Certified Anesthesiologist Assistants can practice in 24 U.S. jurisdictions: 22 states, the District of Columbia, and the territory of Guam. On top of that, CAAs can work at any Veterans Affairs medical facility in all 50 states, even ones with no AA licensing framework of their own. If you’re trying to figure out which states license anesthesiologist assistants, the short list below is the current map, followed by how each state’s authorization actually works.
The 24 Jurisdictions That Authorize CAA Practice
The states and territories where CAAs currently hold practice authority are:1American Society of Anesthesiologists. Certified Anesthesiologist Assistants
- Alabama
- Colorado
- District of Columbia
- Florida
- Georgia
- Guam
- Indiana
- Kansas
- Kentucky
- Michigan
- Missouri
- Nevada
- New Mexico
- North Carolina
- Ohio
- Oklahoma
- Pennsylvania
- South Carolina
- Tennessee
- Texas
- Utah
- Vermont
- Virginia
- Washington
- Wisconsin
Georgia was the first to authorize AAs, in 1971, followed by Ohio in 1973. More than a dozen states have added authorization since 2000, and the pace has picked up recently.2American Society of Anesthesiologists. Statement on Certified Anesthesiologist Assistants Description and Practice Four states joined between 2022 and 2025 alone: Nevada, Tennessee, Virginia, and Washington.
Two Ways States Authorize AA Practice
Not every state credentials AAs the same way. Most states issue a direct license: the AA applies to the state medical board or an equivalent agency, meets the requirements, and receives a standalone credential. The AA then works under a supervising anesthesiologist but holds an independent license tied to their own qualifications.
A smaller group of states uses delegatory authority instead. Under that model, the AA doesn’t carry a separate license. A supervising anesthesiologist formally delegates specific anesthesia tasks to the AA under the physician’s own medical license. Kansas, Michigan, Pennsylvania, and Texas currently operate this way,1American Society of Anesthesiologists. Certified Anesthesiologist Assistants as does Guam.2American Society of Anesthesiologists. Statement on Certified Anesthesiologist Assistants Description and Practice
States can move between models. Wisconsin started with delegatory authority in 1980 and transitioned to full licensure in 2012. Clinically, the patient experience is the same either way, because in both models the supervising anesthesiologist must be physically present in the operative area and immediately available to intervene.
Arizona: Passed, But Not Yet Licensing
Arizona is worth flagging separately because its status is easy to misread. The state passed HB 2674 during its 2024 legislative session, adding anesthesiologist assistants to the professions licensed by the Arizona Medical Board.3Arizona Legislature. Arizona House Bill Summary – HB 2674 As of 2025, however, the Board was still writing the administrative rules needed to actually issue licenses, so Arizona doesn’t appear on most current practice maps. Passing a bill is the first step; the rulemaking that follows can take a year or more before the first license is handed out.
VA and TRICARE: Federal Authorization in All 50 States
Practice authorization at Veterans Affairs medical facilities runs on federal policy, not state law. CAAs can work at any VA facility in any state, including states with no AA licensing framework at all.4AAAA. Resources For AAs weighing federal employment, that opens the entire country regardless of where you live.
The Department of Defense’s TRICARE program similarly recognizes anesthesiologist assistants who are authorized to practice by licensure, certification, or delegated authority in their state. Medicare also covers AA-delivered anesthesia services under Part B, provided the AA is legally authorized in their state and works under an anesthesiologist meeting CMS medical direction standards.5Centers for Medicare & Medicaid Services. Anesthesiologist Assistants Federal statute groups AAs with certified registered nurse anesthetists for Medicare payment purposes.6Legal Information Institute. 42 USC – Definition: Certified Registered Nurse Anesthetist
The 28 States Without AA Authorization
The remaining 28 states have no statute or regulation enabling AA practice. Without specific enabling legislation, a state medical board has no mechanism to license or authorize AAs, no matter how well qualified the applicant is. It isn’t a judgment on competency. The legal authority to credential the role simply hasn’t been created in those states yet.
Legislative efforts continue every session, and the trend line is expansion rather than contraction. Four new state authorizations in three years, plus Arizona working through rulemaking, suggests the map will keep changing. If you’re a CAA in a non-authorizing state, your practical options are a VA facility in that state, relocating to one of the 24 authorized jurisdictions, or working through organizations like the AAAA and ASA on the legislation that would add your state to the list.
Checking a State Before You Commit
Before accepting a position or filing an application, confirm two things directly with the state medical board: whether the state uses licensure or delegatory authority, and what paperwork each model requires. In licensure states you’ll file your own application, submit transcripts from your CAAHEP-accredited program, provide your NCCAA certification, and clear a fingerprint-based background check. In delegatory-authority states, you and your supervising anesthesiologist typically file delegation paperwork together instead of you obtaining a standalone license. Processing runs from several weeks to a few months in either case.