Missouri requires 75 hours of CNA training — the federal minimum — and uses D&S Diversified Technologies to administer the state competency exam, the same vendor used in Kansas, Georgia, Arizona, and Oklahoma. What makes Missouri distinctive is that the Missouri Department of Health and Senior Services (DHSS) manages the Missouri Nurse Aide Registry, not the Board of Nursing — a key distinction candidates must understand. Missouri is home to two major CNA markets: Kansas City and St. Louis, each anchored by nationally recognized health systems. The Kansas City metro straddles the Missouri-Kansas state line — CNAs working in Jackson, Clay, or Cass counties hold Missouri certification, while those on the Kansas side need separate Kansas credentials (Kansas requires 90 hours; Missouri only 75). St. Louis is dominated by BJC HealthCare — one of the largest nonprofit health systems in the US — and Mercy Health, creating some of the strongest CNA hiring markets in the Midwest. Missouri CNA salaries range from $26,000 to $32,000 annually, with hospital CNAs in St. Louis and Kansas City earning significantly more. This guide covers all 2026 CNA requirements in Missouri, including free CNA classes near me in Missouri.
Missouri requires exactly 75 hours of CNA training — the federal minimum established by OBRA 1987 — making it one of the most accessible states for CNA certification. Training must include at least 16 hours of classroom/theory instruction and at least 16 hours of supervised clinical practice at a licensed Missouri nursing facility. The remaining hours can be split between laboratory training and additional instruction. Programs must be approved by the Missouri Department of Health and Senior Services (DHSS). Training is offered at community colleges (e.g., Metropolitan Community College, St. Louis Community College), vocational schools, hospital systems, and employer-based programs at nursing homes and long-term care facilities. Accelerated full-time programs complete in 2–3 weeks; part-time evening programs take 6–10 weeks.
Missouri uses D&S Diversified Technologies — not Prometric — to administer the state CNA competency exam. This is the same vendor used by Kansas, Georgia, Arizona, and Oklahoma, so practice resources designed for D&S Diversified's NNAAP format are directly applicable. The written section contains 70 multiple-choice questions with a 105-minute time limit. The clinical skills evaluation requires demonstrating 5 randomly selected nursing skills from the approved Missouri skills list in front of a trained evaluator. Both sections must be passed to receive Missouri CNA certification. Candidates have up to 3 attempts within 24 months of completing their DHSS-approved training program. Testing sites are available in Kansas City, St. Louis, Springfield, and other Missouri cities.
Missouri requires a criminal background check for all CNA candidates seeking to work in nursing facilities and other DHSS-licensed settings. The background check is conducted through the Missouri State Highway Patrol (MSHP) and includes both state and federal criminal history via fingerprinting. The Missouri DHSS maintains an Employee Disqualification List (EDL) — individuals on the EDL are barred from employment in any licensed Missouri healthcare facility, regardless of CNA certification status. Medicaid and Medicare-funded employers must also verify candidates are not on the OIG exclusions list. Most DHSS-approved CNA training programs require background check clearance before clinical rotations begin.
Before beginning supervised clinical rotations at a Missouri nursing facility, CNA students must provide a negative TB test result (Mantoux PPD or QuantiFERON Gold blood test) within the past 12 months, a physician's physical clearance form, and current CPR/BLS certification. Most DHSS-approved programs also require documentation of Hepatitis B, MMR, Varicella, Tdap, and seasonal flu vaccinations. Major Missouri health systems — including BJC HealthCare and Mercy — require a pre-employment drug screen in addition to the background check. These requirements are consistent across Kansas City and St. Louis metro area programs.
The Kansas City metro area — on the Missouri side encompassing Jackson County, Clay County, and Cass County — is Missouri's largest CNA market. Kansas City, MO anchors this region with a mix of acute care hospitals, skilled nursing facilities, home health agencies, and assisted living communities. Saint Luke's Health System, one of the most respected integrated health systems in the Midwest, operates Saint Luke's Hospital of Kansas City and multiple satellite campuses — a major CNA employer known for strong wages and career advancement. HCA Midwest Health operates several Kansas City-area hospitals including Research Medical Center and Menorah Medical Center. Veterans Affairs Medical Center Kansas City employs a significant number of CNAs serving Missouri's veteran population. For training, Metropolitan Community College (MCC) — with campuses across the KC metro — offers some of the most accessible and affordable DHSS-approved CNA programs in Missouri. Penn Valley Community College (MCC Penn Valley, Kansas City) and State Fair Community College also offer CNA pathways. CNA wages in Kansas City, MO average $13–$17/hour, with hospital positions at Saint Luke's and HCA reaching $17–$21/hour. Free CNA training programs may be available through Missouri Workforce Development centers and employer-sponsored programs at long-term care facilities. Important: CNAs working on the Kansas side of the KC metro must hold a separate Kansas CNA certification — see the KC Metro dual licensing highlight below.
