How to Become a CNA in Texas

To become a CNA in Texas, you need to complete a state-approved 100-hour training program, pass the Prometric competency exam, and get listed on the Texas Nurse Aide Registry. The process typically takes 4-12 weeks from enrollment to certification, according to the Texas Health and Human Services Commission (HHSC).

Texas CNA certification is managed by HHSC, not the Board of Nursing (which handles RN and LVN licenses). This guide covers every step: eligibility requirements, training programs and costs, the Prometric exam, getting on the registry, and what you can do once you’re certified.

Requirement	Details
Minimum Age	18 years old
Training Hours	100 total (60 classroom + 40 clinical) — free classroom option available
Program Cost	$400-$1,200 (or free through employer-paid training or HHSC CBT)
Exam Cost	$125 (written + skills) or $135 (oral + skills)
Time to Certification	4-12 weeks (plus 1-3 weeks for exam scheduling and processing)
Governing Body	Texas Health and Human Services Commission (HHSC)

The sections below walk you through each requirement in the order you’ll encounter it.

Meet Texas Eligibility Requirements

Before enrolling in a training program, you need to meet five requirements set by HHSC:

• Age: At least 18 years old.
• Physical health: Good physical health with up-to-date immunizations (most clinical sites require a TB test and proof of certain vaccines).
• English proficiency: You must be able to read, write, speak, and understand English.
• Background check: HHSC runs a criminal history check through the Texas Department of Public Safety and FBI databases.
• No Employee Misconduct Registry entries: Any entries for abuse, neglect, or exploitation in any state’s registry will result in denial.

Most people who meet the age and health requirements will clear eligibility without issue. The background check is where most anxiety lives, so here is exactly how HHSC approaches it.

Background Check Requirements

HHSC does not automatically disqualify applicants based on a criminal record. Under HB 1508, Texas evaluates each case using four criteria: the type of offense, the time elapsed since the conviction, whether the offense relates to direct patient care, and the potential for harm to vulnerable persons.

Automatic disqualifiers include violent offenses, sexual offenses, and crimes against vulnerable individuals (elderly, children, or people with disabilities). These cannot be waived. For other offenses, HHSC weighs rehabilitation evidence, time since the offense, and the nature of the work.

If you have a past conviction and want to know where you stand before committing to a training program, you can request a Criminal History Evaluation Letter from HHSC. This proactive step can save you the cost of training if your specific offense is disqualifying. For questions about your situation, contact HHSC through the Nurse Aide Registry page.

Once you’re working as a CNA in Texas, conditions vary significantly by facility. Texas does not mandate statewide CNA-to-patient ratios, which means working conditions are largely determined by the facility you choose and whether staff advocate collectively for better conditions.

Complete an Approved NATCEP

This section covers more ground than any other Texas CNA guide because this is where most of the cost and time decisions are made.

What Is a NATCEP?

A Nurse Aide Training and Competency Evaluation Program (NATCEP) is the state-approved training required by HHSC before you can sit for the competency exam. According to HHSC, every NATCEP must include at least 100 hours: 60 hours of classroom instruction and 40 hours of supervised clinical practice. Completing an unapproved program means you cannot sit for the state exam and will need to retrain.

The Free Option: HHSC Computer-Based Training

Most guides skip this entirely: HHSC offers a free Computer-Based Training (CBT) program that covers all 60 required classroom hours. It is self-paced and completed entirely online, at no cost. Access the free CBT through the HHSC NATCEP page.

Here is what that means in practice. If you use the HHSC free CBT for classroom hours, your remaining costs drop to finding an approved NATCEP for clinical-only placement and paying the exam fee. You still need to complete the 40 clinical hours in person. But the classroom cost drops from $400-$1,000+ to zero.

Can you get CNA certified entirely online in Texas? Partially. The 60 classroom hours can be completed online through HHSC’s free CBT. The 40 clinical hours require in-person training at an approved facility. Any program advertising “fully online CNA certification” is not recognized by HHSC for registry purposes. For more on online CNA classes and what portions of training can realistically be completed remotely, see our national resource.

The most cost-effective complete path: use HHSC’s free CBT for classroom hours, then find an employer-sponsored program that covers clinical hours in exchange for a work commitment. Combined, this can bring your out-of-pocket training cost to near zero.

Program Types and Costs

Three types of NATCEP programs operate in Texas, each with different cost structures and timelines.

