How to Become a CNA in Missouri

To become a CNA in Missouri, you need to complete 175 hours of DHSS-approved training, pass a two-part competency exam, and get listed on the Missouri Nurse Aide Registry. Most people finish the process in 8 to 16 weeks, with program costs ranging from $0 for employer-sponsored training to $2,550 at community colleges.

The requirements are clear, the timeline is manageable, and there is a free path if you are willing to commit to a short-term employment contract. This guide covers every step, from choosing the right program to what your first paycheck will look like, with the specific numbers and official links you need to move forward.

If you are still exploring whether this role is the right fit, start with what a CNA does day to day before diving into the certification process.

Missouri CNA Requirements at a Glance

Missouri requires 175 hours of state-approved training, a passed competency exam, and placement on the Missouri Nurse Aide Registry to work as a certified nursing assistant. That 175-hour requirement is more than double the 75-hour federal minimum, which means you enter the workforce with substantially more preparation than CNAs certified in minimum-requirement states.

For an overview of all Missouri CNA programs available in the state, the state hub has a searchable directory.

Requirement	Details
Minimum Age	18
Education	No GED or diploma required by state (some programs require it)
Training Hours	175 (75 classroom + 100 on-the-job training)
Approved Programs	DHSS facility-based and school-based agencies
Exam	Two-part: written/oral knowledge test + hands-on skills evaluation
Cost Range	$0 (employer-sponsored) to $2,550 (community college)
Timeline	8–16 weeks depending on program format
Renewal	Every 24 months

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

Meet Basic Eligibility Requirements

Missouri does not require a high school diploma or GED to become a CNA. That is the state’s standard, per DHSS, but individual training programs may set their own admission requirements, so check directly with your program before applying. Community colleges are more likely to require a diploma; facility-based training programs generally are not.

Age and Education

You must be at least 18 years old to enroll in a Missouri CNA program, according to mohealthcare.com and cnaonlinecourse.com. There is no upper age limit. The state’s education requirement stops at age, nothing about a diploma or GED.

What this means practically: if you left school before graduating, you can still pursue CNA certification in Missouri. Your program choice may narrow the options (some community colleges require a diploma), but the path is open.

Background Check and Health Requirements

Before you can work as a CNA in Missouri, you must clear two background screenings: the Family Care Safety Registry (FCSR) and the Employee Disqualification List (EDL).

FCSR registration is on you. Visit health.mo.gov/safety/fcsr to complete worker registration and pay the one-time fee. You only register once, but employers check your status each time you are hired. Do this before enrolling in a program, as some programs require it for admission.

The EDL is checked by DHSS through health.mo.gov. Disqualifying findings include abuse, neglect, and misappropriation of patient property. An arrest alone is not necessarily disqualifying, but certain convictions will prevent you from working as a CNA. The full list of disqualifying offenses is maintained by DHSS. If you have a conviction and are unsure whether it applies, call 573-526-5686 before enrolling. Better to know upfront than after investing time and money.

Most training programs also require a TB test, a physical exam, and proof of immunizations before you begin clinical hours. These are program-level requirements, not state law, and they vary by program. Some programs also require CPR and First Aid certification before enrollment. Ask your specific program for its complete list before you apply.

Choose a DHSS-Approved Training Program

Missouri approves two categories of CNA training programs: facility-based training agencies and school-based training agencies. The right choice depends on your budget, your schedule, and whether you want to choose your employer after certification. Only programs on the DHSS-approved lists qualify you to sit for the state exam. Training from any other source will not count.

Not sure which format fits your situation? Our guide on how to choose a CNA program walks through the trade-offs in detail.

Facility-Based Training Agencies

Facility-based programs are run by nursing homes, hospitals, and other healthcare facilities. The facility trains you in exchange for a commitment to work there after certification, usually 6 to 12 months. In many cases, the training is completely free.

The complete list of DHSS-approved facility-based programs is published and regularly updated at data.mo.gov — CNA Approved Facility Training Agencies. This is the only official source. If a facility tells you it is approved but does not appear on this list, do not enroll.

The free training is real. But the employment contract matters. Before you sign anything, ask about staffing ratios, shift expectations, and exactly what happens financially if you need to leave before the contract period ends. One CNA in the r/cna community described what can go wrong:

“said facility paid for my CNA training and was my first ever job as a CNA… I have had a plethora of issues with management here at this facility”

(2,489 upvotes — Reddit user)

This is not an isolated experience. The 2,489 upvotes show how many CNAs have faced the same situation. Employer-sponsored training can be an excellent deal. Just treat the contract like any other employment agreement: read it fully, ask the hard questions, and verify the facility’s reputation on CMS Care Compare before you commit.

