On January 1, 2026, California changed the game for massage therapists. An amendment to the state’s Massage Therapy Act added language to Section 4600.5(e) of the Business and Professions Code, stating the Legislature’s intent that “both state and local regulation of massage therapy reflect the recognized status of certified massage professionals as health care providers.”
That single sentence carries enormous weight. For the first time, California — the largest state economy in the U.S. — officially classifies certified massage therapy as a healthcare service, not a personal service.
And California isn’t alone. Several other states are advancing legislation that elevates the professional status of massage therapists, from workers’ compensation recognition in New York to Medicaid coverage in Washington. If you’re a massage therapist running your own practice, these changes directly affect how you operate, how you’re regulated, and how you protect yourself legally.
What California’s Healthcare Provider Recognition Actually Means
Let’s be precise about what the law does and doesn’t do, because the distinction matters.
What It Does
The amendment to Section 4600.5(e) of the California Business and Professions Code establishes legislative intent — a legal signal to every state agency, city government, and regulatory body that massage therapy performed by CAMTC-certified professionals should be treated as healthcare, not as a personal or cosmetic service.
This matters in several practical ways:
Zoning and business classification. Massage practices have long struggled with being lumped into the same zoning category as salons, spas, or — in some municipalities — businesses subject to vice-related restrictions. With healthcare provider recognition, CAMTC-certified therapists have stronger legal standing to be classified alongside chiropractors, physical therapists, and acupuncturists when it comes to where they can operate.
Professional credibility. When you’re building referral networks with physicians, orthopedists, or sports medicine specialists, being able to point to state law that recognizes your work as healthcare — not pampering — changes the conversation. It’s the difference between “I do massages” and “I provide a state-recognized healthcare service.”
Local regulatory treatment. Cities and counties that have historically imposed burdensome regulations on massage establishments — extra permitting, moratorium zones, special inspections — now face a legislative backdrop that frames their oversight in a healthcare context. This doesn’t eliminate local authority, but it does shift the lens.
What It Doesn’t Do
It does not make massage therapists medical providers. You cannot bill medical insurance, prescribe treatment, diagnose conditions, or claim the same scope of practice as a licensed physician or physical therapist. The recognition is about regulatory classification, not clinical scope.
It does not apply to everyone. The healthcare provider designation applies only to CAMTC-certified professionals. If you’re practicing in California under a local city permit without CAMTC certification, this law doesn’t cover you. This is a significant distinction — there are over 50,000 CAMTC-certified therapists in California, but not every practicing massage therapist holds that credential.
It is not a self-executing mandate. Legislative intent provides interpretive guidance, but it doesn’t automatically rewrite every city ordinance or zoning code. It gives you legal leverage, not automatic compliance from local governments.
Why This Matters for Independent Massage Therapists
If you’re a 1099 contractor renting a room in a wellness center, or running a solo practice out of a small office, the shift from “personal service” to “healthcare provider” has real implications:
Lease negotiations
Landlords and commercial property managers often have different rules (and different willingness) for healthcare tenants versus personal service tenants. Healthcare classification can open doors to medical office spaces, shared health practitioner suites, and professional buildings that previously wouldn’t consider a massage therapist.
Insurance positioning
While the California law doesn’t automatically grant insurance billing privileges, it strengthens the argument for massage therapy coverage in workers’ compensation, personal injury, and health insurance contexts. When the state itself calls you a healthcare provider, insurers have a harder time arguing you’re not.
Liability and documentation
Healthcare providers are held to healthcare documentation standards. This is actually a benefit — it means your intake forms, liability waivers, and client records carry more weight when they follow healthcare conventions. Digital waivers with proper health disclosure, informed consent, and timestamped signatures aren’t just good practice — they’re expected of healthcare providers.
Other States Making Similar Moves
California’s recognition didn’t happen in a vacuum. Across the country, legislatures are rethinking how massage therapy fits into the healthcare landscape. Here’s where the most significant action is happening:
New York: Workers’ Compensation Coverage (S4612)
New York Senate Bill 4612, introduced in February 2025 by Senators Ramos and Jackson, would amend the state’s workers’ compensation law to include coverage for treatment rendered by licensed massage therapists.
Under current New York law, injured workers can only receive massage therapy reimbursement on an ad-hoc basis — some carriers allow it, others deny it, and there’s no consistency. S4612 would create a formal pathway for massage therapists to participate in workers’ compensation networks as recognized providers.
Key limitation: The bill specifies that massage therapists could provide care but would not be permitted to establish workplace injury causation or determine disability status. This preserves the diagnostic role of physicians while expanding treatment access.
If passed, this would be a landmark recognition of massage therapy as a legitimate treatment modality within one of the country’s largest workers’ compensation systems.
Washington State: Medicaid Coverage (SB 5507)
Washington’s Senate Bill 5507, sponsored by Senators Cleveland, Hasegawa, Saldana, and Valdez, would provide coverage for massage therapy under the state’s medical assistance (Medicaid) plans.
