How to Become a CNA (Certified Nursing Assistant) in Missouri

Checked against Missouri Department of Health and Senior Services (DHSS), Health Education Unit, CNA Registry · Verified 2026-10-14

Exam: Required
Training: Required
Term: 2 years
State fee: See state office
Certified by: Missouri Department of Health and Senior Services (DHSS), Health Education Unit, CNA Registry

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Who can apply

You must be at least 18 to take a CNA course, unless you take it through a high school vocational-technical program.
You cannot be listed on the state Employee Disqualification List (EDL).
Some convictions or guilty pleas bar you from enrolling unless DHSS grants a good cause waiver. These include crimes that would be Class A or B felonies under Chapters 565, 566 or 569 RSMo.

Step by step

Enroll in a DHSS-approved CNA training program at a school or facility.
Complete 75 hours of classroom training and 100 hours of on-the-job (clinical) training.
Your instructor enters you in Headmaster's TMU system. Pay the $32 knowledge and $103 skills fees and schedule your test.
Pass the knowledge exam and the skills test within one year of your course start date.
You are placed on the Missouri CNA Registry. Print your certificate from TMU.

Official application →

Training and exam

Training: Missouri requires 175 hours: 75 classroom hours and 100 hours of supervised on-the-job (clinical) training, under Section 198.082 RSMo. This is 100 hours above the 75-hour federal minimum. If you leave a course before finishing, you have up to six months to re-enter it.

Exam: D&S Diversified Technologies-Headmaster gives Missouri's DHSS-approved exam: a written (knowledge) test and a practicum (skills) test. The knowledge test has 75 multiple-choice questions, and you need 80% to pass. On the skills test you get 30 minutes for three or four tasks. You must pass both within one year of your training start date. You get three attempts. After a first failure you may retake twice within 90 calendar days of your first exam. If you fail a third time, you must retake the whole course.

Practice for the CNA written exam free — physical care skills, safety & infection control, and the nurse aide role →

What it costs in Missouri

Fixed amounts are set by the state. Items marked “your quote” are priced by private sellers, so enter what you’re quoted.

CNA training program tuition$
Headmaster exam (knowledge $32 + skills $103)$135

Estimated total in Missouri$135Plus 1 item with no state-set price. Add your quotes above to complete the total.

Cost details from the state

Headmaster exam fees (effective January 1, 2026): knowledge test $32, skills test $103, so $135 for both. Each retake costs the same.
Audio (read-aloud) knowledge test: the DHSS FAQ says it costs an extra $10, but Headmaster's September 2026 handbook lists the audio version at $32, the same as the regular test.
Renewal fee: $20, paid in TMU.
Training tuition varies by program. Federal rule: if a nursing facility employs you, or has offered you a job, when you start training, you cannot be charged for the training or its books. If a nursing facility hires you within 12 months after you finish, the state must arrange for you to be paid back for training costs (42 CFR 483.152(c)).

Pay in Missouri

Before you compare job offers, see what a paycheck takes home in Missouri after taxes.

Starting out on an entry-level wage? Check the SNAP income limits in Missouri by household size.

Staying on the registry

Renewal: To stay active, you must document at least 8 hours of nursing or nursing-related work in each 24-month period. Upload a pay stub, W-2 or employer letter in TMU and pay the $20 fee; your employer then verifies by email. After a 2-year break in work your status becomes Inactive, and you can renew with proof of work or challenge the exam. After a 5-year break it becomes Expired, and you may have to retake the course. CNAs who work in long-term care facilities get 12 hours of in-service training each year from the facility; DHSS says CNAs outside long-term care do not need it to stay active.

Online options: Headmaster offers a remotely proctored knowledge exam you can take from home or elsewhere; the skills test is in person. DHSS does not say whether the 75 classroom hours can be taken online.

Good to know in Missouri

Transferring from another state: Missouri has reciprocity. If your CNA certification in another state is active and in good standing, complete the Missouri Reciprocity form in TMU and upload proof of your certification. You do not take the Missouri exam. Once approved, print your Missouri certificate from TMU.

Challenging the exam: Some people can take the exam without the course: nursing students with at least 4 months of RN or LPN school, including Fundamentals of Nursing with a clinical rotation, in the last 5 years; nursing graduates who failed the NCLEX; foreign-educated nurses awaiting U.S. licensure; people who finished an Unlicensed Assistive Personnel program; and inactive Missouri CNAs. You get one attempt; if you fail, you must complete the full course.

Working before certification: If you work in a facility, you must be certified within 120 days (4 months) of your start date.

Sources

General information, not legal advice. Fees and rules change — confirm with Missouri Department of Health and Senior Services (DHSS), Health Education Unit, CNA Registry before you apply.