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updated May 24, 2025

A quick primer. The label "certified fellow" is an ASHA-branded term. All states, excluding North Dakota, require a mentored new graduate work experience. Some require the completion of ASHA's CF (but don't necessarily require the CCC purchase at the end), and other states have a different name for it. Requirements vary by state, and in some states, the requirements are more complex. Even if you are getting the CCC, it is your responsibility, not your mentor's, to know and understand your state's requirements and ensure that you meet them. The STATE LICENSE is the thing that matters.

I am a new grad. Do I Need the CCC?

Be a good consumer and know what you are paying for.

The Certificate of Clinical Competence (CCC) is an optional certification product sold by the American Speech-Language-Hearing Association (ASHA), the largest SLP membership association in the United States. It is not required to practice as an SLP.

ASHA also operates the Council for Academic Accreditation (CAA), which accredits SLP master’s programs in the United States. Because ASHA has complete, authoritative control over university programs (as in the CAA decides if programs live or die), your faculty likely has a biased view of the CCC product because to be accredited, university programs need the approval of the CAA, which ASHA operates. Because ASHA sells the certification program and has a financial interest in ensuring that SLPs buy its product, this creates a very unfortunate conflict of interest where SLP grad students are targeted as potential lifetime purchasers of the CCC, whether they want to be or not. Think of it like this: Let’s say that you want to become an engineer. Let’s say that the company that accredits your engineering program also sells a certification product that they know will bring in a lifetime revenue of $10,000 throughout your career. Let’s say that your engineering professor wanted to impress the accreditation company because they wanted to pass the accreditation process, and to do that, they are willing to talk up the certification product as a sign of good faith. This example would be (and is) entirely illegal, yet it happens daily in SLP grad programs (but not engineering programs)!

It’s important to understand that the CCC is a PRODUCT you buy, not a license to practice. All 50 states + D.C. have licensing boards that regulate SLP licenses. A state license is all that is required to work as an SLP. 

In almost all cases, state license requirements are equal to or more stringent than the requirements to purchase the CCC. The CCC is NOT a gold standard, does NOT prove your lifelong commitment to the field, and does NOT make you a better clinician than a colleague who chooses not to purchase it. If anything, the CCC is a one-time training milestone indicating that you got your degree, passed the Praxis, and completed nine months of mentored work (the same standards as most state licensing boards). It is unethical for ASHA to charge you $221/year to maintain what you already earned. 

Many SLPs feel forced to purchase ASHA’s certification product and continue to renew it year after year because of the way that ASHA has influenced state regulations through their own lobbying efforts (not via a lobbyist). Examples include the following:

• The CCC is required to obtain an initial license in Delaware and Nevada.
• The CCC is required to bill Medicaid in Idaho, Kansas, Kentucky, Massachusetts, Nebraska, Nevada, Rhode Island, and Washington, D.C.
• The CCC is required to be credentialed with BCBS in Maine, Pennsylvania, and Wisconsin.

We need to change the language.

As an SLP student and new graduate, you are not working hard to earn the CCC. You are working hard to obtain a state license.

The idea that the CCC is your ultimate professional goal is antiquated and continues to be used by university faculty either because they are operating from an outdated mindset (the last state to install a state licensing for SLPs was in 2016) or they personally choose to support ASHA and the current model of certification instead of licensure.

To be clear, professors are not lying to you. Many are simply operating from an outdated perspective. Earning the CCC was necessary until every state established a licensing board. The CCC is now redundant and does not offer additional regulation or competency standards above and beyond what a state license requires. Unfortunately, because of the long-standing influence of ASHA and its certification product on our profession, it is a common misconception that purchasing the CCC to practice is legally required. It’s time to break the cycle of misinformation.

Here is an eye-opening comparison. APTA is the national association for PTs, and AOTA is the national association for OTs. Neither one of these associations sells a certification product. Both professions are fully regulated by state licensing boards, as are other professions such as architecture, engineering, surveying, psychology, etc. ASHA brings in over $40M/year in certification renewal fees, yet according to their 2022 Financial Report, the certification program costs them less than $3M/year to operate.  

We need to remove the stigma.

Until recently, many clinicians choosing to practice without the CCC often hid that fact from their colleagues in shame. Why? Because ASHA was able to inflate the status of the CCC so successfully, clinicians felt their colleagues perceived them as less competent, even though the training and requirements for licensure were equivalent to the CCC. Highly skilled clinicians have been working as licensed SLPs for decades and can now live and work without the stigma that was part of our professional fabric for so long. Fix SLP is hearing from many of these clinicians who are now feeling a sense of relief and healing. In the same spirit, we do not believe clinicians should feel shame in applying for or maintaining the CCC. This platform is all about choice.

What do I do?

Fix SLP isn’t here to tell you what to do. This part of the platform aims to empower clinicians and advocate for choice. You get to choose what you want to do. This decision is an integral part of your life and your career. We have some facts and advice for you to consider as you make your choice (and know that your choice can always change, and that’s ok, too).

Research if there is a CCC requirement in your state. You’ll want to consider:

1. Meet the current academic requirements (which could mean returning to school for a course or two).
2. Complete ASHA's CF.
3. Pay all fees and meet the requirements requested from ASHA at the time of application.
4. Your state’s licensing board regulations.
5. Your state’s Medicaid regulations.
6. A small handful of private health insurance companies that require the CCC are scattered, but these are few and far between.
   1. We are aware of the following insurance companies that ask for proof of the CCC: BCBS (PA, WI & ME), Centene (ATC SC/GA), and WellCare (ME).
7. When interviewing, investigate if the potential employer requires the CCC. If it isn’t clear in the job posting, then ask in the interview. If the answer is yes and you stay there, you must get the CCC. You do not have a choice. If the answer is no, then you have options. If you have options, get educated on them and understand the decisions.

