Certified Anesthesiologist Assistants (CAAs) can currently practice in 24 U.S. jurisdictions. That number has grown steadily over the past decade, and several additional states are actively considering legislation to join the list. Whether you’re a student choosing this career path or a practicing CAA weighing a relocation, here’s exactly where the profession stands geographically.
All 24 Jurisdictions Where CAAs Can Practice
The following states and territories authorize CAA practice as of 2024, according to the American Society of Anesthesiologists:
- Alabama
- Colorado
- District of Columbia
- Florida
- Georgia
- Indiana
- Kansas
- Kentucky
- Michigan
- Missouri
- Nevada
- New Mexico
- North Carolina
- Ohio
- Oklahoma
- Pennsylvania
- South Carolina
- Tennessee
- Texas
- Utah
- Vermont
- Virginia
- Washington
- Wisconsin
Not all of these states authorize practice the same way. Most have specific CAA licensure statutes, but a handful rely on what’s called delegatory authority, meaning the state medical board allows anesthesiologists to delegate anesthesia tasks to a CAA without a separate CAA-specific license. Kansas, Michigan, Pennsylvania, and Texas fall into this delegatory category. The practical difference matters: in delegatory states, practice rights can sometimes be more limited or less clearly defined, and they may depend on the policies of individual hospital systems or medical boards rather than a standalone law.
States Considering New Legislation
New York is one of the most notable states currently pursuing CAA authorization. Assembly Bill A1072, introduced for the 2025-2026 legislative session, would create a formal licensure framework for anesthesiologist assistants in the state. The bill proposes establishing a State Committee for Anesthesiologist Assistants, setting clear licensure requirements, and creating a limited permit system (lasting one year) for individuals who meet all qualifications except the certification exam. If passed, New York would become one of the largest job markets to open for CAAs.
Other states periodically introduce similar bills. The general trend over the past several years has been expansion, not contraction, of CAA practice authority. States that already have large anesthesiology group practices or academic medical centers tend to move faster on these measures because the demand for anesthesia providers is high and CAAs help fill the gap.
How VA and Federal Facilities Work
The Department of Veterans Affairs recognizes CAAs as anesthesia professionals alongside anesthesiologists and Certified Registered Nurse Anesthetists (CRNAs). This means VA hospitals can hire and credential CAAs. However, there’s a catch: VA facilities still look to the individual’s state license to determine the maximum scope of practice they can offer. If you hold a license in a state that authorizes CAA practice, a VA hospital can credential you up to that scope (or narrower, at the facility’s discretion). You cannot use VA employment to bypass the absence of CAA authorization in a state where you hold no qualifying license.
VA policy also requires that an anesthesiologist be immediately physically available at all times when a CAA is providing care. “Immediately available” includes being in a nearby care area or adjoining office space, not just somewhere in the building.
What CAAs Actually Do
CAAs work exclusively under the direction of an anesthesiologist. They’re trained at the master’s degree level in programs modeled on medical school curricula, with prerequisites that mirror pre-med coursework. In practice, a CAA helps prepare anesthesia equipment, assists with airway management, administers anesthetic agents, monitors patients throughout surgery, and supports emergence from anesthesia. The key distinction from CRNAs is the supervision model: CAAs always work as part of the anesthesia care team with a physician anesthesiologist directing their care, while CRNAs in some states can practice independently.
This team-based model is a significant factor in where CAAs gain practice authority. States with strong physician-led anesthesia traditions tend to be more receptive to CAA legislation. States where CRNAs have established independent practice norms sometimes see more political resistance to adding a new provider type.
Medicare Reimbursement Across States
From a reimbursement standpoint, Medicare treats CAAs and CRNAs similarly. Both are classified as nonphysician anesthetists, and rural hospitals or Critical Access Hospitals can choose to reimburse their services at cost rather than under the standard fee schedule. This option applies when a hospital’s annual surgical caseload requiring anesthesia stays below 800 procedures, and the nonphysician anesthetist agrees in writing not to bill Medicare on a fee-schedule basis at that facility.
For most CAAs working in urban or suburban settings, standard fee-schedule reimbursement applies. The reimbursement parity between CAAs and CRNAs means that from a hospital’s financial perspective, hiring either type of provider produces roughly the same Medicare revenue. The deciding factor for employers is usually state law, local workforce availability, and the facility’s anesthesia care model.
Choosing Where to Practice
If you’re planning a career as a CAA, geography matters more for this profession than for most healthcare roles. The 24 authorized jurisdictions span a wide range of practice settings, from major metro areas in Florida, Texas, and Ohio to smaller markets in states like Vermont and New Mexico. Georgia and Ohio have historically been the two largest employers of CAAs, largely because Emory University and Case Western Reserve University (two of the earliest CAA training programs) are located there.
Before committing to a move, verify the specific regulatory pathway in your target state. In licensure states, you’ll apply to a state board and receive a distinct CAA license. In delegatory-authority states, the process may involve working under a physician’s delegation agreement rather than holding a standalone credential. Both pathways allow you to practice, but the licensure route generally offers more professional stability and clearer legal protections.