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Health First Colorado for a child with autism

Yes, Health First Colorado covers behavioral therapy such as ABA for any child on it when the therapy is medically necessary, and an autism diagnosis is not required. Start with a doctor's referral; the therapy provider then asks the state for prior authorization.

Children with higher support needs can also get the Children's Extensive Support (CES) waiver, through the county's case management agency. Find yours by county.

Checked against HCPF's own pages, manuals and directory, 9 November 2026.

A parent and child reading together at the kitchen table (illustration) — Illustration

What Health First Colorado covers for a child with autism

Health First Colorado, also called Colorado Medicaid, is the state's Medicaid program. It covers behavioral therapy for a child on the autism spectrum, and for other members 20 and under, when it is medically necessary, under the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit. Asked whether a child needs an autism diagnosis, the state answers: "No. Behavioral therapy is available to all children currently eligible for Health First Colorado when the service is medically necessary."

Who qualifies	Two or more of four things in the state's criteria, such as a condition behavioral therapy is known to help (autism is one example) or a safety risk like self-injury, aggression or running off.
What is needed	A standardized assessment of behaviors, and a prescription from a physician, physician assistant, nurse practitioner or psychologist. The billing manual also expects a documented condition, such as autism, a developmental delay or another developmental or behavioral condition, and a recommendation from a diagnostic evaluation.
Under age 3	The billing manual also lists children under 3 who are "At Risk for Delay".
Not covered	Services that are mainly respite or daycare, or that pay a parent to take part.
School hours	Since 15 April 2025 the state no longer covers 40 hours of service in a clinic when the child has school hours, unless the district shows the child cannot be served in a classroom.

From 1 December 2026, the state will review therapy requests using InterQual criteria; HCPF says this does not change the EPSDT benefit. Children on a waiver such as CES keep the therapy benefit: "All EPSDT services are available to all children receiving Health First Colorado."

How a child starts ABA therapy on Health First Colorado

After a doctor's referral, the therapy provider evaluates your child, writes a treatment plan and asks the state for prior authorization. Services start once the state approves the hours.

A referral
Your child's doctor (or a physician assistant, nurse practitioner or licensed psychologist) writes the order.
Pick a provider on the state list
Only providers on the state's Pediatric Behavioral Therapies list can bill for it. See them by county.
Assessment and plan
The provider assesses your child and writes a treatment plan (the BCBA and RBT roles are explained on the providers page).
Prior authorization
The provider sends a Prior Authorization Request (PAR) to the state's review vendor, which checks medical necessity. HCPF says all behavioral health services go through this step.
Approved hours
An approved PAR sets the hours and lasts up to six months, then the provider asks again.

One provider on the state list that takes Health First Colorado in every Colorado city:

Every other provider is on the providers page, A to Z.

How to apply for Health First Colorado

There are four ways to apply for a child. Health First Colorado says "PEAK is the fastest way to apply."

Online: PEAK.
Phone: 1-800-221-3943 (State Relay 711), Monday to Friday, 8 a.m. to 4 p.m.
Mail: the paper application from the same page.
In person: your county office or a local application assistance site.

If your family earns too much for Health First Colorado

The Buy-In Program for Children with Disabilities lets a family "buy into" Health First Colorado for a child with a disability when the family earns too much for regular Health First Colorado or CHP+.

Your child is under 19.
Family income after disregards is below 300% of the federal poverty level.
You pay a monthly premium based on income. You do not have to apply for Social Security disability.
Buy-In help line: 1-800-711-6994.

The Children's Extensive Support (CES) waiver

The CES waiver is for children under 18 who live at home and have a developmental disability with high support needs. It adds services such as respite, home changes and assistive technology, on top of regular Health First Colorado. Since Colorado's 2024 case management change, families apply through the county's case management agency.

In HCPF's words, it "helps children and families by providing services and supports that will help children with a developmental disability establish a long-term foundation for community inclusion as they grow into adulthood."

Age	Under 18, living in the family home.
Disability	A developmental disability (a developmental delay counts under age 5) that meets Social Security's definition of disability.
Support need	A behavior or medical condition that needs an adult's direct help at least every two hours during the day, and on average every three hours at night.
Tests	A Functional Needs Assessment for level of care, and the Health First Colorado long-term services financial check.
What it adds	Respite, home and vehicle changes, assistive technology, specialized equipment, caregiver education, a community connector, movement and massage therapy, and more. Behavioral therapy is not on this list; it comes through the regular benefit above.

Waitlists: HCPF says only that "some programs may have waitlists." Developmental Pathways, the case management agency for Arapahoe, Douglas and Elbert counties, says of CES: "There is no State waitlist for this program."