St. Louis is Missouri's largest city and most diverse CNA market, anchored by two nationally recognized health systems: BJC HealthCare and Mercy Health. BJC HealthCare — one of the largest nonprofit health systems in the United States — operates Barnes-Jewish Hospital (consistently ranked among the nation's top hospitals), St. Louis Children's Hospital, Christian Hospital, and multiple community hospitals. BJC is the single largest private employer in Missouri and one of the top CNA employers in the state, offering competitive wages, tuition reimbursement, and clear career advancement pathways. Mercy Health St. Louis operates Mercy Hospital St. Louis, Mercy Hospital South, and numerous specialty facilities — another major CNA employer across the region. SSM Health (St. Mary's, DePaul campuses) rounds out the major St. Louis health systems. For training, St. Louis Community College (STLCC) — with campuses at Florissant Valley, Forest Park, and Meramec — offers DHSS-approved CNA programs at community college tuition rates. Ranken Technical College and the American Red Cross St. Louis chapter also offer approved programs. CNA wages in St. Louis average $14–$18/hour, with BJC hospital positions reaching $18–$23/hour for experienced CNAs. The St. Louis metro is consistently one of the higher-paying CNA markets in Missouri due to the concentration of major teaching hospitals and academic medical centers.
Springfield, in the Ozarks region, is Missouri's third-largest city and an important regional CNA market anchored by CoxHealth and Mercy Springfield. CoxHealth is a locally owned, community-based health system that operates Cox Medical Center South and Cox Medical Center North — the two largest hospitals in southwest Missouri — and is one of Springfield's largest employers. CoxHealth's strong community presence and emphasis on career development make it a preferred CNA employer in the region. Mercy Hospital Springfield, part of the Mercy Health network, operates as the second major acute-care system in Springfield and offers competitive CNA employment. For training, Ozarks Technical Community College (OTC) offers DHSS-approved CNA programs that are well-regarded in the region. Missouri State University's nursing department and Drury University's healthcare programs also provide pathways into CNA certification. CNA wages in Springfield average $12–$16/hour — lower than Kansas City and St. Louis due to the lower cost of living in southwest Missouri, but employment is stable given the region's growing senior population in the Ozarks.
Columbia is Missouri's fourth-largest city and home to a unique CNA market shaped by the presence of major academic and state institutions. University of Missouri Health Care (MU Health Care) operates University Hospital and multiple specialty clinics — as an academic medical center, MU Health Care is a significant CNA employer and also supports nursing education pipelines. Boone Hospital Center (BJC affiliate) provides additional acute-care employment. Columbia is also the home of the University of Missouri (Mizzou) and Columbia College, creating a large student population that drives demand for healthcare services and CNA staffing. For training, Columbia Area Career Center (CACC) offers high school and adult CNA programs that are DHSS-approved. State Fair Community College (Sedalia campus, 60 miles west) serves mid-Missouri candidates. CNA wages in Columbia average $13–$17/hour, with MU Health Care positions reaching $16–$19/hour. Mid-Missouri rural counties — Boone, Callaway, Cole (Jefferson City) — have growing home health demand due to the aging rural population, with the Missouri Division of Senior Services funding HCBS waiver-based CNA positions across the region.
Independence (Jackson County suburb of Kansas City) has a dense concentration of SNFs and assisted living facilities serving a large senior population — it falls under the KC metro MO CNA market but has its own significant employer base. Independence Regional Health Center and numerous long-term care facilities make Independence a reliable CNA employment hub within easy commute of Kansas City. Joplin, in southwest Missouri near the Kansas and Oklahoma borders, is anchored by Freeman Health System and Mercy Hospital Joplin (rebuilt after the 2011 tornado). CNA wages in Joplin are among the lowest in Missouri ($11–$15/hour) but demand is steady. Outstate Missouri — including the Bootheel, Ozarks, and northern Missouri — faces a documented rural CNA shortage, with nursing homes and home health agencies in rural counties struggling to fill positions due to limited training programs and lower wages. Missouri's HCBS waiver program funds CNA positions across all 114 counties, providing home-based care employment options even in remote areas. For candidates willing to relocate or commute, rural Missouri facilities often offer employer-paid training and signing bonuses to attract candidates — check with local long-term care facilities directly for sponsored program availability.
