What Benefits Can You Claim for Autism?
If your child is diagnosed with autism, there are several types of benefits and supports you may be able to claim. Which ones apply to you will depend on your state (like Colorado or Utah), your insurance plan, and eligibility for public programs.
Insurance Coverage for Autism Services
Most states have laws requiring health insurers to cover diagnosis and treatment services for autism, including Applied Behavior Analysis (ABA).
What services are typically covered?
These can include:
- Diagnostic assessments and evaluations
- ABA therapy or behavioral interventions
- Speech therapy, occupational therapy, physical therapy
- Psychological, psychiatric, and pharmacy care
How regulation differs by state
- In Colorado, insurers must covers diagnosis, ABA, habilitative/rehabilitative services (speech, OT, PT), and more, and the state has removed age/dollar caps.
- In Utah, state law requires coverage for autism treatment (including ABA) under many health plans, and in 2019, the state removed age and dollar caps.
- But note: self-funded employer plans are often exempt from these state mandates; federal rules (like the Affordable Care Act and mental health parity laws) may then apply.
Public Programs & Additional Supports
Beyond private insurance, there may be public programs and supports you can tap into:
- Medicaid/CHIP: Many states cover medically necessary autism services for children under 21 through their Medicaid programs or Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit.
- State disability/waiver programs: Some states offer waivers or specialized disability supports for families of children with autism (though these often have waiting lists or eligibility thresholds).
- Early intervention/Part C/IDEA (for children): Through public school systems, some therapy services may be provided as part of a child’s Individualized Educational Program (IEP) under IDEA.
- Tax credits/deductions: In some cases, medical or dependent care expenses (for therapy, transport, etc.) might be deductible on federal income tax, depending on your circumstances (always check IRS rules).
Conclusion
Autism services can be life-changing—but figuring out how to pay for them doesn’t have to be overwhelming. From insurance coverage and Medicaid programs to state-funded resources and school-based support, there are multiple ways families in Colorado and Utah can access the help their child needs. The key is knowing what benefits you’re entitled to and how to apply for them. Whether you’re just starting your autism journey or looking to expand your child’s current services, understanding your options can open the door to consistent, high-quality care. And with the right support—both therapeutic and financial—your child can thrive.
What sets Little Champs ABA apart isn’t just our evidence-based therapy—it’s the way we care for the whole family. We offer in-home, clinic-based, and community-centered ABA services tailored to your child’s unique strengths and goals. But we also go beyond therapy, offering hands-on help with insurance approvals, financial aid paperwork, and access to local resources. With dedicated teams across Colorado and Utah, we make it easier for families to get started, stay supported, and see meaningful progress. When you choose Little Champs ABA, you’re not just choosing a provider—you’re gaining a trusted partner in your child’s growth.
FAQs
Q: Can insurance refuse to cover ABA therapy altogether?
A: Some plans—often self-funded ones—may exclude or limit autism coverage. In those cases, you may have to appeal or rely on federal mental health parity laws.
Q: Are there dollar or age caps on autism services?
A: In Colorado and Utah, state laws generally prohibit caps on autism coverage (age and dollar limits) for state-regulated plans.
Q: Does Medicaid always cover autism services?
A: Medicaid in many states covers autism services for children, but coverage and access depend on the state policies, scheduling. and regional availability.
Q: What if my insurance denies a claim?
A: You can file an appeal or grievance with your insurer. Document medical necessity. treatment plans, and supporting letters from providers.
Q: Are there therapy expenses tax-deductible?
A: Possibly—if the costs qualify as medical expenses under IRS rules and you itemize deductions. Always consult a tax professional for your specific case.
Sources:
- https://www.autismspeaks.org/what-autism
- https://www.autismspeaks.org/applied-behavior-analysis