California’s regulation of massage therapy has evolved through several legislative efforts aimed at professionalizing the industry and addressing issues related to public health, human trafficking, and the quality of care. Despite these improvements, there remain significant gaps that have left the profession lagging behind other states and healthcare fields.

Local Regulation and Zoning

Before 2008, many municipalities viewed massage therapy establishments with suspicion due to their association with illicit activities, particularly human trafficking and prostitution. To counter this, local governments implemented strict zoning laws and required costly permits, often making it difficult for legitimate practitioners to operate. These ordinances weren’t designed to standardize massage therapy as a healthcare profession but rather to regulate businesses as a law enforcement matter.

Fragmented Educational Standards

The lack of state oversight meant there was no consistent requirement for massage therapy education. Training programs ranged from unaccredited short courses to more structured vocational programs, with no single standard that ensured therapists were adequately prepared to meet public health needs. This led to significant variations in the quality of practitioners and the services they offered.

Push for Reform

In the early 2000s, growing recognition of massage therapy as a legitimate healthcare service led to increased calls for state-level regulation. Advocates argued that California needed to follow the example of other states, which had implemented standardized certification processes, education requirements, and licensure for massage therapists. These calls were motivated by public safety concerns, the need to elevate the profession’s status, and the desire to integrate massage therapy more fully into healthcare systems.  Despite the rising demand for reform, the state's initial steps toward legislation moved slowly.

SB 731 (2008) - Establishing CAMTC

Sponsored by Senator Mark Wyland, SB 731 established the California Massage Therapy Council (CAMTC) as a voluntary certifying body. This bill sought to centralize certification, helping massage therapists bypass inconsistent local regulations and gain a recognized credential. While it aimed to professionalize massage therapy, the lack of state licensure and continuing education requirements meant it did not fully align with national standards.

AB 1147 (2014) - Strengthening Local Control

Sponsored by Assemblymember Susan Bonilla, AB 1147 reformed SB 731 by giving more power back to local governments. It allowed cities to regulate massage establishments more strictly in order to combat human trafficking and other illicit activities. While it tightened enforcement, this bill didn’t significantly enhance educational standards for practitioners or address the lack of continuing education, leaving the profession still underdeveloped compared to other healthcare fields.

AB 2194 (2016) - Extending CAMTC’s Role

Sponsored by Assemblymember Cristina Garcia, AB 2194 extended CAMTC’s authority until 2021 and made slight adjustments to its oversight. This bill focused on maintaining the CAMTC framework without introducing significant changes to the educational or professional development structure. The ongoing issue of inconsistent training across massage schools and the lack of continuing education remained unaddressed.

AB 2687 (2020) - Combatting Human Trafficking

Sponsored by Assemblymember Cristina Garcia, AB 2687 focused primarily on human trafficking concerns, emphasizing better vetting of schools and practitioners. However, it didn’t impose stricter educational requirements or continuing education, meaning California continued to lag behind states with more robust regulatory frameworks.

Massage Therapy Act of 2023 - Improving Oversight but Falling Short

Sponsored by Assemblymember Cristina Garcia, the*Massage Therapy Act of 2023 made significant strides in several areas:

• Tightened oversight of massage schools: Ensuring that schools meet consistent educational standards, which had been a longstanding issue.
• Improved enforcement capabilities: Enhancing CAMTC’s ability to swiftly act against unethical practitioners and establishments.
• Clarified local vs. state regulatory roles: Helping resolve conflicts between statewide certification and local control.
• Despite these improvements, the 2023 Act still did not mandate continuing education or address the issue of state licensure, which leaves California’s massage therapists ineligible for inclusion in interstate practitioner compacts.
• The absence of ongoing professional development requirements presents risks to public health, as it prevents therapists from keeping up with evolving best practices. This also holds the profession back relative to other states that have adopted more rigorous standards.

While California's legislative efforts, culminating in the Massage Therapy Act of 2023, have improved the regulation and oversight of massage therapy, they still fall short in key areas such as continuing education and mandatory licensure. These gaps not only affect public health and patient privacy but also hinder the professionalization of massage therapists within California and across state lines. California's lack of these requirements is one reason the state is not currently part of the Interstate Massage Therapy Compact (IMpact), an initiative aimed at easing the mobility of licensed massage therapists between states. States with more robust licensure and continuing education systems are prioritized for inclusion in the compact, while California’s more lenient framework holds the profession back relative to states that have stricter educational standards and mandatory licensing. Without further reforms, California will remain outside of interstate agreements, limiting career mobility for therapists and reducing the overall quality of care available to the public.

