Missouri Department of Health and Senior Services (DHSS), Health Education Unit — the unit named in the rule as the ‘Section for Long-Term Care Regulation, Health Education Unit’ (19 CSR 30-84.010(8)(A)6.) and reachable at PO Box 570, Jefferson City MO 65102, [email protected] , 573-526-5686. Testing and the day-to-day registry system are contracted out: the rule calls the contractor ’the department approved third party test administrator’ (19 CSR 30-84.010(18)(B)), and DHSS names it on its own pages as Headmaster D&S. The contractor states the same scope: ‘Headmaster is honored to partner with the Missouri Department of Health and Senior Services to work with and offer Certified Nurse Aide Testing and Registry Services to the Missouri Health Care Community.’ administers certified nursing assistant licensing in Missouri. Every figure below is verified against the board’s own official pages and dated. Who must personally hold a credential — the contractor, the business, or the individual worker — is set out under Requirements.
What it’s called
MISSOURI’S OWN NOUN IS CERTIFIED NURSE ASSISTANT, ABBREVIATED CNA — that is the title of DHSS’s page, the name in 19 CSR 30-84.010 (‘Nursing Assistant Training Program’, with the credential itself called a certified nurse assistant), and the wording on the state’s competency score sheet. The register is the MISSOURI CERTIFIED NURSE ASSISTANT REGISTRY, abbreviated MOCNAR in the state-linked handbook, and DHSS’s own site calls the current system ’the New Missouri Registry’. ‘Nurse aide’, ‘certified nurse aide’ and ‘certified nursing assistant’ are used interchangeably by DHSS and its contractor. MISSOURI DOES NOT ISSUE A NURSE AIDE LICENCE, THOUGH ITS OWN WORDING SOMETIMES SAYS OTHERWISE — DHSS’s FAQ asks ‘Is it required for me to have twelve (12) hours of in-service each year in order to keep my CNA license active?’ and one application on the state-linked list is headed ‘Inactive/Expired CNA License Renewal’ — but what exists is a certificate and an active registry entry, not a licence from a board. The Missouri State Board of Nursing licenses RNs and LPNs and has no role in the CNA credential beyond the instructor and clinical-supervisor qualifications that reference its licences. FOUR RELATED MISSOURI CREDENTIALS SHARE THE SAME REGISTRY AND ARE NOT THIS ONE: Certified Medication Technician (CMT), Level I Medication Aide (LIMA or L1MA), Insulin Administration (IA), and Restorative Nurse Assistant (RNA). TMU (TestMaster Universe) is the contractor’s software, not the credential. NATA — Nurse Assistant Training Agency — is the school. EDL is the Employee Disqualification List, a separate DHSS list that bars employment independently of the registry.
License types & fees
| Type | Notes | Who Its For |
|---|---|---|
| Certified Nurse Assistant (CNA) — active listing on the Missouri Certified Nurse Assistant Registry, basic-course route | The rule is direct about what listing depends on: 'If the CNA passes the final examination, the individual's name shall be placed on the CNA active registry' (19 CSR 30-84.010(18)(A)). There is a deadline on the front end too — 'A newly trained nurse aide candidate must pass both the knowledge and skills exams within one (1) year of the training start date' (state-linked candidate handbook), which DHSS restates as 'You have 1 year from the start date of your course to complete the program and take the test.' | A person who completes the 175-hour Missouri basic course and passes the two-part final examination. |
| CNA by challenge — the final examination without the course | The rule defines it plainly: 'Challenge the final examination—means taking the final examination of the basic course without taking the entire basic course' (19 CSR 30-84.010(1)(D)). It is one shot only: 'If an individual fails the final examination after one (1) attempt, he or she shall successfully complete basic course in its entirety' ((8)(F)). Permission is a letter with a shelf life — 'Those individuals permitted to challenge shall take the final examination within one hundred twenty (120) calendar days of the department notification. Permission letters not utilized within the one hundred twenty- (120-) day period shall be considered invalid' ((8)(E)). | People in eight categories the rule lists: nursing students both former and CURRENT, RN/LPN licensure-examination failures, foreign nursing graduates and foreign licence holders, Unlicensed Assistive Personnel graduates, HOSPITAL-TRAINED nursing assistants and psychiatric aides, Missouri CNAs inactive for less than five years who cannot document work, and a catch-all for anyone whose background the department evaluates as equivalent. |