School-Based Training Agencies

Community colleges, vocational schools, and private training programs make up the school-based category. You pay tuition, but you have no employment obligation and more scheduling flexibility. Community college programs often qualify for Pell Grants and other financial aid, which can significantly reduce your out-of-pocket cost.

The DHSS-approved list for school-based programs is at data.mo.gov — CNA Approved School Training Agencies. Specific costs from current programs include: East Central College at $800–$1,500, and Jefferson College at $2,550, per registerednursing.org.

The Missouri Health Care Association (MHCA) offers an online hybrid option at $700 for MHCA members and $1,400 for non-members. The MHCA course covers the classroom portion only. You arrange the on-the-job training separately through an approved facility. The 100-day completion deadline is strict: exceed it and you pay $200 for every additional 30-day extension.

Online and Hybrid Options

Missouri allows hybrid CNA training where the 75 classroom hours are completed online. But the 100 hours of on-the-job training must be done in person at an approved clinical facility. There is no fully online path to CNA certification in Missouri.

If you find a program claiming you can complete everything remotely, check it against the DHSS school-based portal before enrolling. Unapproved programs will not qualify you for the state exam. Some lecture content and coursework can be completed through online CNA classes, but the clinical requirement remains in-person regardless of program format.

CNA Training Costs in Missouri

Here is how the three main paths compare:

Program Type	Cost	Timeline	Employment Obligation
Facility-based (employer-sponsored)	$0	8–16 weeks	Yes (typically 6–12 month contract)
MHCA online hybrid (members)	$700	Self-paced, 100-day limit	No
MHCA online hybrid (non-members)	$1,400	Self-paced, 100-day limit	No
Community college (low end)	$800–$1,500	8–16 weeks	No
Community college (high end)	$2,550	8–16 weeks	No
Exam fees (Headmaster/TMU)	Paid separately	Knowledge test + skills evaluation	N/A

Beyond tuition, budget for: the competency exam fee (knowledge test + skills evaluation, paid to Headmaster through the TMU portal at mo.tmutest.com — check the portal for current pricing), background check fees, FCSR registration, scrubs ($50–$150), a stethoscope and basic clinical supplies ($50–$150), and possibly CPR certification.

Financial Aid and Free Training Options

The employer-sponsored path is the primary $0 option. Workforce Innovation and Opportunity Act (WIOA) funds, available through Missouri Job Centers at jobs.mo.gov, may cover tuition at approved programs for qualifying individuals. Community college programs accept Pell Grants for eligible students. Some hospital systems also offer tuition reimbursement for CNAs who commit to a defined employment period, which is a different structure from the facility-training contract but worth asking about.

If cost is the deciding factor and you are worried about what you are getting into, you are not alone in wanting to think it through carefully:

“I need a little encouragement. Due to life’s circumstances I am starting my life again. I love helping people. I want to eventually be a nurse. The only thing I can afford at the moment is a CNA course. I am scared I might not be smart, fast, young, or tough enough.”

(223 upvotes — Reddit user)

That post could have been written by thousands of Missouri CNA students. The 223 upvotes reflect how universally people feel this before starting. The program is designed for people with no prior healthcare experience. That is its entire purpose.

Complete 175 Hours of Training

Missouri requires 175 hours of approved CNA training: 75 hours of classroom instruction and 100 hours of on-the-job training (OJT). Per health.mo.gov, both components are mandatory. Federal law under 42 CFR § 483.152 sets a minimum of 75 hours. Missouri’s 175-hour standard means you finish training with nearly 2.5 times the preparation of a CNA from a minimum-requirement state, a fact that Missouri-based employers recognize.

You must complete training and pass the competency exam within 6 months of starting your program, per mohealthcare.com. For MHCA online students, the 100-day classroom completion deadline is even tighter, with the $200/30-day extension penalty applying after that point.

Classroom Hours (75 Hours)

The classroom portion covers the foundational knowledge you need before working with patients: body mechanics, infection control, patient rights, vital signs, communication, nutrition, and basic nursing skills. In hybrid and online programs, these hours are delivered through video lectures, readings, and online assessments. This is the portion of training that can be completed remotely.

