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.
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.
| Pros | Cons |
|---|---|
| D&S Diversified exam (same vendor as Kansas, Georgia, Arizona) — extensive national prep resources available | DHSS manages the registry (not the Board of Nursing) — candidates must know the correct agency for inquiries |
| BJC HealthCare and Mercy offer some of the Midwest's best CNA wages, benefits, and career advancement | KC metro cross-border licensing adds complexity — dual MO/KS certification requires extra steps and fees |
| Two major metro markets (St. Louis and Kansas City) provide diverse employment options and specialties | D&S Diversified exam (not Prometric) — verify practice resources specifically match the D&S NNAAP format before studying |
| DHSS registry is straightforward to navigate online — status checks, lookups, and renewal are web-accessible | Missouri Employee Disqualification List (EDL) blocks many candidates with prior healthcare violations |
| KC metro dual MO/KS certification is achievable and dramatically expands job placement options | Limited public transportation in many Missouri cities — CNAs may need reliable personal transportation |
Try these questions from our free CNA practice tests. The correct answer and an explanation follow each question.
A CNA is working in a state where, with additional certification and under specific circumstances, they are permitted to perform certain advanced tasks. Which of these tasks would most likely require this type of special certification?
Answer: B. Discontinuing a resident's indwelling urinary catheter.
While specific regulations vary by state, discontinuing (removing) an indwelling urinary catheter is an invasive procedure that is generally outside the standard CNA scope. Some states or facilities may allow a specially trained CNA to perform this task. The other tasks, such as assisting with inhalers (but not administering the medication independently), performing restorative exercises, and documenting I&O, are more commonly within the standard CNA role.
A CNA's certification in Florida became null and void 3 years ago after they failed to meet renewal requirements. To regain active status, what must the individual do?
Answer: D. Reapply for licensure and meet all current initial application requirements.
According to the Florida Board of Nursing, once a CNA license becomes 'Null and Void,' it cannot be reactivated or renewed. The individual must start the process over by reapplying for licensure and complying with all laws and rules that are current at the time of the new application.
Which of the following observations about a resident's stool should be reported to the nurse immediately?
Answer: B. Small, dark, tarry stool with a foul odor
Dark, tarry (melena) stool suggests upper GI bleeding and requires immediate nurse notification.
A resident with moderate dementia is resistant to eating meals. Which intervention should the CNA try FIRST?
Answer: B. Offer finger foods that the resident can eat independently
Finger foods promote independence and may be more acceptable to residents who resist being fed or using utensils.
Take the full CNA practice test
Many readers pair this guide with the cna test practice to check their readiness before exam day.
Many readers pair this guide with the cna practice test pdf to check their readiness before exam day.