CNA certification requirements: training, exam, registry and renewal

Why certification is required

Federal rules for nursing homes that take part in Medicare or Medicaid set the floor for every state. Under 42 CFR 483.35(d), a facility may not use anyone as a nurse aide for more than 4 months on a full-time basis unless that person is competent and has completed a state-approved training and competency evaluation program (or a competency evaluation program). Before letting someone work as a nurse aide, the facility must also get registry verification, and check every state registry it believes will have information on that person.

States build their own rules on top of that floor, so the requirements below come in two layers: the federal minimum, then examples of what states add. The exam itself is covered on our CNA practice test page.

Step 1: a state-approved training program

42 CFR 483.152 says an approved program must, at a minimum:

• last no less than 75 clock hours;
• include at least 16 hours of supervised practical training, in a lab or other setting where you perform tasks on a person under the direct supervision of a registered nurse or licensed practical nurse;
• give at least 16 hours of training before any direct contact with a resident, on communication and interpersonal skills, infection control, safety and emergency procedures including the Heimlich maneuver, promoting residents' independence, and respecting residents' rights;
• cover basic nursing skills, personal care skills, mental health and social service needs, care of cognitively impaired residents, basic restorative services and residents' rights.

The training must be given by or under the general supervision of a registered nurse with at least 2 years of nursing experience, at least 1 of them in long-term care.

States that require more than 75 hours

Washington's rule was last amended effective July 1, 2026. California adds that skills lab hours may be included in a curriculum but do not count toward the 60 classroom or 100 clinical hours.

Some states also allow other routes. Florida, for example, has a "challenger" route for people with no nursing assistant training or experience who believe they can pass the exam without training; if you fail one part three times, you must complete a state-approved program of at least 120 hours and retake both tests (Florida bulletin).

If your training costs worry you: an aide who is employed by, or has a job offer from, a facility on the day they start the program may not be charged for any part of it, including textbooks (42 CFR 483.152(c)). Our CNA exam cost guide covers the reimbursement rules.

Step 2: pass the competency evaluation

The evaluation has two parts, and you must pass both (42 CFR 483.154):

• a written or oral exam: you choose which, and it must address each subject of the federal curriculum;
• a skills demonstration of randomly selected tasks, evaluated by a registered nurse with at least one year of experience caring for the elderly or chronically ill.

Each state sets its own passing standard, and you must get at least three opportunities to pass. Some states add a time limit: South Carolina requires both parts within two years of finishing training or three attempts, whichever comes first, after which you must retrain in a 100-hour program (South Carolina handbook); Ohio allows three attempts within two years of completing training (Ohio handbook).

The details of each part are in our guides to the CNA skills test and to how many questions are on the CNA exam.

Step 3: the nurse aide registry

Once you pass, the state must add your record to its nurse aide registry within 30 days (42 CFR 483.154). South Carolina's handbook puts it at about ten business days after you pass both parts (South Carolina, Exam Results). The registry is what employers check.

From 42 CFR 483.156:

• The state may not charge you for being listed.
• The registry shows your name, identifying information and the date you became eligible.
• Any finding of abuse, neglect or misappropriation of property by the state survey agency is added within 10 working days and stays permanently, with your statement disputing it if you make one, unless the finding was made in error, you were found not guilty in court, or the state is notified of your death.

Staying certified: the 24-month rule

This is the federal rule behind most renewal requirements. If, since you last completed a training and competency evaluation program, there has been a continuous period of 24 consecutive months during which you did not provide nursing or nursing-related services for pay, you must complete a new training and competency evaluation program or a new competency evaluation program before a facility may use you as an aide (42 CFR 483.35(d)(6)). The registry must remove entries for people who have performed no nursing or nursing-related services for 24 consecutive months, unless the entry includes a documented finding of abuse, neglect or misappropriation (42 CFR 483.156).

While you work, the facility must review your performance at least once every 12 months and give you in-service training of at least 12 hours a year, including dementia management and abuse prevention (42 CFR 483.35(d)(7), 483.95(g)).

A state example: South Carolina

South Carolina's handbook shows how a state turns this into a renewal process (The Registry):

• A certificate is valid for 24 months; Credentia emails renewal directions about 90 days before it expires.
• To renew, you must have worked at least 8 hours in nursing or nursing-related services for pay in the past 24 months.
• The renewal fee is $35; if a Medicaid-certified employer employs you, you give it the payment receipt for reimbursement.
• If your certification has lapsed for no more than 24 months and you already completed a 100-hour program, you retest both parts; if it lapsed more than two years ago, or you never completed a 100-hour program, you retrain and retest.

Moving to another state

If you move, ask the new state's registry about reciprocity before you go, because the receiving state applies its own minimum. South Carolina, for example, accepts aides who are active and in good standing on another state's registry, but only if they completed at least a 100-hour state-approved course, and it keeps the expiration date from the original state (The Registry).

Checklist

1. Choose a program approved by your state's agency and check its hours against the state minimum.
2. Ask whether a facility will hire you first: then you pay nothing for training or testing.
3. Prepare for both parts of the exam; our CNA study guide shows where the points are.
4. After you pass, check your name on the registry and keep your contact details up to date.
5. Keep working at least part time, or plan to retrain or retest if you stop for 24 months.

Sources

• 42 CFR 483.152, Requirements for approval of a nurse aide training and competency evaluation program — eCFR (checked October 3, 2026)
• 42 CFR 483.154, Nurse aide competency evaluation — eCFR (checked October 3, 2026)
• 42 CFR 483.156, Registry of nurse aides — eCFR (checked October 3, 2026)
• 42 CFR 483.35, Nursing services (facility hiring and use of nurse aides) — eCFR (checked October 3, 2026)
• 42 CFR 483.95, Training requirements (nurse aide in-service training) — eCFR (checked October 3, 2026)
• Nurse Assistant Training Program Applicants — California Department of Public Health (checked October 3, 2026)
• WAC 246-841A-440, Common curriculum in approved nursing assistant training programs — Washington State Legislature (checked October 3, 2026)
• South Carolina Nurse Aide Candidate Handbook, Eligibility Criteria — Credentia (checked October 3, 2026)
• South Carolina Nurse Aide Candidate Handbook, The Registry — Credentia (checked October 3, 2026)
• South Carolina Nurse Aide Candidate Handbook, Exam Results — Credentia (checked October 3, 2026)
• South Carolina Nurse Aide Candidate Handbook, Introduction — Credentia (checked October 3, 2026)
• Florida Certified Nursing Assistant Candidate Information Bulletin (Rev. 11012025) — Prometric (checked October 3, 2026)
• Ohio Nurse Aide Candidate Handbook, Version 27 (December 2025) — D&S Diversified Technologies (Headmaster) (checked October 3, 2026)

NNAAP is a registered trademark of its owner. passmock is not affiliated with or endorsed by Credentia, the National Council of State Boards of Nursing (NCSBN), Prometric, D&S Diversified Technologies (Headmaster) or any state nurse aide registry.