On-the-Job Training (100 Hours)

OJT is the hands-on portion. You work directly with patients under the supervision of a licensed nurse at an approved clinical site. A typical OJT day includes assisting patients with activities of daily living (bathing, dressing, eating, repositioning), taking vital signs, and recording basic observations. This portion cannot be done remotely, regardless of your program format.

The mix of confidence and nerves during training is something nearly every CNA student experiences:

“I’m currently enrolled in a 4 week course and I’m feeling comfortable but anxious at the same time.”

(551 upvotes — Reddit user)

The 551 upvotes on that simple statement show how widely this feeling resonates. Your supervising nurse is not expecting you to perform perfectly on day one. The OJT exists specifically to let you build competence under supervision, not to test what you already know.

Pass the Missouri Nurse Aide Competency Exam

The Missouri CNA exam has two parts, and you must pass both: a written (or oral) knowledge test and a hands-on skills evaluation. Both are administered through the TMU (Test of Mastery and Understanding) system operated by Headmaster/D&S. You schedule both parts through the portal at mo.tmutest.com.

Your primary study resource is the Missouri Nurse Aide Handbook Version 13 (updated January 2026), available on health.mo.gov. It covers every skill that can appear on the evaluation, the exam format, and what evaluators are looking for.

To understand what kinds of questions the written portion covers, a CNA exam overview explains the structure and question types. When you are ready to test your knowledge before exam day, a CNA practice exam helps identify where you need more review. For structured skills practice, the CNA skills test series walks through each evaluated skill step by step. And if you want a full study plan, how to study for the CNA exam covers the approach from start to finish.

Written (or Oral) Knowledge Test

The written portion is a multiple-choice exam. The number of questions, time limit, and passing score are specified in the Missouri Nurse Aide Handbook Version 13, in the "Examination" section. If reading is a barrier, Missouri offers an oral exam option. You take this test at an approved testing site through the TMU system.

Hands-On Skills Evaluation

For the skills evaluation, you perform a set of randomly selected nursing tasks in front of an evaluator. Handwashing is tested on every exam. Failing it fails the entire evaluation regardless of other skills. The full list of testable skills and the number drawn per exam are published in the Handbook v13. You narrate your steps as you go.

Performing skills while someone watches you is stressful. Every CNA who is currently working in Missouri stood in that same room. The skills are the same ones you practiced repeatedly during training. Preparation is the difference between passing and not.

What Happens If You Don't Pass

You do not have to retake both parts if you passed one. Missouri allows you to retake only the failed portion. The Handbook v13 specifies retake limits, waiting periods, and fees. Review those details before your first attempt so you know the stakes. If you need to retake, the retake the CNA exam resource covers the Missouri-specific process.

Get Listed on the Missouri CNA Registry

Once you pass both parts of the competency exam, your name is added to the Missouri Nurse Aide Registry automatically. This registry, managed by DHSS Health Education Unit through the TMU portal at mo.tmutest.com, is your official proof of certification. Missouri does not issue a separate CNA license card. Your listing on the registry IS your license.

For everything related to the registry, including how to look up your certification status, how employers verify your credentials, what the different status types mean, and step-by-step guidance on the TMU portal, see our Missouri CNA Registry guide.

If you have questions or cannot locate your registry listing, contact DHSS directly:
- Phone: 573-526-5686
- Email: [email protected]
- Hours: 9:00 AM – 3:30 PM

The Challenge Exam: An Alternative Path

If you have qualifying healthcare experience or nursing education, you may be able to take the Missouri CNA competency exam without completing the 175-hour training program. This is called the CNA challenge exam.

The exam itself is identical to what standard training graduates take, written/oral test plus hands-on skills evaluation. The difference is that you skip the training program and apply directly to test. Visit health.mo.gov/safety/cnaregistry/challenge.php for the official, current eligibility requirements before applying.

Who Qualifies

• Nursing students who have completed fundamentals of nursing coursework (enrollment alone is not enough, the coursework must be completed)
• Experienced healthcare workers with at least 6 months of Missouri CNA employment within a qualifying window
• Other categories as defined by DHSS on the challenge exam page

The eligibility requirements have specific documentation standards. Do not assume you qualify based on general healthcare experience. Verify against the DHSS criteria.

How to Apply

Confirm your eligibility on the DHSS challenge exam page, then apply through the TMU portal at mo.tmutest.com. Once your application is approved, you schedule the exam through the same system all other candidates use. The evaluation is the same; only the path to it is different.

