Applied behavior analysis (ABA) is a service that aims to improve a person’s quality of life. It is most often known as a treatment for autism spectrum disorder (ASD), but ABA can also be helpful for other diagnoses such as ADHD, for general behavioral issues, for learning disabilities, for parenting concerns, and more.
ABA is also often an intensive intervention which means it is typically provided at a high rate, such as 20 or more hours per week, and for an extended period. This could result in high costs for families seeking ABA therapy. However, this shouldn’t deter you from seeking out ABA services for your child as ABA can be very effective at helping kids learn new skills, decrease the frequency of challenging behaviors, and improve daily functioning and independence. For those who qualify, ABA therapy is a covered benefit under state-sponsored Medicaid. In this article, we will take an in-depth look at utilizing Medicaid for ABA therapy in the state of Colorado.
Colorado Medicaid Eligibility
Medicaid is a state-funded insurance program that is provided to low-income individuals and families. To qualify for Medicaid, you must meet certain income requirements. Colorado Medicaid or Health First Colorado, as it is widely known, indicates the following income limits based on household size (the number of people in the household) to qualify for Medicaid assistance.
If your household income is at or below these income limits, you will be able to apply for Health First Medicaid Colorado. If you qualify, Medicaid (Health First Colorado) will provide you with free or low-cost health insurance. Your insurance may be provided through a health insurance marketplace which allows you to browse various insurance options.
Medicaid (Health First Colorado) provides coverage for behavioral health therapy regardless of diagnosis. This means that you don’t need to have a diagnosis of autism spectrum disorder to have insurance coverage for behavioral therapy under Colorado Medicaid.
Medically Necessary Treatment
Medicaid covers medically necessary treatment. Behavioral health service providers provide what is known as “medically necessary” services for behavioral health conditions. Medically necessary services are services that are required for the management or treatment of a particular diagnosis or medical condition. Medicare.gov defines medically necessary services as “health care services or supplies needed to diagnose or treat an illness, injury, condition, disease, or its symptoms and that meet accepted standards of medicine.”
Applied behavior analysis (ABA) is considered a medically necessary treatment for autism. As evidenced by scientific research, ABA can help alleviate symptoms of ASD such as social and communication difficulties or behavioral challenges.
If you have Medicaid (Health First Colorado) and private insurance, you will need to have your private insurance provide verification that they don’t cover applied behavior analysis (ABA) before Medicaid will cover ABA services. Medicaid is considered the payor of last resort which means that if you have another funding source that could cover ABA services, you will need to go through that source first. If the funding source doesn’t cover ABA services, they would need to provide you with a denial letter stating that ABA is not covered under their program.
Applying for Medicaid
There are four ways to apply for Colorado Medicaid. These include:
- Apply Online
- Apply In Person
- Apply by Mail
- Apply by Phone
To apply for Colorado Medicaid (Health First Colorado), you can complete an application online. Follow this link to apply.
To apply by mail, print out an application, complete the application and send the application in through post mail. You can find PDF documents for the Medicaid application by going to the ‘Apply by Mail’ section at this link.
You can also apply by phone. To do this, call 1-800-221-3943 / State Relay: 711.
Services Offered through Colorado Medicaid
If your child needs ABA treatment and qualifies for Medicaid (Health First Colorado), you will have the opportunity to access a variety of services for your child. These services can help your child improve their quality of life in different ways.
Some of the services that will likely be covered by Medicaid and available for your child include:
- Case management services
- Clubhouse/drop-in centers
- Emergency services
- Individual and group therapy
- Inpatient hospital psychiatric care
- Medication management
- Outpatient hospital psychiatric services
- Prevention/early intervention activities
- Psychiatrist services
- Recovery services
- School-based and day treatment services for children/youth
These services can support your child’s development. Medicaid will also cover applied behavior analysis (ABA) services for children with certain conditions. You can learn more about the covered benefits of Colorado Medicaid here.
Now Enrolling for Children with Colorado Medicaid
Behavioral Innovations accepts Health First Colorado or Colorado Medicaid to provide quality in-center ABA therapy for children with autism. If you have Medicaid, Behavioral Innovations can help you navigate through the entire process and start ABA services for your child. If you’d like to learn more about ABA, contact Behavioral Innovations at 855-782-7822 or submit a short form here.
Medicaid Coverage for ABA Therapy in Colorado
ABA therapy is a very effective intervention to help children learn new skills, help reduce challenging behaviors, and support independent living and quality of life. Medicaid is an insurance program that offers coverage for ABA therapy for those who qualify. Reach out to your local health department to get started on your application for Medicaid Coverage (Health First Colorado).
PASCO. Guide to Receiving Behavioral Health Services in Colorado. Retrieved December 11, 2022 from https://pascohh.com/how-to-access-behavioral-therapy-services-in-colorado/