Medical and Dental Assisting Pathway Guide

At a glance

This guide covers a high school pathway in medical assisting (CIP 51.0801) and dental assisting (CIP 51.0601) in Michigan, Virginia, North Carolina, Arizona, Pennsylvania, Missouri and Hawaii. You can run one track or both. The guide sets out the rules that differ by state. The how-to for staffing, partnerships, approvals, facilities, curriculum and scheduling sits in six implementation toolkits, linked in the launch steps at the end.

What the pathway leads to

None of the seven states licenses medical assistants. Arizona is the exception that matters: its Medical Board sets the training a medical assistant must have before a physician can employ them, and for a high school completer that means passing an accredited national certification exam. Entry-level dental assistants are not licensed either, but each state’s dental board decides which duties they may perform, and in most of the seven states a dental assistant must pass a course or exam before taking X-rays.

In high school, students can earn national credentials: the NHA Certified Clinical Medical Assistant (CCMA), phlebotomy (CPT) and EKG (CET) certifications, and for dental assisting the DANB Radiation Health and Safety (RHS) exam or the DANB National Entry Level Dental Assistant (NELDA) credential. Registered and expanded-function dental assistant roles come after high school in every state checked. Graduates go to work in clinics and dental offices, to an accredited college program, or on to nursing and other health programs.

The decisions you face

1. Medical, dental, or both. Medical assisting has a state course or program in Virginia, North Carolina (pilot), Arizona, Pennsylvania and Missouri. Dental assisting has one in Virginia (new), Arizona and Pennsylvania. Michigan runs both as tracks inside Health Sciences (51.0000).
2. Which credential, and when students test. The national medical assisting credentials require a high school diploma, not a minimum age. NHA lets students test up to 12 months before graduation under a provisional certificate that they must convert after graduating.
3. Clinical partners for live-patient skills. The phlebotomy credential needs 30 live venipunctures and 10 capillary sticks, and the EKG credential needs 10 live EKGs. Your clinical partner has to let minors perform them.
4. Whether students take dental X-rays on patients. Four states require an exam or credential before an assistant exposes radiographs, Michigan requires a course, and Missouri and Hawaii require neither.
5. Who teaches. Medical and dental assistants hold national certifications rather than state licenses, so confirm that your state’s health teaching credential accepts them before you recruit.

Where the states differ most

Items are labeled Confirmed, Confirm with the agency, or Changing. Last checked October 5, 2026.

Jobs and pay

Medical assistant jobs are projected to grow faster than the national rate in five of the seven states. Every state has more medical assistant openings than dental assistant openings, about twice as many in most. Dental assistants earn more than medical assistants in six of the seven states (Hawaii is the exception).

Arizona leads projected growth for both medical (+24.0%) and dental (+15.7%) assistants

Projected change in jobs, 2024 to 2034: medical assistants (SOC 31-9092) and dental assistants (SOC 31-9091)

Show the numbers

State	Medical assistants	Dental assistants
Arizona	+24.0%	+15.7%
North Carolina	+15.9%	+8.6%
Hawaii	+13.8%	+5.7%
Michigan	+13.0%	+4.8%
Virginia	+12.8%	+6.0%
Missouri	+11.6%	+3.9%
Pennsylvania	+10.5%	+5.5%
United States	+12.5%	+6.4%

Medical assistants

Dental assistants

Wages are from the BLS Occupational Employment and Wage Statistics state file (Medical Assistants, SOC 31-9092; Dental Assistants, SOC 31-9091). Jobs and openings are from Projections Central. Check regional demand with local clinics, health systems and dental offices before you decide which track to run.

Credentials students can earn

No national medical assisting or dental assisting certifier states a minimum age. The gate for medical assisting credentials is the high school diploma, and the gate for the phlebotomy and EKG credentials is live-patient practice.

The CCMA is the credential most often listed by the states that publish a list. NELDA is the national dental credential written for high school programs, but no state checked lists it.