Program Type	Tuition Range	Examples	Duration	Financial Aid
Community college	$400-$1,000	NTCC: $750; HCCS: $600-$900	8-12 weeks (often part-time)	FAFSA, TPEG, WIOA eligible
Private vocational school	$800-$1,500+	H2H Health TX: $850; East TX Nursing Academy: $800-$1,500	4-6 weeks (faster pace)	Varies; often WIOA eligible
Employer-sponsored	Free (work commitment)	Nursing homes, hospitals, LTC facilities	Varies by employer	N/A — no cost

Beyond tuition, budget for these additional costs:

• Uniforms/scrubs: ~$120
• Background check, drug screen, immunizations: ~$103
• Textbooks: varies by program (some include in tuition)

Total realistic investment:

Path	Total Cost Range
Community college path	$650-$1,305 all-in
Private school path	$980-$1,805+ all-in
Employer-paid path	$0-$103 (background check and immunizations still apply in most cases)

Given that Texas CNA pay tends to run below the national average, minimizing training costs matters more here than in higher-paying states.

“I’ve been reading the pay in the $20’s for CNA’s who post here and I’m just like well what the heck is up with Texas??”

(Reddit user, r/cna)

That wage gap is real. For the full breakdown of Texas CNA pay by metro, facility type, and experience level, see our Texas CNA salary guide.

Not sure which program type fits your schedule, budget, and goals? Our guide on how to choose a CNA program walks through the decision factors.

How to Verify a Program Is HHSC-Approved

Before you pay anything or commit to a program, check the HHSC NATCEP provider list to confirm the program is currently approved. If a program does not appear on that list, do not enroll. Completing an unapproved program means starting over at full cost.

Pass the Texas CNA Competency Exam

Once you complete your NATCEP, you must pass a two-part competency exam administered by Prometric. For a full overview of the CNA exam structure, see our CNA exam guide. Here is what is specific to Texas.

Written Exam Format

The written portion consists of 70 questions: 60 multiple-choice covering nursing assistant knowledge domains (activities of daily living, infection control, patient rights, safety, and communication) and 10 reading comprehension questions. You have 2 hours to complete it.

If you have documented reading difficulties or limited English proficiency, you may qualify for the oral exam option instead. The oral version contains 160 questions and is administered verbally. Contact Prometric at 800-488-5787 to request this accommodation before scheduling your exam.

Skills Evaluation

The skills portion requires you to perform 5 randomly selected skills in front of a Prometric evaluator. You have 25 minutes total. Skills are drawn from the full Texas nurse aide skills list, which means you need to be prepared to perform any skill — not just the ones you practiced most.

The most effective preparation: practice each skill until you can complete it in under 5 minutes while narrating your steps aloud. Evaluators assess both technique and verbal narration. Review each skill using our CNA skills test guide.

Scheduling, Fees, and Retake Policy

Schedule your exam through Prometric's website or by calling 800-488-5787. Testing centers are located throughout Texas.

Exam Type	Fee
Written exam + skills evaluation	$125
Oral exam + skills evaluation	$135
Retake: written only	$35
Retake: oral only	$45
Retake: skills only	$90

The 3-attempt rule is important: You can take the competency exam up to three times within 24 months of completing your NATCEP. After three failures on either part, you must re-enroll in and complete an approved NATCEP before testing again. Plan adequate preparation before your first attempt — retakes add both time and cost.

Prepare thoroughly with our free CNA practice exam and study tips in our how to study for the CNA exam guide.

Get Listed on the Texas Nurse Aide Registry

Passing the competency exam is not the final step. Prometric reports your results to HHSC, which then adds your name to the Texas Nurse Aide Registry. Employers check this registry before hiring. Until your name appears on it, you are not legally authorized to work as a CNA in Texas.

TULIP Registration Process

HHSC uses the Texas Unified License Information Portal (TULIP) for nurse aide registry functions. After passing your exam, you can check your registry status at the TULIP portal. The process is largely automatic: Prometric sends your results, and HHSC processes your listing. If there is a delay or discrepancy, contact HHSC at [email protected].

For a complete walkthrough of TULIP, how to verify your status, and what to do if there is a processing delay, see our Texas Nurse Aide Registry guide.

Your certification must be renewed every two years. Texas has no continuing education requirement for CNA renewal, but you must have worked at least 8 hours of paid nursing services during the 24-month period. See CNA Renewal in Texas for the complete renewal process and deadlines.

How to Pay for CNA Training in Texas

Texas has more financial aid options for CNA training than most people realize. Here are the paths available, starting with the one most likely to cover 100% of your costs.

Employer-Paid Training

The most reliable free path is employer-sponsored training. Many nursing homes, hospitals, and long-term care facilities pay your entire training cost in exchange for a work commitment after certification, typically 6-12 months. This is how the majority of Texas CNAs who paid nothing for training got certified.

Some Texas hospital systems cover training costs entirely. As one parent of a Texas CNA shared:

"Look for a hospital system that will pay for further training. My daughter got a CNA position in a hospital and they paid for classes."

(Reddit user, r/cna)

Hospital-sponsored training typically requires a post-certification employment commitment. That trade-off eliminates upfront costs while guaranteeing your first CNA position.