Option 1: Follow the traditional path. Complete ASHA's CF, apply for and purchase the CCC and ASHA membership (“certified member” category), apply for your state license, repurchase the CCC and ASHA membership every year, and renew the state license per your state’s cycle.

What this means
- You pay $490 for the initial CCC application fee.
- You pay $250 annually ($221 for the CCC and $29 for the ASHA membership).
- You pay for the state license (the cycle and cost varies by state).

Option 2: Take a modified approach. Complete ASHA's CF, apply for and purchase the CCC without ASHA membership (“certified non-member” category), apply for your state license, repurchase the CCC every year, and renew the state license per your state’s cycle.

What this means
- You pay $490 for the initial CCC application fee.
- You pay $221 each year to renew the CCC.
- You pay for the state license (the cycle and cost varies by state).
- You lose access to membership benefits such as access to journals, the ASHA leader, and other discounts.

Option 3: Take a modified approach. Complete ASHA's CF, apply for and purchase the CCC without ASHA membership (“certified non-member” category), apply for your state license, DO NOT repurchase the CCC every year, and renew the state license per your state’s cycle.

What this means
- You pay $490 for the initial CCC application fee.
- You pay for the state license (the cycle and cost varies by state).
- You lose access to membership benefits such as access to journals, the ASHA leader, and other discounts.
- You can not supervise students or CFs who wish to purchase the CCC later.
- If you wish to reinstate the CCC later, you will be subject to the reinstatement requirements:

• Pay a reinstatement fee ($375 for CCC and ASHA membership and $349 for CCC without ASHA membership).
• Complete ten professional development hours each year that you didn’t pay for the CCC, up to 30 hours. These must be completed within the three years before submitting the reinstatement application.
• Provide a passing Praxis score achieved no more than five years before application for reinstatement. (For example, if you took the Praxis in 2024, dropped your CCC in 2026, and wanted to reinstate it in 2027, you would not need to re-take the Praxis. If you waited until 2031, you must retake the Praxis.)

Option 4: Opt out of the CCC. You will not complete ASHA's CF, but will still need to complete the mentored new graduate work experience for your state's provisional state license (check your state requirements here) and renew the state license per your state's cycle. The only state that does NOT have a mentored new graduate work experience is North Dakota.

What this means

- You pay for the state license (the cycle and cost varies by state).
- You do not gain access to ASHA membership benefits, such as access to journals, the ASHA Leader, and other discounts.
- You can not supervise students or new graduates who wish to purchase the CCC later.- If you want to obtain the CCC at a later time, you will be subject to new application requirements:

**FAQ: "If I opt out of the CCC, do I still need to take the Praxis?"

YES, you still need to pass the Praxis. Every state, plus Washington DC, requires a passing score for state licensure.

Wait! Isn’t there an option five where we are ASHA members but do not pay for the CCC? Unfortunately, this is not an option, as this would be a violation of ASHA’s code of ethics. They don’t want you in their club unless you pay them $221/year for their certification renewal fee.

Our thoughts about all of this.

While we would love to say that we are in a system that would guarantee employment without the CCC in any state with any employer, we are not there yet. Informed Jobs reports that 30-40% of listings on their job boards do not require the CCC, so we are making progress! We hope this information is helpful as you weigh the pros and cons of each option. Just know that you are entering the field during a time of significant disruption and revolution. It’s an exciting time! However, it can also be a confusing and overwhelming time for students trying to tease fiction from fact and get a solid start to their careers. If you do not yet feel strongly one way or the other about paying for the CCC, then take steps to complete ASHA's CF. You do not need to apply for the CCC at the end of the CF, but at least you will have the option (you have 90 days from the end of your CF to decide if you want to pay for the CCC). If you are still trying to decide, apply for the CCC and decide at renewal time if you want to repurchase. Repeat the process until you know. Our best advice is to get educated. You can use our resources at fixslp.com and @fix.slp as a place to start. The beauty is that none of these decisions are permanent. No matter what you choose to do, consider advocating for choice alongside your colleagues once you are practicing. Be a force for change. There is no shame in having the CCC. There is no shame in not having the CCC. There is power in fully embodying the right to choose.

I am a student. What can I do?

First, understand that many clinicians are dropping membership but are still retaining the CCC (for now). Clinicians who are certified without membership can still supervise students. ASHA and the CAA (the arm of ASHA that accredits programs) DO NOT require that a clinical instructor have the CCC. This policy is a university department policy and a CFCC policy (the arm of ASHA that sells the CCC). That means your program can decide to allow a clinician who does not hold the CCC to supervise you during your practicum experiences.

While obtaining these hours would allow you to meet the 400 hours required for state licensure, they would NOT count if you ever wanted to purchase the CCC product. The CFCC/ASHA currently allows audiologists to obtain mentored hours towards the CCC-A later, but the CFCC/ASHA has not created a similar policy for the CCC, which means that, for now, it would be a permanent decision. Your earned hours will remain valid if a clinician holds the CCC during your clinical practicum but discontinues purchasing it after your placement.

Suppose you feel strongly about being mentored by someone without the CCC. In that case, you need to advocate for a change in policy because your university is denying you access to quality supervision outside of the classroom. Hopefully, as this movement continues to grow and SLPs continue to advocate for removing the CCC requirement from jobs, there will come a time when it doesn’t matter if you leave your program prepared to purchase the CCC.

Fix SLP will create a template you can use for this type of advocacy in the future.