What each state counts

Working with minors

For the full federal and state rules, a task-by-task decision path and a student-learner agreement template, see Working with Minors in CTE Pathways. For clinical affiliation agreements, HIPAA confidentiality, bloodborne pathogens coverage and host-site checklists, see the Clinical and Work-Based Learning Partnerships toolkit.

Federal rules

No federal hazardous occupations order covers ordinary medical or dental assisting tasks such as vital signs, specimen collection, EKGs or chairside assisting. Two orders reach work in clinics and dental offices, and neither has a student-learner exemption.

HO 6 matters only for paid minors who expose dental radiographs, and only above 0.5 rem a year. It does not bar the work below that level. Ask the employer to document operator dose or radiation safety practice. Federal law sets no hour limits for 16- and 17-year-olds.

Two clauses to add to your clinical agreements:

• Medical assisting: live-patient skill counts (venipunctures, capillary sticks, EKGs), whether minors may perform them, and who verifies them on the NHA attestation.
• Dental assisting: whether students will expose radiographs, and the credential your state requires first (see Licensing and outside approvals). Sharps and saliva exposure is higher in dental assisting and phlebotomy, so name who provides hepatitis B vaccination or declination and post-exposure evaluation for unpaid students.

State rules

State dental board rules on radiography apply to students on top of these labor rules. They are in the next section.

Licensing and outside approvals

The state CTE agency approves the program. Three other kinds of body also shape it: the Arizona Medical Board for medical assisting in Arizona, each state’s dental board for dental assisting duties, and the national certification bodies (NHA, AMT, AAMA, NCCT and DANB) that decide who may sit their exams.

Medical assisting

Arizona does not license medical assistants, but A.R.S. 32-1456 lets a medical assistant take body fluid specimens and give injections under direct supervision of an MD, PA or NP, and directs the Arizona Medical Board to set training requirements. Under A.A.C. R4-16-401(A), before employing a medical assistant the supervising physician or PA must make sure the person completed one of three routes:

1. A CAAHEP- or ABHES-accredited program.
2. An unapproved training program and a passing score on a medical assistant exam from a certifying organization accredited by the National Commission for Certifying Agencies (NCCA) or ANSI.
3. A physician-designed program meeting A.R.S. 32-1456.

A high school or CTED program is route 2, so the national certification exam is what lets an Arizona completer work as a medical assistant. CCMA (NHA) and RMA (AMT) are NCCA-accredited and on ADE’s 2026-27 list. R4-16-402 limits procedures to the 2015 Core Curriculum under direct supervision. Using the title without meeting the rules is a class 3 misdemeanor. (Confirmed, R4-16-401 as amended effective January 8, 2024)

In Michigan, a physician may delegate tasks to an unlicensed person under supervision, but not tasks that need the licensee’s own education, skill and judgment (MCL 333.16215). Delegation rules in the other five states were not checked.

Dental assisting

In Virginia, Pennsylvania, Arizona and North Carolina, build RHS (or the state’s equivalent) into the sequence before any student exposes radiographs on a patient. Expanded-function and registered dental assistant roles are post-high school in every state checked; present them as the next step after graduation.

Certification bodies

X-ray equipment

A school dental lab with an X-ray unit likely needs registration with the state radiation control program. This was not checked in any state. Confirm with the agency before you buy equipment.

Who can teach

Every state has a health or industry-based teaching route. The open question in most states is whether a national certification such as CCMA, RMA or CDA counts where a rule asks for a professional license, because medical and dental assistants are not licensed. Nurses and other licensed clinicians qualify more easily. For recruiting, pay and alternatives, see the Staffing toolkit.

Instructor certifications worth funding

A current CCMA (and CPT or CET if you teach those skills) lets the instructor model the credential students are working toward and, in Virginia, may meet the certification requirement once VDOE confirms. For dental assisting, an instructor who has passed DANB RHS, or who holds the CDA, matches the radiography credential that Virginia, Pennsylvania and Arizona name. BLS instructor status lets you certify students in-house. Confirm each choice with your state licensure office before you pay for it.