This is significant because Medicaid coverage is one of the clearest possible signals that a state considers a service to be healthcare. Washington already licenses massage therapists at the state level through the Department of Health — adding Medicaid coverage would complete the circle, putting massage therapy alongside other covered healthcare services.
The bill received a public hearing in the Senate Health & Long-Term Care Committee, signaling serious legislative consideration.
Minnesota and Kansas: Statewide Licensure
Minnesota and Kansas are two of the remaining states without comprehensive statewide massage therapy licensure. Both have active legislative efforts underway:
Minnesota introduced SF 1131 and HF 362 to create a formal licensure framework for massage therapists and Asian bodywork therapy. While neither bill advanced in 2025, the American Massage Therapy Association (AMTA) continues to advocate and is targeting the 2026 session.
Kansas has an ongoing effort to establish licensure for all massage therapists, with AMTA committed to advancing the effort in 2026.
Why does licensure matter for healthcare recognition? Because statewide licensure is typically a prerequisite for healthcare provider status. You can’t be recognized as a healthcare provider if the state doesn’t formally regulate your profession in the first place.
Interstate Massage Compact (IMpact)
In 2025, Arkansas, Montana, and Virginia enacted the Interstate Massage Compact — a multistate licensing framework that allows licensed massage therapists to practice across member states with a single credential.
While this isn’t directly about healthcare provider status, it’s part of the same professionalization trend. The compact treats massage therapy as a regulated healthcare profession worthy of interstate licensure reciprocity — the same framework used by nurses, physical therapists, and other healthcare providers.
Maryland: Two-Tier Healthcare Recognition
Maryland already operates a two-tier licensing system that implicitly recognizes massage therapy as healthcare:
- Registered Massage Practitioner — Can practice massage in general settings
- Licensed Massage Therapist — Can practice in medical provider offices, hospitals, and healthcare facilities
Only the Licensed Massage Therapist designation permits practice in clinical healthcare settings, creating a clear pathway from general practice to healthcare provider status within the same profession.
What This Means for Your Waiver and Documentation Practices
As massage therapy moves toward healthcare provider status, the documentation expectations change too. Healthcare providers are expected to maintain:
Comprehensive intake forms
Your client intake should include detailed health history, medication lists, contraindication screening, and informed consent — not just a name and signature. A well-crafted liability waiver that covers health disclosure, assumption of risk, and treatment consent positions you as a healthcare professional, not a service provider handing out a generic form.
Digital records with audit trails
Healthcare records need to be retrievable, timestamped, and tamper-proof. Paper forms crammed in a filing cabinet don’t meet this standard. Digital waiver platforms that capture signatures with timestamps, device information, and secure cloud storage align with healthcare documentation expectations.
Retention compliance
Healthcare records typically require longer retention periods than general business records — often 7+ years, and longer for minors. Digital storage makes indefinite retention effortless at no additional cost.
HIPAA awareness
If you’re collecting health information as a recognized healthcare provider, HIPAA compliance becomes relevant. While most massage therapists aren’t covered entities under HIPAA (that typically requires billing insurance electronically), moving toward healthcare provider status means understanding how protected health information (PHI) should be handled.
How to Prepare Your Practice
Whether your state has already made these changes or you’re anticipating similar legislation, here’s how to position your practice:
1. Get (or maintain) your state certification or license
In California, this means CAMTC certification. In your state, it means whatever the highest available credential is. Healthcare provider recognition almost always ties to formal credentialing — not just completing a training program.
2. Upgrade your documentation
Move from paper to digital waivers with health disclosure, informed consent, and legally binding signatures. This isn’t just about protecting yourself legally — it’s about meeting the documentation standard expected of healthcare providers.
3. Review your business classification
Check how your city or county classifies your business. If you’re categorized as a “personal service” or “salon,” the new healthcare recognition may give you grounds to request reclassification. Consult with a local business attorney if you’re unsure.
4. Join your professional association
Organizations like AMTA, ABMP, and your state massage therapy association are the ones driving these legislative changes. Your membership dues fund lobbying efforts, and these organizations provide resources, legal updates, and advocacy support.
5. Stay informed
Legislative changes happen at the state level, and they move fast. Follow your state association’s legislative updates, sign up for AMTA or ABMP alerts, and check your state legislature’s bill tracker.
The Bigger Picture
The trend is clear: massage therapy is being recognized as healthcare across the United States. California’s amendment to Section 4600.5(e) is the most explicit example, but New York’s workers’ compensation bill, Washington’s Medicaid coverage bill, and the Interstate Massage Compact all point in the same direction.
For massage therapists — especially independent 1099 contractors who bear full responsibility for their own legal protection — this shift brings both opportunity and responsibility. Healthcare provider status opens doors to better business locations, stronger insurance arguments, and greater professional credibility. But it also raises the bar for documentation, compliance, and professional conduct.
The therapists who will benefit most are the ones who prepare now: get credentialed, upgrade your documentation, and run your practice like the healthcare provider your state is recognizing you to be.
Ready to bring your practice documentation up to healthcare standards? Start your free 14-day trial with Waiver World — create HIPAA-aware digital waivers with health disclosure forms, informed consent, and secure cloud storage. No credit card required.