| CNA by reciprocity (interstate transfer) — no Missouri examination | The rule exempts them from the exam outright: 'Individuals who are certified and active on another state's nurse aide registry shall not be required to challenge the final examination' (19 CSR 30-84.010(8)(B)). DHSS puts it in plain terms — 'Reciprocity allows you to become a CNA without taking the Missouri CNA exam' — and directs applicants to an online reciprocity application rather than to email. | A nurse aide certified and active on another state's registry. |
| Certified Medication Technician (CMT), Level I Medication Aide (LIMA), Insulin Administration and Restorative Nurse Assistant (RNA) — separate Missouri credentials built on the CNA, not covered by this record | CMT requires the CNA first: 'You must be a CNA and listed as active on the Mo Certified Nurse Assistant Registry for at least six months', plus age 18, a high school diploma or GED, no federal marker or EDL listing, and an employer letter of recommendation. The dependency runs the other way too — DHSS states that if a CNA goes inactive or expired, 'If the individual has a Certified Medication Technician (CMT) certificate or Insulin Administration (IA) certificate, these certifications are also inactive... When the individual has regained Active CNA status, the CMT and IA certifications will also be considered Active.' LIMA is limited by setting: 'You may pass medications only in a Licensed Residential Care Facility or Assisted Living Facility.' Their rules are 19 CSR 30-84.020, .030 and .040. This record documents the CNA only. | Named because they sit in the same DHSS registry and the same rule chapter, and because CNA status controls them. |
| Paid feeding assistant — a separate federal-law role, not a nurse aide credential | DHSS: 'Code of Federal Regulations 483.160 allows for paid feeding assistants in certified facilities in Missouri. The paid feeding assistant does not have to be a certified nurse assistant.' The training is 'a minimum of 8 hours' on eight prescribed topics, taught by a licensed registered nurse, and the record of completion is kept by the facility rather than by a state registry. | Named because DHSS runs it from the same page set and it is routinely confused with the CNA. |
Who does NOT need this license — exemptions
MISSOURI’S CARVE-OUTS ARE ABOUT WHO MAY SKIP THE COURSE AND WHO MAY WORK BEFORE CERTIFICATION, NOT ABOUT WHO ESCAPES THE CREDENTIAL. (1) THE FOUR-MONTH HIRING WINDOW: a CNA hired into an intermediate care or skilled nursing facility must already have completed an approved program, or ‘shall enroll in and begin the first available approved training program which is scheduled to commence within ninety (90) days of the date of the CNAs employment and which shall be completed within four (4) months of employment’ (19 CSR 30-84.010(7)). (2) THE CHALLENGE CATEGORIES, which waive the course but not the examination. 19 CSR 30-84.010(8)(A) lists EIGHT, and they are worth reading in the rule’s own order because two of them are easy to miss: ‘1. Individuals who were enrolled in a RN or LPN nursing education program for at least four (4) months and successfully completed a course on the fundamentals of nursing, including clinical hours within the last five (5) years; 2. Individuals currently enrolled in a RN or LPN nursing education program and who have successfully completed a course on the fundamentals of nursing, including clinical hours; 3. RN or LPN nursing licensure candidates who have failed state licensure examinations within the last five (5) years; 4. Individuals who have met the requirements of unlicensed assistive personnel contained in 19 CSR 30-20.125; 5. Individuals trained by a hospital as nursing assistants or psychiatric aides who have completed the following: A. One hundred (100) hours of supervised on-the-job training in an ICF, SNF, hospital, Missouri Veterans’ Home, or hospital-based nursing facility or hospital-based skilled nursing facility; and B. Instruction that covers the basic course content outlined in paragraphs (5)(B)1. and 2. of this rule; 6. Any other persons whose background, education, and training in gerontology and health occupations includes components of the basic course content outlined in paragraphs (5)(B)1. and 2. may be allowed to challenge the final examination after taking those portions of the course as determined to be necessary based on evaluation of their credentials by the Section for Long-Term Care Regulation, Health Education Unit; 7. A CNA who is listed as inactive for less than five (5) years on the Missouri Certified Nurse Assistant Registry and cannot provide the required employment documentation in accordance with section (18) of this rule; and 8. Individuals who have successfully completed a nursing program outside the United States within the last five (5) years or who have obtained a nursing license outside the United States.’ ⚠ THE DEPARTMENT’S OWN CHALLENGE PAGE LISTS ONLY SIX OF THE EIGHT: it merges the two nursing-student categories into one bullet and omits the hospital-trained nursing assistant and psychiatric aide category altogether. Someone trained as an aide by a hospital, or as a psychiatric aide, will find nothing about themselves on that page and is in the rule anyway. The paperwork also differs by category: applicants under paragraphs 1 through 7 file a written request with name, Social Security number, address, telephone number, e-mail and transcripts ((8)(C)), while a foreign graduate under paragraph 8 files ‘a copy of the out-of-country license or certificate translated to English; a copy of the school transcript translated to English; and a copy of the out-of-country criminal background check translated to English’ ((8)(D)). (3) RECIPROCITY, which waives the examination entirely for an active out-of-state aide. (4) THE 16-YEAR-OLD SCHOOL ROUTE, which waives the age-18 rule for secondary-school health occupations students under direct supervision. (5) PAID FEEDING ASSISTANTS are outside the credential altogether: ‘The paid feeding assistant does not have to be a certified nurse assistant.’ WHAT IS NOT WAIVABLE: the EDL listing and the class A or B felony bar, except by a good cause waiver granted by the department; and the federal indicator, which permanently bars work or volunteering in a certified long-term care facility or the long-term care wing of a hospital. SCOPE — WHERE THE CREDENTIAL IS REQUIRED: Missouri’s rule is written around intermediate care facilities and skilled nursing facilities, and DHSS describes active status as eligibility ’to be employed as a CNA in a long-term care facility’. No Missouri source read on 2026-08-16 states a general prohibition on aide work outside long-term care, and this record claims none — note, though, that Missouri does accept private-duty nursing work as qualifying employment for keeping the certificate active, which is about maintenance rather than about where certification is required.
Fees
MISSOURI’S PUBLISHED CANDIDATE COSTS ARE THE EXAM AND THE RENEWAL, AND BOTH ARE COLLECTED BY DHSS’S CONTRACTOR RATHER THAN BY DHSS. EXAM — DHSS publishes the split in its own FAQ: ‘The CNA exam is $135.00 total. The Knowledge exam is $32.00. The skills exam is $103.00’, plus ‘There is an additional $10 fee for test to be read to you.’ The rule authorises the charge without setting an amount: the final examination is conducted by the department approved third party test administrator ‘and a fee will be assessed for each examination.’ Payment is by Visa or MasterCard inside the TMU system and must be made before a test date can be scheduled; some training programs prepay for their graduates. Note that the state-linked candidate handbook carries the heading ‘Price Increase Effective January 1st, 2026’ over its fee table, so a reader should treat DHSS’s figures as the ones to confirm at booking. RENEWAL — $20.00, stated twice by DHSS (‘The CNA renewal fee is $20.00’) and described in the handbook as a ’non-refundable renewal fee of $20.00’. An employer may pay it instead of the aide, either by sponsoring the individual renewal or in bulk: DHSS tells employers they can ‘Choose to pay for your employee’s renewals in bulk’ using a form obtained from the contractor. TEST REVIEW — $25.00 non-refundable, to dispute a test result. NO FEE IS PUBLISHED for reciprocity: the Missouri CNA Reciprocity application on the state-linked applications list shows no price, unlike several other applications on the same list. NO FEE IS PUBLISHED for the challenge approval itself, which is granted by DHSS in writing, although the challenge examination is a final examination and carries the examination fee. TRAINING CAN BE FREE, AND OFTEN MUST BE: DHSS states the federal prohibition in its own words — ‘No nurse assistant who is employed by, or who has an offer of employment from, a nursing facility on the date on which the assistant begins training and testing program may be charged for any portion of the program’ — and adds that ‘A facility is obligated by federal regulation… to reimburse on a prorated basis, a nurse aid for any training that he/she took prior to being hired, if the training took place within 12 months of hire.’ Medicaid-certified nursing facilities bill the state for that training, and must wait 60 days after the final exam and bill within one year of it. One limit: ‘At this time the regulations do not allow reimbursement for an individual who needs to retake the course or challenge the exam because of expired or inactive status if their original training was reimbursed.’ A $100.00 application fee applies to becoming an RN Test Observer, which is a testing-staff role rather than a candidate cost.
