorado HCPF — PBT Provider Information).

Step 2: BCBA Assessment Before a PAR can be submitted, a BCBA conducts a comprehensive behavioral assessment of the child. This is not the same as the autism diagnosis — it is a separate, more detailed evaluation of the child's skills, behaviors, and support needs. The assessment produces the individualized treatment plan and the clinical documentation submitted with the PAR.

Step 3: PAR Submission to Acentra Colorado's Medicaid utilization management (UM) vendor is Acentra Health (formerly Kepro). Providers submit PARs through the Acentra Atrezzo portal. Documentation submitted includes the behavioral assessment, treatment plan, and supporting clinical records. The PAR must demonstrate that services are medically necessary (Colorado HCPF — PBT Provider Information).

Step 4: PAR Review Acentra's licensed clinical reviewers evaluate the PAR. Both the provider and the member receive a determination letter through Gainwell Technologies — Health First Colorado's claims system.

Step 5: Approval and Start An approved PAR is valid for up to 6 months. After 6 months, the BCBA updates assessments and submits a renewal PAR. If a PAR is denied, families can request a PAR Reconsideration — a second review by a different physician — and may also appeal through standard Health First Colorado appeal channels.

Typical approval timelines, after all documentation is submitted correctly, range from 1–3 weeks (Alpaca Health).

Important: When Medicaid is primary payer and a child also has private insurance, private insurance must be billed first. Medicaid is the "payor of last resort." If private insurance does not cover ABA, that denial documentation is submitted alongside the Medicaid PAR process.

What Medicaid Covers — and What It Doesn't

Understanding the scope of Health First Colorado ABA coverage prevents surprises:

Covered under EPSDT:

• All medically necessary ABA hours as determined by the BCBA — no hard annual cap
• Assessment and re-assessment every 6 months
• Parent training as part of the authorized treatment plan
• Telehealth delivery (place of service code 02, and as of May 3, 2024, place of service 03 is also allowed for community settings including schools)
• Services in the home, clinic, school, and community

What families should know:

• EPSDT guarantees no co-pay for covered services for most qualifying children
• If a PAR is partially denied, the approved hours are still covered — Medicaid does not allow providers to bill members for denied portions
• Documentation must meet Council of Autism Service Providers (CASP) minimum standards

A family in Lakewood had a 4-year-old son recently diagnosed with autism. Both parents worked, and the family had private insurance through the employer — but the plan was a self-funded ERISA plan that did not cover ABA therapy.

Because their income was above standard Medicaid limits, they initially assumed Medicaid wasn't an option. Their ABA provider informed them about the Children with Disabilities Buy-In Program. After submitting a PEAK application, they enrolled in Health First Colorado for their son at a monthly premium of $89 — far less than ABA out-of-pocket costs.

The BCBA at their home-based ABA provider completed the assessment, submitted the PAR to Acentra, and received authorization within 12 business days. Services began the following week.

Their son received 25 hours per week of home-based ABA therapy, with parent training sessions integrated into the schedule. Total family cost: $89/month for coverage. Inclusive ABA coordinated the entire enrollment and authorization process.

Getting Started with Health First Colorado ABA Therapy: Step by Step

Step 1: Apply for Health First Colorado or CHP+ through PEAK (colorado.gov/PEAK) or Connect for Health Colorado. Applications are accepted year-round.

Step 2: If you have too high an income for standard Medicaid, explore the Children with Disabilities Buy-In Program at colorado.gov/PEAK.

Step 3: Obtain your child's formal autism diagnosis if not already in hand. Contact Inclusive ABA — we can help connect families who need an evaluation with diagnostic specialists.

Step 4: Contact Inclusive ABA. We verify your Medicaid coverage on the first call, confirm your child's eligibility for the PBT benefit, and begin the intake process.

Step 5: The BCBA assessment is scheduled and completed. We submit the PAR to Acentra. You receive updates throughout.

Step 6: PAR is approved. ABA therapy begins in your home — Denver, Aurora, Lakewood, Littleton, Arvada, Thornton, and Englewood, or wherever you are in Colorado.

Conclusion: Health First Colorado Is One of the Best ABA Coverage Programs in the Country

EPSDT-backed coverage with no hour cap. Three pathways to access. Prior authorization managed by your ABA provider. And home-based delivery across the entire Colorado Front Range.

Colorado Medicaid ABA therapy is a genuinely strong benefit — when families know how to access it. Most delays happen because families don't know which pathway applies to them, or because they work with providers who aren't experienced with the Acentra PAR process.

At Inclusive ABA, navigating Health First Colorado isn't something families do alone. We handle enrollment verification, prior authorization, documentation, and every step between your first call and your child's first session.

One phone call is all it takes to find out what your child qualifies for. Don't let uncertainty about Medicaid keep your child from starting therapy.

👉 Call Inclusive ABA today — free same-day coverage verification for Health First Colorado families. No waitlist. Home-based therapy across Colorado..

Inclusive ABA provides home-based ABA therapy with no waitlist — accepting Health First Colorado Medicaid and all major private insurance plans.

Frequently Asked Questions