Program, curriculum and lab

Both tracks need state CTE program approval like any other pathway. Dental assisting can also need the dental board (North Carolina, for any student work on patients) or a call to the state CTE office before you start (Virginia). The Approvals toolkit lists each state’s process and deadlines.

Program codes by state

In Hawaii, schools reach medical assisting through the Diagnostic Services program, which may carry CCMA, CPT and CET (Confirm with HIDOE CTE), or through Kapiʻolani Community College’s CAAHEP-accredited program after graduation. To formalize a track, ask HIDOE CTE how to add medical or dental assisting content within the Health Services pathway. Dental assistants in Hawaii need no course to take radiographs, so a local program faces fewer outside rules.

The lab

A medical assisting lab is a clinical skills room: exam table, vital signs equipment, phlebotomy and EKG stations, sharps disposal and handwashing. Arizona publishes an equipment list for each program on its program page. A dental assisting lab adds dental chairs and, if students take radiographs, an X-ray unit with the shielding and registration your state’s radiation program requires (not checked in any state).

OSHA’s bloodborne pathogens standard covers your teacher as an employee in most of the seven states (see the Facilities toolkit). Plan sharps handling, exposure control and hepatitis B vaccination for the teacher, and set out who covers students in the clinical agreement.

Equipment funds rarely pay for plumbing or room changes. Michigan’s 61v grant bars renovation, Arizona puts infrastructure costs on the recipient, Pennsylvania’s Supplemental Equipment Grant covers items of $3,000 or more per unit, and Missouri’s Enhancement Grant pays 50% of renovation for approved programs. Check each fund’s current window and threshold.

Curriculum

Build the sequence to two targets: your state’s program standards and the test plan of the credential students will take (CCMA, CPT and CET for medical assisting; RHS and ICE, or NELDA, for dental assisting). Schedule the radiography unit and RHS exam before any patient radiography in the states that require it, and schedule credential testing within 12 months of graduation for NHA credentials. The Curriculum toolkit has a review rubric.

Credit after high school

Apprenticeship

The AAMA’s Alternative Pathway to the CMA is open to apprenticeship completers, so a registered medical assistant apprenticeship after high school is one route to that credential. Ask local health systems whether they sponsor one and what they credit from high school training. No dental assisting apprenticeship was checked.

Academic credit

This guide found no state rule that lets a medical or dental assisting course replace a required academic course. If your district awards academic credit for course content (for example, anatomy and physiology as a science credit), confirm in writing that the substitution still meets your state university admission requirements before students rely on it; a CTE course counted in place of a required lab science can leave a student short for admission. North Carolina’s HU45 and HU46 are honors courses, which affects GPA weighting, not the academic courses universities require. In Michigan, where no crosswalk exists between Health Sciences content and Michigan Merit Curriculum requirements, use the S4IS CTE Crosswalk prototype (Product A) as interim guidance. The Curriculum toolkit covers the steps.

Launch steps

Work through these steps in order; several can run at the same time. The Pathway Launch Guide links all six toolkits.

Review status and sources

Last checked October 5, 2026. An independent check on October 5, 2026 tested 16 claims against official sources and corrected 0. These items are open for reviewers:

