How to Become a CNA in Missouri 2026
To become a CNA in Missouri, you must complete a state-approved training program (75 classroom hours and 100 clinical hours), pass a two-part competency exam administered by D&S Headmaster, and be listed on the Missouri Nurse Aide Registry. The Missouri Department of Health and Senior Services (DHSS) oversees certification and the registry.
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Missouri’s CNA requirements are set by the Department of Health and Senior Services, which approves training programs, administers the registry, and determines who qualifies to challenge the exam without completing the full course. The state’s 175-hour training requirement exceeds the federal minimum, and all candidates, including those certified in other states, must pass the Missouri competency exam to be listed on the Missouri Nurse Aide Registry. For a broader look at nursing credentials in the state, see Missouri nursing license requirements.
Use the links below to jump to training requirements, the exam challenge pathway, registry and renewal rules, and specialty credentials.
- CNA training requirements in Missouri
- Challenging the CNA exam
- Registry listing and renewal
- Reinstating inactive or expired credentials
- Out-of-state CNAs
- The application process
- Specialty CNA credentials
CNA Training Requirements in Missouri
Missouri requires 175 total training hours for CNA certification, split between 75 hours of classroom instruction and 100 hours of supervised clinical training in a long-term care setting. Community colleges, vocational-technical schools, private schools, high schools, nursing homes, and qualifying hospitals offer programs. The Missouri CNA, CMT, LIMA, and Insulin Registry maintains a list of approved training agencies on the DHSS website.
To enroll, most applicants must be at least 18 years old. Students who are 16 or 17 can train if they’re enrolled in a high school health education or cooperative work education program and are placed in an approved facility through that program. All applicants are subject to background screening. A student with certain criminal convictions won’t be eligible to work as a CNA in Missouri.
Programs end with a two-part final examination that tests both practical skills and knowledge. The knowledge portion is available in written or oral formats. Candidates must complete the exam within six months of finishing the course. Those who wait longer must repeat training. If a candidate fails the written or skills portion, they have two additional attempts but must pass within 90 days of the first failure.
Challenging the CNA Exam
Some individuals can skip the full Missouri CNA training course and go straight to the exam. This is called challenging the exam, and it’s available to a defined set of candidates with prior healthcare training or experience.
DHSS lists the following categories as eligible to challenge the exam:
- Individuals enrolled in an RN or LPN program for at least four months, or those who completed a fundamentals of nursing course (including a clinical rotation) within the previous five years
- RN or LPN candidates who failed the state licensure exam
- Individuals who completed a nursing program outside the United States and are awaiting U.S. licensure
- Individuals who completed Unlicensed Assistive Personnel (UAP) or Patient Care Technician (PCT) training, provided the program hours mirror the CNA training requirement of 175 hours.
- Missouri CNAs with inactive status on the registry
Individuals with other backgrounds in gerontology and health occupations may also be approved to skip portions of the course on a case-by-case basis, based on DHSS’s evaluation of their credentials.
Candidates who challenge the exam are allowed only one attempt. Failing either the written or skills portion means completing the full CNA training course before retaking the test.
Registry Listing and Renewal
After passing both portions of the competency exam, the D&S Headmaster submits scores to DHSS, and your name is added to the Missouri Nurse Aide Registry. No separate application is required. You can verify your status, check expiration dates, and manage renewals through the Missouri Nurse Aide Registry TMU portal maintained by Headmaster on behalf of DHSS.
Certification must be renewed every 24 months. To renew, you must document at least eight hours of paid nursing or nursing-related services during the prior 24-month period. Acceptable proof includes a W-2, pay stubs, or a signed employer letter. Renewals are processed online through the TMU portal and carry a $20 fee. Setting up a TMU profile is recommended so you receive renewal reminders before your certification goes inactive.
Employers in Missouri are required to verify a CNA’s registry status before allowing them to work as a certified nurse assistant. The registry is searchable by name or certificate number and shows current status, expiration date, and any disciplinary findings. Many CNAs use the registry as a starting point to advance to RN status once they’ve built clinical experience.
Reinstating Inactive or Expired Credentials
Missouri distinguishes between inactive and expired CNA status, and the reinstatement path depends on which applies to you.
A certificate becomes inactive when a CNA hasn’t submitted proof of nursing services during the renewal period. An inactive CNA can reinstate by providing documentation of nursing work and paying the $20 renewal fee through the TMU portal.
A certificate is considered expired when a CNA hasn’t provided nursing services in five consecutive years. In this case, the full CNA training course is required before returning to work in a long-term care facility in Missouri. However, if you have performed nursing duties since the expiration, you may be able to update your work history through TMU to regain active status without repeating training. Contact DHSS to confirm your eligibility before enrolling in a new program.
Out-of-State CNAs
CNAs certified in another state can transfer to Missouri through reciprocity without having to repeat the training course or exam. Requirements include an active CNA certification from another U.S. state and no findings of abuse, neglect, or misappropriation on any state registry. The reciprocity application is submitted through DHSS. Out-of-state registries that don’t track employment history require the applicant to provide documentation of at least 8 hours of work for every 2 years.