Exam
TWO PARTS — A WRITTEN (OR ORAL) KNOWLEDGE EXAM AND A PRACTICUM SKILLS EXAM — AND THE PASS STANDARDS ARE DIFFERENT FOR EACH. DHSS describes the shape: ‘The two part final examination includes a written (or oral) and practicum examination.’ KNOWLEDGE: ‘You will have 60 minutes to complete the 75 multiple-choice questions Knowledge Exam’ and ‘You must have a score of 80% or better to pass the knowledge portion of the exam’ — a standard the rule fixes as well (‘The student shall achieve a passing score of at least eighty percent (80%)’). DHSS confirms the count in its own FAQ: ‘There are 75 questions on the CNA Exam.’ The published Missouri blueprint distributes those 75 as: Safety 9, Basic Nursing Skills 8, Infection Control 8, Personal Care 8, Communication 6, Disease Process 6, Mental Health 6, Aging Process and Restorative Care 5, Care Impaired 5, Resident Rights 5, Role and Responsibility 5, Data Collection 4. LANGUAGE: ‘In addition to English, the Knowledge Exam only is offered in the following alternate languages: Spanish.’ A read-aloud audio version is available for an extra fee, and paper word-for-word translation dictionaries are allowed if they contain no writing or definitions. SKILLS: 30 minutes, one mandatory task first (catheter care for a female resident on a manikin; a don-PPE, empty-urinary-drainage-bag, doff-PPE sequence; perineal care for a female resident on a manikin; or perineal care for a male resident on a manikin) with hand washing embedded, then ‘an additional two (2) or three (3) randomly selected tasks’. The scoring rule is strict and asymmetric: ‘You must successfully complete 100% of the tasks you are assigned. You may not miss any key steps (the bolded steps) and must achieve 80% or higher on the non-key steps on each task to pass the Skill Test.’ The rule states the same standard as a flat number — ‘The student shall successfully complete the skills evaluation portion of the examination proctored by the department approved third party test administrator. The student shall achieve a score of one hundred percent (100%).’ Steps must be performed, not described: ‘Steps that are only verbalized or simulated WILL NOT COUNT.’ ATTEMPTS: three, on a clock. ‘Any individual who fails the final examination, except those who have been permitted to challenge the examination, shall have the opportunity to retake the examination twice within ninety (90) calendar days of the initial examination. If the individual fails the final examination a third time, the entire basic course shall be retaken before another examination can be given’ (19 CSR 30-84.010). Challenge candidates get one attempt only. A PAYMENT-DISPUTE RULE WORTH KNOWING: if a card charge for testing fees is later disputed, ’the candidate would not be placed on the Registry until the disputed fee and charges are paid’, and an already-listed candidate ‘will be removed from the Registry until the disputed fee and charges are paid.’
Renewal & continuing education
EVERY 24 MONTHS, ON PROOF OF EIGHT HOURS OF PAID NURSING WORK, FOR $20. The rule states the duty: ‘CNAs shall submit documentation (e.g., pay stubs, W-2, letter from employer, etc.) of work in nursing or nursing related services for at least one (1) day (e.g. eight (8) hours) within each twenty-four- (24-) consecutive month period to maintain active status. Documentation shall be submitted to the department approved third party test administrator and a fee will be assessed for each renewal’ (19 CSR 30-84.010(18)(B)). HOW IT IS DONE: sign in to the TMU account, enter the employment information, upload ‘a Paystub, W2, or letter from your employer on the company letterhead’, pay the $20, and the system emails the employer for verification — ‘Once your employer verifies that you were working your CNA will be renewed’ (DHSS). The state-linked handbook describes a self-attestation step alongside it: ‘You will be self-attesting that you have worked as a CNA for at least 8 hours during the last certification period at the facility (employer) you listed. Your eligibility will be extended an additional twenty-four months.’ PRIVATE-DUTY AIDES HAVE THEIR OWN ROUTE: ‘Log into your profile in TMU and select private duty from the drop down menu. You will need to upload a work verification letter from the person you were caring for or their Power of Attorney. The letter will need to contain your dates of employment, a brief description of what you are helping them with, and the letter will need to be signed and notarized.’ THE DOCUMENT HAS TO SHOW NURSING WORK, NOT JUST WORK: ‘If the documentation of work hours is unrelated to nursing services, your renewal may be denied. If denied, you may be allowed 15 business days to provide the correct documentation before you will be required to pay another renewal fee.’ NOTICES: renewal alerts go by email and text 60 days before the expiration date, and ‘No renewal certifications are sent via USPS mail.’ AN EMPLOYER-SIDE ROUTE EXISTS: facilities can register in the system ‘as an eligible employer to verify the employment of nurse aides for the renewal of their Federal certification’, and can pay renewals in bulk. A CNA can check status, update address and phone, and see the eligibility expiration date in the system at any time. NONE FOR THE CERTIFICATE — AND MISSOURI ANSWERS THE COMMON CONFUSION DIRECTLY. Asked whether twelve hours of in-service a year are needed to keep a CNA active, DHSS replies: ‘A long-term care facility is required by state regulation to provide 12 hours of in-service to nursing personnel. If you are not employed in a long-term care facility you are not required to have the 12 hours of in-service in order to keep your certificate active.’ The duty is therefore the facility’s, and the aide’s certificate turns on paid work rather than education: the only condition 19 CSR 30-84.010(18)(B) imposes to maintain active status is documented nursing or nursing-related work of at least eight hours in each 24-month period, plus the renewal fee. No continuing-education requirement for the individual CNA appears in 19 CSR 30-84.010 in full, on any of the DHSS CNA registry pages, or in the state-linked Missouri Nurse Aide Candidate Handbook (January 2026) — all read on 2026-08-16. Note the contrast with a neighbouring Missouri credential DHSS runs: a Level I Medication Aide does have a renewal class — ‘If you are employed as a L1MA you can check with your employer about the 4 hour renewal class’ — which is a LIMA requirement, not a CNA one.
How to apply
Applications are handled by Missouri Department of Health and Senior Services (DHSS), Health Education Unit — the unit named in the rule as the ‘Section for Long-Term Care Regulation, Health Education Unit’ (19 CSR 30-84.010(8)(A)6.) and reachable at PO Box 570, Jefferson City MO 65102, [email protected] , 573-526-5686. Testing and the day-to-day registry system are contracted out: the rule calls the contractor ’the department approved third party test administrator’ (19 CSR 30-84.010(18)(B)), and DHSS names it on its own pages as Headmaster D&S. The contractor states the same scope: ‘Headmaster is honored to partner with the Missouri Department of Health and Senior Services to work with and offer Certified Nurse Aide Testing and Registry Services to the Missouri Health Care Community.’. Start at the official application page .
Verify a license in Missouri
D&S Diversified Technologies (D&SDT)-Headmaster, under contract to the Missouri Department of Health and Senior Services. DHSS links it from every CNA registry page as ‘Search the New Missouri Registry’. publishes a public license search , searchable by name, Social Security number, registration number or misconduct. It covers Missouri Certified Nurse Assistant Registry entries — status (Active, Inactive or Expired), and the markers that bar employment. The state-linked handbook describes the content: the registry ’lists the names of certified nurse aides who, through training, testing, and experience, meet federal and/or state requirements to work as a certified nurse aide in Missouri’ and ‘also identifies candidates who have been placed on the EDL (Employee Disqualification List) or who have a Federal Indicator… on their license.’ The page also offers a bulk ‘Download Misconduct List’. DHSS treats this search as the answer to out-of-state verification requests: asked how to have Missouri verify a certification for another state, DHSS replies ‘If you need Missouri to verify your CNA certification, visit Missouri CNA registry.’ A SEPARATE SEARCH covers the teaching side — DHSS links a public search of active instructors and clinical supervisors alongside it. A LIMITATION READERS SHOULD KNOW: the registry is not on a Missouri state web address; it is the contractor’s system, and a search result is drawn into the page after the form is submitted rather than living at its own web address, so a result cannot be linked to or bookmarked and an automated check cannot confirm an individual record. A CNA can also sign in to see their own status and eligibility expiration date from any internet-capable device.
Records come from D&S Diversified Technologies (D&SDT)-Headmaster, under contract to the Missouri Department of Health and Senior Services. DHSS links it from every CNA registry page as ‘Search the New Missouri Registry’.’s own system. LicensingAtlas does not hold license records and cannot confirm any individual’s status — the date on this page refers to the requirements described above, not to anyone’s credential.