As a healthcare profession, massage therapists have long faced the dual challenge of being targeted by law enforcement while not receiving adequate protection from sexual harassment and violence. Historically, many local jurisdictions equated massage therapy businesses with illicit activities, particularly human trafficking and prostitution. This leads to aggressive policing tactics, such as random inspections, licensing raids, and arbitrary closures, often without distinction between legitimate practices and unlawful enterprises.

However, while law enforcement focused on shutting down so-called “problematic” massage establishments, there was a glaring lack of effort to protect therapists from the frequent sexual harassment and violence they endure in their daily work. Many massage therapists report being propositioned, groped, or assaulted by clients, yet they often feel unsupported by law enforcement when these incidents occur, as reporting such abuse frequently leads to dismissal or a lack of serious investigation. This failure to protect therapists perpetuates a dangerous cycle of harm, leaving practitioners vulnerable while criminalizing their profession rather than safeguarding it. 

Massage therapy has continued to grow in its role as a health-related service, yet the profession remains burdened by outdated laws that often prioritize criminal regulation over healthcare standards. It's time for an update—a law that establishes a Licensed Clinical Massage Therapy (LCMT) designation based on passing and maintaining a national board-certified status with the NCBTMB s to recognize massage therapists as integral members of the healthcare system.

Some ways the current law is failing Californians:

• Inconsistent Regulation Across Jurisdictions: AB 1147 gave local governments authority over massage businesses, creating a patchwork of regulations that vary dramatically from city to city, often focusing on crime prevention rather than healthcare.  This law enforcement often does not focus on preventing frequent sexual harassment and violence against massage therapists at all.
• No Clear Healthcare Integration: While massage is increasingly recognized for its health benefits, the law still treats it more like a service industry than a healthcare profession, limiting its integration into medical treatment plans and insurance coverage.
• Lack of Protection Against Misclassification: Massage therapists are often misclassified as independent contractors or gig workers, which deprives them of employment protections, including health benefits and workers' compensation.
• Limited Consumer Safety: Without a statewide licensing standard for clinical massage therapy, consumers cannot easily distinguish between therapists trained to address complex medical conditions and those offering general wellness services.
• Assumed Privacy: As public recognition of massage therapy grows, clients increasingly view it as a legitimate healthcare service, expecting the same privacy protections they receive in medical settings. However, current laws regulating massage therapy fall short in addressing these expectations. Unlike other healthcare professions, there are limited legal requirements for the safeguarding of sensitive client information, such as health history and treatment records.
• Insufficient Access to Massage for Medical Reasons: The current system does not encourage insurance reimbursement for massage therapy, making it difficult for Californians to access and afford clinical massage for conditions like chronic pain, stress management, or injury recovery.
• Lack of Continuing Education Requirements in California: Unlike many other states, California does not require continuing education for licensed massage therapists, which poses significant public health risks by allowing practitioners to operate without up-to-date training. This absence also limits California’s inclusion in interstate practitioner pact agreements, placing its massage therapy profession behind states with stricter regulatory standards.

Some benefits of creating a Licensed Clinical Massage Therapy (LCMT) designation:

• Standardized Training and Care: An LCMT designation based on national board certification would ensure all clinical massage therapists meet a rigorous, uniform training standard, focusing on medical knowledge, anatomy, clinical best practices, and experience with minimal burden to the State to provide new exams or develop systems for certifying and tracking continuing education records.
• Improved Public Safety: By creating a licensed clinical designation, consumers would have greater assurance that their massage therapist has the expertise to handle health-related issues safely, especially for vulnerable populations like the elderly and chronically ill.
• Integration with Healthcare Providers: A formal LCMT designation would foster better collaboration between massage therapists and healthcare providers, allowing massage therapy to be more easily integrated into treatment plans for patients dealing with pain, injury, and mental health challenges.
• Insurance Coverage for Medical Massage: A clinical designation could open the door for more insurance companies to recognize massage therapy as a reimbursable medical expense, making it more accessible to Californians in need of healthcare services.
• Economic Benefits for Therapists and Communities: By recognizing clinical massage therapists as healthcare providers, the new law would elevate the profession, allowing therapists to earn more competitive wages, secure employment benefits, and contribute to the healthcare workforce shortage in underserved areas.

California has led the nation in forward-thinking healthcare reform, and it's time to apply that leadership to the field of massage therapy. We need a law that not only protects the public but also recognizes the vital role that massage therapy plays in the healthcare system. By establishing an LCMT designation, California can pave the way for a more equitable, accessible, and effective approach to pain management and wellness.

Let’s support the future of healthcare in California by updating the law for massage therapists. Tell your state senators! https://findyourrep.legislature.ca.gov/