Search the Missouri DHSS website for a current list of approved nurse aide training programs. Options include community colleges (St. Louis Community College, Metropolitan Community College, Ozarks Technical Community College), vocational schools, American Red Cross chapters, and some nursing homes offering employer-sponsored programs. Confirm the program is currently DHSS-approved before enrolling.
Obtain your TB test within 12 months, physical examination clearance, current immunizations, and CPR/BLS certification. Submit to a criminal background check through the Missouri State Highway Patrol (MSHP). Most programs require these before clinical placement. Verify you are not listed on Missouri's Employee Disqualification List (EDL). A pre-enrollment drug screen may also be required.
Attend your DHSS-approved program for at least 75 hours including a minimum of 16 hours classroom instruction and 16 hours of supervised clinical practice at a licensed Missouri nursing facility. Full-time accelerated programs complete in 2–3 weeks; part-time evening programs take 6–10 weeks.
After program completion, register for both the written and clinical skills exam sections through D&S Diversified Technologies — Missouri's state exam vendor (not Prometric). You will need your program completion certificate. Testing sites include Kansas City, St. Louis, Springfield, Columbia, and other Missouri locations.
Pass the written knowledge test (70 questions, 105 minutes, 70% to pass) and the clinical skills evaluation (5 randomly selected skills — all must pass). If you fail one section, you may retake only that section. You have 3 total attempts within 24 months of training completion.
After passing both exam sections, D&S Diversified transmits your results to Missouri DHSS. You are added to the Missouri Nurse Aide Registry within 2–4 weeks. You can verify your registry status online at the DHSS website. Your name, certification status, and any abuse/neglect findings are publicly searchable.
Apply to BJC HealthCare, Mercy Health, Saint Luke's Health System, CoxHealth, HCA Midwest, and local SNFs and home health agencies. Many Missouri employers use Indeed and internal career portals. Staffing agencies like AMN Healthcare and Aya Healthcare offer per-diem and travel CNA opportunities in Missouri's two major metros.
To maintain active Missouri CNA certification, you must complete at least 8 hours of paid nursing service as a nurse aide within every 24-month renewal period. If your certification lapses, you must retake the full competency exam to reactivate. DHSS sends renewal reminders to the address on file — keep your contact information current on the registry.
The Kansas City metro straddles the Missouri-Kansas state line, and this creates a real licensing challenge for CNAs working in the region. Missouri and Kansas are two separate states with two separate nurse aide registries, two different training hour requirements, and separate exam registrations. Here is exactly what you need to know:
Missouri Side (Jackson County, Clay County, Cass County): CNAs working in Kansas City MO, Independence, Lee's Summit, Blue Springs, Liberty, or Raytown must hold a Missouri CNA certification — listed on the Missouri DHSS Nurse Aide Registry. Missouri requires only 75 hours of training and uses D&S Diversified for the competency exam. The Missouri DHSS manages the registry — not the Board of Nursing.
Kansas Side (Johnson County, Wyandotte County, Leavenworth County): CNAs working in Overland Park, Olathe, Leawood, Prairie Village, Kansas City KS, or Leavenworth must hold a Kansas CNA certification — listed on the Kansas Nurse Aide Registry managed by KDADS. Kansas requires 90 hours of training (15 more than Missouri) and also uses D&S Diversified. The registries are completely separate.
Can you hold both? Yes. Many KC metro CNAs maintain dual certification in both Missouri and Kansas to maximize job opportunities, staffing agency placement, and facility choice. Kansas will accept reciprocity from Missouri without retesting if your MO certification is active and in good standing with no abuse/neglect findings. The reverse is also possible: a Kansas-certified CNA can apply to Missouri DHSS for reciprocity.
Important for staffing agency workers: If you are placed by a Kansas City staffing agency, always confirm on which side of the state line your assignment facility is located before accepting. Working at a Missouri facility without valid Missouri CNA certification (or vice versa for Kansas) is a regulatory violation. When in doubt, verify the facility's state with your agency coordinator using the full street address. See our CNA reciprocity guide for the full multi-state transfer process.