Government-run facilities often pay above the private-sector average on top of covering training. One Texas CNA working at a veterans home described making $20 per hour plus a shift differential within their first year of certification. State veterans homes in Texas are operated by the Texas Veterans Land Board and typically offer structured pay scales and benefits that private facilities may not match.

Government and Military Funding

If employer-sponsored training is not available in your area, these government programs can cover all or most of your costs:

Funding Source	What It Covers	Who Qualifies	How to Apply
WIOA (Workforce Innovation and Opportunity Act)	Tuition, books, supplies, exam fees	Unemployed, underemployed, or career-changing adults	Local Workforce Solutions office (twc.texas.gov)
TPEG (Texas Public Education Grant)	Tuition at public colleges	Texas residents attending public colleges	Submit FAFSA at participating institution
Pell Grant	Tuition at qualifying programs	Low-income students meeting federal criteria	Submit FAFSA
MyCAA	Up to $4,000 in training costs	Military spouses (active duty, National Guard, Reserves)	MyCAA.com
GI Bill	Varies by benefit tier	Veterans with qualifying service	VA.gov
Hazlewood Act	Tuition at Texas public colleges	Texas veterans and eligible dependents	Institution's financial aid office

For WIOA, you do not need to be unemployed. "Career-changing" qualifies. Visit your local Workforce Solutions office to check eligibility and start an Individual Training Account.

Combination strategy: Use the HHSC free CBT for your 60 classroom hours, then find an employer willing to sponsor your clinical hours. That combination can bring total training cost to $0 — minus the background check and immunizations.

Transferring Your CNA to Texas (Reciprocity)

If you are already certified as a CNA in another state, Texas allows you to transfer your certification through reciprocity. HHSC charges no fee for this process, and no additional exam is required if your current certification is active and in good standing.

The process follows five steps:

1. Confirm your current CNA certification is active and unencumbered. Texas accepts reciprocity from all 50 states, but your certification must have no disciplinary actions or restrictions.
2. Complete a Texas DPS criminal history check. This is required regardless of your home state's background check.
3. Check the Employee Misconduct Registry. Any entries in any state's registry will result in denial.
4. Submit Form 5505-NAR through the TULIP portal. Form 5505-NAR is the official Texas reciprocity application, submitted electronically through TULIP.
5. If your home state certification has no expiration date, also submit Form 5506-NAR. This Employment Verification form is only required in this specific edge case. According to The CNA Guide, most transfers complete within 2-4 weeks after submission.

For questions about reciprocity, contact HHSC at [email protected].

What You Can (and Can't) Do as a Texas CNA

Texas CNAs assist with activities of daily living: bathing, dressing, feeding, and toileting. You take and record vital signs, help patients move and position safely, assist with ambulation, and support nursing staff — for a broader overview of what a CNA does across clinical settings, see our national guide.

Texas has specific rules about what CNAs can and cannot do. For example:

"In my state Texas, CNAs could not insert Foley catheters, they could only remove them."

(Reddit user, r/cna)

That distinction — remove but not insert — is the kind of detail that matters on the job. Your NATCEP training covers the full list of procedures Texas CNAs are authorized to perform, and your supervising nurse will clarify facility-specific protocols during orientation.

Other tasks outside your scope include administering medications (unless certified as a med aide), performing nursing assessments, and making independent clinical decisions. Some Texas hospitals train CNAs for additional skills like EKG monitoring or phlebotomy under supervision, which can expand what you do within your specific facility.

Your working conditions are not set in stone — facility-level advocacy can change them. One Texas hospital CNA described how a single conversation started a chain reaction:

"My work changed them from 1:25-30 for CNAs in my Texas hospital to 1:15 and got a raise. It started when a tech asked me how to draft a letter addressing their pay and staff ratios."

(57 upvotes — Reddit user, r/cna)

That ratio improvement — from 25 patients down to 15 — came with a raise. Texas does not mandate CNA-to-patient ratios statewide, which means facility-level advocacy like this is often the most direct path to change.

Advancement Pathways

CNA certification is both a career and a launching pad. Three common paths forward:

Medication Aide (Med Aide): In Texas, CNA certification is a prerequisite for becoming a medication aide — one of the most direct advancement routes that does not require a nursing degree. Med aide training adds approximately 100 hours of pharmacology and medication administration coursework. Med aides typically earn $1-3 more per hour than CNAs in the same facility.

Patient Care Technician (PCT): PCT is an expanded role that adds phlebotomy and EKG skills to the CNA foundation. Hospital systems often provide this training on the job for CNAs who demonstrate clinical aptitude.

LVN/RN Pathway: CNA work gives you the clinical hours and patient care experience that strengthen nursing school applications. Many Texas nursing programs look favorably on applicants with CNA experience because it demonstrates you understand floor work before committing to a degree program.

Your earning potential grows with each step. See CNA Salary in Texas for pay by role and facility type.