Colorado Autism Insurance Mandate: What Parents Are Legally Entitled To

Many Colorado parents do not realize that state law requires most insurance plans to cover ABA therapy for children with autism. This coverage can mean the difference between starting therapy quickly and sitting on a waitlist because of cost.

This guide explains what Colorado law requires, what it covers, and how to use your rights to access services.

Colorado's Insurance Law for Autism

Colorado requires fully-insured health insurance plans sold in the state to cover the diagnosis and treatment of autism spectrum disorder, including ABA therapy. This means that if your child has an autism diagnosis and your insurance plan is subject to Colorado state law, the insurance company cannot simply refuse to cover ABA therapy.

What Is Covered?

Under Colorado's autism coverage law, services typically covered include:

• ABA therapy
• Speech therapy for autism-related communication challenges
• Occupational therapy for autism-related needs
• Behavioral health treatment supervised by qualified professionals

Coverage must be provided to the same extent as other medical services. Insurance companies cannot put special limits on autism treatment that do not also apply to other conditions.

Which Plans Are Covered?

Most fully-insured commercial plans sold in Colorado are subject to this law. This includes plans purchased through Connect for Health Colorado and many employer-sponsored plans.

Important exception: Some large employers use what are called self-funded plans, which are regulated by federal law rather than state law. These plans are not required to follow Colorado's autism law, though many choose to cover ABA therapy anyway.

Medicaid in Colorado (called Health First Colorado) covers ABA therapy for children with an autism diagnosis without a yearly limit on hours. This is a significant benefit for families enrolled in Medicaid.

How to Use Your Coverage

Step one: Get a formal autism diagnosis. Coverage requires a diagnosis from a qualified provider. Most ABA programs require this before starting services.

Step two: Check whether you need a referral. Some plans require a physician referral before approving ABA therapy. Check your plan or call member services to find out.

Step three: Find an in-network provider. In-network providers significantly reduce your out-of-pocket costs. Ask your ABA provider whether they are in-network with your specific plan.

Step four: Know that your provider handles the insurance paperwork. ABA therapy almost always requires your insurance to approve services before they begin. A good provider handles this process for you.

Step five: Know your right to appeal. If your insurer denies a claim for ABA therapy, you have the right to appeal. Many denials are reversed on appeal, especially with proper documentation.

When Insurance Says No

If your insurance company denies coverage for ABA therapy:

• Ask for the denial in writing with the specific reason
• Contact Colorado's Division of Insurance if you believe the denial violates state law
• Work with your ABA provider on the appeal process, they have done this before
• Consider contacting a patient advocate

Medicaid in Colorado

For families on Medicaid, ABA therapy is covered for children under 21 with an autism diagnosis. There is no set cap on hours, though approval is required and services must be shown to be necessary.

If you are on Medicaid and have been told ABA is not covered, ask for that in writing, because it is almost certainly incorrect.

Hannah's Gift accepts Medicaid and most major commercial insurance plans. We handle the verification and approval process on your behalf at no cost to you.