Note: Missouri still requires all candidates, including out-of-state CNAs applying through reciprocity, to be listed on the Missouri Nurse Aide Registry before working as a CNA in the state. Verify your status through the DHSS registry or the TMU portal.
The Application Process
For most candidates, the training program coordinates exam registration. The exam is administered by the D&S Headmaster at approved testing centers statewide, including some nursing homes and community colleges. Contact information for DHSS is: 573-526-5686 or [email protected].
Candidates seeking an exam challenge exemption submit materials directly to DHSS. Required documents vary by background:
- Nursing students: transcripts from the fundamentals course with clinical rotation documentation
- Failed licensing exam applicants: educational documentation and official notification of exam failure
- Healthcare workers with long-term care training: documentation of training and employment history
- Psychiatric aides: copy of psychiatric aide certification and training documentation
- Internationally educated nurses: translated copies of criminal background checks, transcripts, and certificates or licenses
- Out-of-state CNAs: copy of current certification, plus employment proof if the out-of-state registry doesn’t track work history
All applicants must include a copy of their Social Security card with the exemption request.
Specialty CNA Credentials
Missouri offers several credentials beyond the standard CNA certification for CNAs who want to expand their scope or take on additional responsibilities.
Certified Medication Technician (CMT) and Insulin Administration: The CMT credential requires an active CNA certification and a high school diploma or GED. Some training programs also require passing portions of the Test for Adult Basic Education (TABE). Confirm current admission requirements with DHSS or the training program before applying. In some cases, qualified candidates can challenge the CMT exam rather than completing the full course. A CMT can also pursue separate certification in insulin administration.
Restorative Nurse Assistant (RNA): DHSS has historically recommended that CNAs have at least six months of experience before training as an RNA. Confirm current guidance with DHSS before enrolling. This credential supports CNAs who work with patients on rehabilitation and recovery goals in long-term care settings.
Find nursing licensure requirements by state for RNs, LPNs, LVNs, and advanced practice nurses.
Frequently Asked Questions
How long does it take to become a CNA in Missouri?
Most Missouri CNA programs take 8 to 16 weeks to complete. The state requires 75 hours of classroom instruction and 100 hours of clinical training for a total of 175 hours. After finishing the program, you’ll need to pass the competency exam administered by D&S Headmaster before your name is added to the Missouri Nurse Aide Registry.
How do I challenge the CNA exam in Missouri?
Eligible categories include nursing students or graduates, RN/LPN candidates who failed a licensing exam, internationally educated nurses awaiting U.S. licensure, individuals who completed UAP or PCT training with hours mirroring the CNA requirement, and Missouri CNAs with inactive registry status. To apply, email a written challenge request, along with the required documentation, to [email protected]. Exam challengers are allowed only one attempt. Failing either portion requires completing the full CNA course.
How do I renew my Missouri CNA certification?
Missouri CNA certification must be renewed every 24 months. Renewal requires documenting at least eight hours of paid nursing or nursing-related work during the prior two-year period. Submit proof (W-2, pay stubs, or employer letter) and a $20 renewal fee through the TMU portal maintained by D&S Headmaster. DHSS will send a reminder 60 days before your certification goes inactive if you have a TMU profile set up.
Can I transfer my CNA certification from another state to Missouri?
Yes. CNAs with an active certification from another U.S. state and no findings of abuse, neglect, or misappropriation can apply for Missouri reciprocity through DHSS without retaking training or the exam. You’ll need to submit the reciprocity application and documentation showing your current certification status. After approval, your name is added to the Missouri Nurse Aide Registry.
What happens if my Missouri CNA certification expires?
If you haven’t provided nursing services in five consecutive years, your certification is considered expired, and you’ll need to complete the full CNA training course before returning to work. If your status is inactive rather than expired, you can update your registry status by submitting proof of nursing work through the TMU portal and paying the $20 renewal fee. If you’re unsure of your current status, search the Missouri Nurse Aide Registry or contact DHSS at 573-526-5686.
Key Takeaways
- 175 training hours required — Missouri’s CNA programs include 75 classroom hours and 100 clinical hours, exceeding the federal minimum and covering both knowledge and hands-on patient care skills.
- Two-part competency exam — The exam tests practical skills and written knowledge. D&S Headmaster administers testing statewide, and passing both parts lists you on the Missouri Nurse Aide Registry.
- Exam challenge pathway available — Qualified candidates with prior healthcare training or experience, including nursing students and nursing graduates, can apply to skip the training course and go directly to the exam.
- Renew every 24 months — Active certification requires documenting at least eight hours of nursing work per two-year period and paying a $20 renewal fee through the TMU portal.
- Out-of-state CNAs can transfer — Reciprocity is available for CNAs with an active out-of-state certification and a clean registry record.
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