1. DANB. How a high school program becomes “DANB-accepted” for NELDA Pathway III; RHS and ICE eligibility and any minimum age from a primary source. Ask DANB (800-367-3262).
2. AMT. Whether a high school medical assisting program can be AMT-approved for the RMA competency route; written confirmation of NCCA accreditation for the RMA; Registered Dental Assistant exam eligibility. Ask AMT.
3. Arizona. The rule or policy naming DANB RHS as the approved radiography exam; whether CTED students may expose radiographs or polish under supervision before passing the exams. Ask the Arizona State Board of Dental Examiners.
4. Michigan. The outcome of the 2025 revision of R 338.11411 and whether a high school radiography course can be substantially equivalent (LARA Board of Dentistry); the Mott renewal after November 1, 2026 and the CTEIS credentials for 51.0000 (MDE OCTE).
5. North Carolina. DPI licensure areas for HU45 and HU46 instructors (NC DPI Licensure); whether the Dental Board has approved any high school dental assisting course; the statewide list of Career and College Promise medical assisting pathways (NCCCS).
6. Virginia. Whether supervised Dental Careers II students may expose radiographs before earning the 18VAC60-21-170 credential (Board of Dentistry); whether CCMA or CDA meets 8VAC20-23-250 and the CIP for courses 8345 and 8346 (VDOE).
7. Pennsylvania. Program of study lists for 51.0801, 51.0899 and 51.0601 and the credential list (PDE); any EFDA minimum age in the Dental Law (State Board of Dentistry); dental X-ray registration (DEP).
8. Missouri. Whether a state dental assisting program code exists and which code career centers report under; the medical assisting MOSIS code and credential list (DESE Health Science); dental X-ray rules (DHSS).
9. Hawaii. The Diagnostic Services credential list (HIDOE CTE); early college offerings in medical assisting or phlebotomy (UHCC Early College); radiation rules for dental X-ray units (DOH Indoor and Radiological Health Branch).
10. All states. X-ray equipment registration for school dental labs; physician delegation limits for medical assistants outside Michigan and Arizona (state medical boards).

Sources

Jobs and pay

• BLS Occupational Employment and Wage Statistics, May 2025 (state file)
• Projections Central, long-term projections 2024-2034

Credentials

• NHA eligibility FAQ and NHA Candidate Handbook
• NHA CCMA
• AMT Registered Medical Assistant
• AAMA CMA eligibility
• NCCT accreditation
• DANB CDA, DANB NELDA and DANB RHS
• ADE 2026-27 CTE Credentials List
• NCCTE CCMA credential page

Working with minors

• 29 CFR 570.57 (HO 6) and 29 CFR 570.58 (HO 7)
• DOL Fact Sheet 52, health care and FAB 2011-3
• Michigan Youth Employment Standards Act
• Code of Virginia Title 40.1, Chapter 5
• G.S. 95-25.5
• ICA Youth Employment FAQ
• PDE Child Labor Law
• Missouri Child Labor Law summary
• HAR Chapter 12-25

Licensing and outside approvals

• A.R.S. 32-1456 and A.A.C. Title 4, Ch. 16
• MCL 333.16215
• Michigan dentistry rules, R 338.11101 to 11821 and R 338.11411
• Va. Code 54.1-2701, 18VAC60-21-170 and 18VAC60-30-120
• G.S. 90-29 and NC Dental Board, dental assisting
• A.R.S. 32-1291 and A.A.C. Title 4, Ch. 11
• PA State Board of Dentistry notice on dental radiology personnel, 49 Pa. Code 33.302 and 33.102
• 20 CSR 2110-2
• Missouri DCI proposed rules and 20 CSR 2110-2.120, Cornell LII copy
• HAR Chapter 16-79 and Hawaii Board of Dentistry FAQ

Instructors

• 8VAC20-23-250
• ADE Medical Assisting Services program description and Dental Assisting program description

Program, lab and credit

• MDE CIP Program Endorsements
• CTE Resource Center: Medical Assistant I, Medical Assistant II, Dental Careers I and Dental Careers II
• NCCTE course guide, HU45 and HU46
• ADE Medical Assisting Services and ADE Dental Assisting
• DESE Health Sciences and Cape Girardeau CTC, Dental Assisting
• HIDOE CTE Pathways and Program Standards
• Mott Community College Health Sciences statewide agreement
• Wake Tech Career and College Promise CTE pathways and Lenoir CC Medical Assisting Skills Certificate
• Kapiʻolani CC Medical Assisting