Case management agency and regional organization, by county

Each county has one case management agency (for waivers like CES) and one regional organization (for care coordination). Case management: Foothills Gateway, Inc. (Larimer), Weld County's Case Management Agency (Weld), A&I Avenues (Boulder), Jefferson County Human Services' Case Management Agency (Jefferson), Rocky Mountain Human Services (Denver), Developmental Pathways (Arapahoe), The Resource Exchange (El Paso). Regional organizations under ACC Phase III: Northeast Health Partners for Larimer and Weld, Colorado Community Health Alliance for Boulder, Jefferson and El Paso, and Colorado Access for Denver and Arapahoe. Phones, from HCPF's directory and the July 2025 contracts:

County	Case management agency	Regional organization
Larimer County	Foothills Gateway, Inc., 970-226-2345	Northeast Health Partners, Region 2, (800) 541-6870
Weld County	Weld County's Case Management Agency (Department of Human Services), 970-400-6950	Northeast Health Partners, Region 2, (800) 541-6870
Boulder County	A&I Avenues, 303-439-7011	Colorado Community Health Alliance, Region 3, (855) 627-4685
Jefferson County	Jefferson County Human Services' Case Management Agency, 303-271-4216	Colorado Community Health Alliance, Region 3, (855) 627-4685
Denver	Rocky Mountain Human Services, 303-636-5600	Colorado Access, Region 4, (800) 511-5010
Arapahoe County	Developmental Pathways, 303-360-6600	Colorado Access, Region 4, (800) 511-5010
El Paso County	The Resource Exchange (TRE), 719-380-1100	Colorado Community Health Alliance, Region 3, (855) 627-4685

Recent changes:

DDRC (Jefferson), Envision (Weld) and North Metro Community Services (Adams outside Aurora) still run Early Intervention but no longer do case management. Jefferson County Human Services, Weld County Human Services and Rocky Mountain Human Services do.
Larimer moved from Rocky Mountain Health Plans to Northeast Health Partners on 1 July 2025.

Other counties: HCPF's case management agency directory.

What a regional organization does

A regional organization (RAE) coordinates Health First Colorado health care in its region. Under ACC Phase III, since 1 July 2025, there are four regions; the table above names each county's. HCPF's fact sheet separates the two jobs: members in long-term services "may also work with a case manager through a Case Management Agency (CMA)."

Region 1: Rocky Mountain Health Plans (RMHP), (800) 421-6204
Region 2: Northeast Health Partners (NHP), (800) 541-6870
Region 3: Colorado Community Health Alliance (CCHA), (855) 627-4685
Region 4: Colorado Access (COA), (800) 511-5010

In Adams, Arapahoe, Denver and Jefferson counties, Denver Health's Elevate Medicaid Choice is also a physical health plan option, at 855-281-2418.

If Health First Colorado denies therapy

Before a denial, the doctor who asked for the therapy gets a call for a "Peer-to-Peer review".
After a denial, your appeal letter must be received by the Office of Administrative Courts no later than 30 calendar days from the date of your Notice of Action.
Questions about the benefit: HCPF_EPSDT@state.co.us.
If your child has private insurance too, Colorado's autism insurance law also applies: what it covers.

Questions parents ask about Health First Colorado and autism

Does Health First Colorado cover ABA therapy for autism?

Yes. Health First Colorado covers behavioral therapy, such as ABA, for children 20 and under when it is medically necessary. The provider must get prior authorization first.

Does my child need an autism diagnosis for therapy on Health First Colorado?

No. The state says behavioral therapy "is available to all children currently eligible for Health First Colorado when the service is medically necessary." Autism is one qualifying condition, not the only one.

How do I apply for Health First Colorado for my child?

Online through PEAK, by phone at 1-800-221-3943 (Monday to Friday, 8 a.m. to 4 p.m.), by mail, or in person at your county office.

My income is too high for Medicaid. Can my child with a disability still get it?

Possibly, through the Buy-In Program for Children with Disabilities: children under 19, family income below 300% of the federal poverty level after disregards, with a monthly premium. Call 1-800-711-6994.

How do I apply for the CES waiver?

Through your county's case management agency. The CES waiver is for children under 18 with a developmental disability who need help from an adult at least every two hours by day.

What if Health First Colorado denies the therapy?

Before a denial, the reviewer calls the requesting doctor for a peer-to-peer review. After a denial, your appeal letter must reach the Office of Administrative Courts within 30 calendar days of the denial letter.

Sources and dates

Read 9 November 2026. HCPF prints no date on most of these pages; PDFs carry their own dates. Something wrong? Tell us.