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If you’re a parent of a child with autism, you may be wondering how to access Applied Behavior Analysis (ABA) therapy through Medicaid. The great news is that Medicaid, known as Health First Colorado, does cover ABA therapy for eligible children. This coverage can make a huge difference in helping your child improve communication, social, and daily living skills.
In this article, we’ll explain exactly what Medicaid covers for ABA therapy, how to access it, and what to expect from the process.
Does Medicaid in Colorado Cover ABA Therapy?
Yes, Colorado Medicaid provides coverage for ABA therapy through its Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) program. This ensures that children under 21 can receive medically necessary services, including ABA therapy, if they have a formal diagnosis of autism or another developmental disorder.
ABA therapy is covered for children and teens up to age 21, with services including evaluations, treatment sessions, and family training. The goal is to ensure your child gets the support they need to thrive.
What ABA Services Are Covered?
Medicaid covers a variety of services related to ABA therapy. These include:
- Comprehensive Behavioral Assessments: A Board Certified Behavior Analyst (BCBA) evaluates your child to create a personalized therapy plan.
- Individualized Therapy Sessions: One-on-one therapy to address your child’s unique needs, using techniques that promote positive behavior and learning.
- Parent Training: Training sessions for parents to learn how to support their child’s development at home.
- Ongoing Progress Monitoring: Regular reviews and updates to your child’s therapy plan to ensure they are making progress.
| Service Type | Description | How It Benefits the Child |
| Initial Behavioral Assessment | A comprehensive evaluation of the child’s behavior and needs | Helps identify specific areas for intervention and goals |
| Direct ABA Therapy Sessions | One-on-one therapy with a certified ABA therapist | Improves communication, social skills, and reduces problem behaviors |
| Parent Training and Support | Training for parents to support ABA at home | Empowers parents to reinforce positive behavior changes |
| Case Management | Ongoing management of the child’s treatment plan | Ensures continuous progress and adjustments to the therapy plan |
| Progress Monitoring | Regular assessment of the child’s progress | Tracks improvement and fine-tunes therapy strategies |
How Do I Access Medicaid-Covered ABA Therapy?
Here are the steps you need to follow to access ABA therapy through Medicaid:
- Get a Diagnosis: First, your child must have a formal diagnosis of autism spectrum disorder (ASD) or another qualifying condition from a licensed professional.
- Obtain a Referral: Your child’s doctor will need to provide a referral, which verifies that ABA therapy is medically necessary for your child.
- Find a Provider: Look for a Medicaid-approved ABA therapy provider. You can search for providers through the Colorado Medicaid provider search tool or ask for recommendations from your pediatrician.
- Start Therapy: After you’ve found a provider, they will assess your child and create a treatment plan. Your child will then begin ABA therapy sessions.
Are There Any Limits to Medicaid Coverage for ABA Therapy?
While Medicaid covers ABA therapy, there are some important guidelines to be aware of:
- Medically Necessary Services: Medicaid only covers services deemed “medically necessary” by a healthcare provider. The therapy must be necessary to address your child’s developmental needs.
- Therapy Hours: The number of hours your child receives each week will depend on their specific needs as determined by the BCBA. The intensity of the therapy may vary, but Medicaid will cover what is medically necessary.
- Ongoing Authorization: Medicaid requires regular reviews to continue authorizing ABA therapy. This ensures that the therapy is helping your child and that the treatment plan is adjusted if needed.
What If My Child Is Denied Coverage?
If Medicaid denies coverage for ABA therapy, you have the right to appeal. The denial letter will explain why the request was denied and how to submit an appeal. Make sure to gather any additional documents that demonstrate the medical necessity of ABA therapy, such as letters from your child’s doctor. You can also work with your ABA provider to strengthen your appeal. Click here to file an appeal.
Bright Pathways ABA Is Here to Help
At Bright Pathways ABA, we understand how confusing the Medicaid process can be. That’s why we’re here to help you navigate it and ensure your child gets the ABA therapy they need. We work directly with Medicaid to make the process as smooth as possible for you. If you have any questions or need assistance, reach out to us today. We’re here to support your family every step of the way!
Disclaimer:
The information provided in this article is for informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Bright Pathways ABA does not assume any responsibility for any outcomes or consequences resulting from the use of this information. Always seek the advice of a qualified healthcare provider with any questions regarding a medical condition or behavioral intervention.