Transferring Your CNA to Missouri (Reciprocity)

Missouri CNA reciprocity is free and requires no additional exam. The process runs through the TMU portal at mo.tmutest.com, and there is no transfer fee, a benefit that distinguishes Missouri from many states that charge $25–$75 for reciprocity, per nursa.com.

To transfer your certification, your current state license must be active and in good standing (no findings on that state's registry). Missouri also requires its standard background check (FCSR and EDL) even for reciprocity applicants. For the complete application requirements, visit health.mo.gov/safety/cnaregistry/reciprocity.php.

If you hold an active CNA in Kansas, Illinois, Iowa, Arkansas, or Oklahoma, Missouri accepts your certification through this process. Processing time is not published by DHSS. Contact 573-526-5686 for a current estimate after submitting your application.

One clarification: if you are transferring OUT of Missouri to another state, that process follows the receiving state's reciprocity rules, not Missouri's. Each state sets its own standards.

Keeping Your Certification Active (Renewal)

Your Missouri CNA certification must be renewed every 24 months, per ltc.health.mo.gov. Renewal is not automatic.

To qualify for renewal, you must have performed nursing aide duties for pay during the renewal period. The employment documentation requirement is part of the DHSS renewal process. A CNA who has been certified but not working in the role may not meet the renewal standard. Contact DHSS at 573-526-5686 to confirm the specific requirements for your situation.

Renewal now runs through the TMU portal at mo.tmutest.com. If you do not have a current email address in the TMU system, call DHSS at 573-526-5686 or Headmaster at 800-393-8664 to get your account updated before the deadline. For a full walkthrough of the TMU renewal process, see the Missouri CNA Registry guide.

Do not let your certification lapse. A certification that expires may require retesting to reactivate, depending on how long it has been inactive. Set a calendar reminder 60 days before your expiration date so you have time to complete the TMU renewal without rushing.

What to Expect: Your First CNA Job in Missouri

Missouri CNAs earned a mean of $37,170 per year ($17.87/hr) in May 2024, according to Bureau of Labor Statistics data. That is approximately $2,360 below the national mean of $39,530. Missouri employs 32,650 CNAs statewide.

Pay varies significantly by setting and location. For a full breakdown by metro area, facility type, and strategies to maximize earnings, see our CNA salary in Missouri guide.

Setting	Approximate Annual Pay	Notes
Nursing care facilities	See BLS NAICS 623110 data for Missouri	Most CNA positions statewide
General medical/surgical hospitals	Typically above state mean	Faster pace, more advancement opportunity
Home health services	Typically below state mean	More autonomy, flexible hours
State government	Per oa.mo.gov classification tables	Note: Missouri's $13.75/hr minimum wage sets an effective floor of ~$28,600/yr regardless of pay grade

For metro-area breakdowns with actual dollar figures, see our CNA salary in Missouri guide.

The BLS data confirms what CNA communities discuss constantly: Missouri wages are below the national average. Where the path makes financial sense is in what it opens up, and employer selection makes a significant difference in take-home pay.

Not all facilities invest equally in the people they hire. This experience is more common than it should be:

"Hey guys! I'm a new CNA and I started working at this facility about 2 months ago. To start off, I was barely trained during orientation..."

(240 upvotes — Reddit user)

Before accepting a position, ask specifically about orientation length, preceptor assignments, and the patient-to-CNA ratio on your shift. A facility that cannot answer these questions clearly is telling you something. Visit the facility during working hours before you commit, and check its staffing and inspection history on CMS Care Compare.

Missouri's larger hospital systems can also produce surprising results:

"I work in the trauma/neuro ICU at a large hospital in the Missouri area... looked at workday, saw my earnings for 2023, and did some math and my mouth dropped."

(585 upvotes — Reddit user)

That quote landed in r/nursing and pulled 585 upvotes because it resonated across the whole profession. Even experienced hospital CNAs are sometimes surprised by the gap between hours worked and total compensation.

Choosing your first employer wisely:
- Ask about the patient-to-CNA ratio before your first shift
- Find out how long orientation lasts and whether you are paired with a preceptor
- If your training was facility-sponsored, confirm the contract terms before starting the job clock
- Check CMS Care Compare for staffing ratings and recent inspection findings

The CNA-to-LPN-to-RN pathway is well established in Missouri. Working as a CNA while pursuing nursing school gives you clinical experience that strengthens nursing program applications, and many Missouri employers offer tuition reimbursement for CNAs who commit to a defined employment period.