CNA in Texas 2026: Training, Certification, Salary, and Requirements
Texas requires 100 hours of CNA training via HHSC. Learn Prometric exam steps, HHSC registry, salary by city, and how to get certified in Texas.
Texas Key Facts and Figures
Texas Important Details
Texas Title 26 Administrative Code §97.285 requires a minimum of 100 hours of training from an HHSC-approved program. The curriculum covers basic nursing skills, safety/emergency procedures, infection control, resident rights, mental health, and personal care. Programs must be approved by HHSC before graduates can sit for the Prometric competency exam. Community colleges, vocational schools, nursing homes, and hospital systems operate HHSC-approved programs throughout the state.
- Classroom Instruction: 75 hours minimum
- Clinical Training: 24 hours supervised
- Skills Demonstration: 1 hour
- Total Required: 100 hours (federal minimum)
Texas uses Prometric to administer the two-part CNA competency exam. The written knowledge test consists of 70 multiple-choice questions with a 90-minute time limit — you need at least 49 correct answers (70%) to pass. The clinical skills evaluation tests 5 randomly selected skills from the HHSC skills list in approximately 30 minutes. Candidates have up to 3 attempts to pass each component within 12 months of program completion.
- Written Exam: 70 questions, 90 minutes
- Skills Evaluation: 5 randomly selected skills
- Passing Score: 70% written; all skills passed
- Exam Fee: $101 (written + skills)
All Texas CNA candidates must undergo a fingerprint-based criminal background check through the Texas Department of Public Safety (DPS). HHSC also cross-references the Employee Misconduct Registry and the OIG Exclusion List. Any substantiated finding of abuse, neglect, or exploitation of a resident results in a permanent bar from the HHSC Nurse Aide Registry. Many employers run independent background checks in addition to the HHSC process.
- Agency: Texas DPS (fingerprint-based)
- OIG Check: Nurse Aide Abuse Registry
- Cost: $40–$60 DPS processing
- Disqualifiers: Abuse, neglect, exploitation convictions
Unlike most states where nursing boards manage nurse aide registries, Texas delegates registry management to the Health and Human Services Commission (HHSC). This distinction matters for out-of-state CNAs seeking reciprocity — they must contact HHSC directly, not the Texas Board of Nursing. The registry is searchable online at hhs.texas.gov and lists certification status, any findings of abuse or neglect, and renewal dates. Employers in Texas are legally required to verify registry status before hiring any CNA.
- Registry Manager: HHSC (not TX BON)
- Verification: hhs.texas.gov online lookup
- Renewal Cycle: Every 2 years
- In-Service Hours: 12 hours per renewal
Texas Detailed Breakdown
Houston and the Gulf Coast represent the largest CNA job market in Texas, anchored by the Texas Medical Center — the world's largest medical complex, with over 60 institutions. Major employers including HCA Healthcare (the largest private hospital operator in Texas), Memorial Hermann, and Houston Methodist all hire CNAs directly and many offer free CNA classes through sponsored workforce programs. San Jacinto College, Houston Community College, and Lone Star College run HHSC-approved programs ranging from $800–$2,000. Program schedules vary from intensive 3-week daytime tracks to 8-week evening programs. The Greater Houston area has over 200 skilled nursing facilities, creating consistent demand. Travel CNA to RN bridge programs are available at University of Houston and HBU.
Texas Costs and Pricing
Texas Step-by-Step Process
Find an HHSC-Approved Program
Meet Program Prerequisites
Complete 100-Hour Training
Register with Prometric
Pass the Prometric CNA Exam
HHSC Registry Placement
Begin Employment
Texas Essential Checklist
Texas CNA Reciprocity: HHSC Endorsement Process
Texas accepts out-of-state CNA certifications through an endorsement process managed by HHSC — not the Texas Board of Nursing. This distinction trips up many applicants. To transfer your CNA certification to Texas:
- Verify your current certification is active and in good standing (no abuse/neglect findings) in your home state's registry.
- Contact HHSC Nurse Aide Registry at (512) 438-2633 or email the registry unit. Request a reciprocity application packet.
- Submit required documentation: completed application form, verification letter from your current state's registry (must be sent directly from state to HHSC), copy of your certification, and a $10 application fee.
- Pass the DPS background check — required for all applicants regardless of out-of-state clearances.
- Wait for processing: HHSC typically processes endorsement applications in 4–6 weeks. No additional training or testing is required if your home state's training met the 75-hour federal minimum.
Texas does not require additional hours of training for CNAs certified in states that met the 75-hour federal minimum — which includes all 50 states. This makes Texas one of the more CNA-friendly reciprocity states. For a full breakdown of state-by-state transfer requirements, see our CNA reciprocity guide.
Texas Advantages and Disadvantages
- +No state income tax in Texas — take-home pay is higher than states with income tax at the same gross wage
- +Low cost of living relative to other large states — San Antonio and Fort Worth are especially affordable
- +Massive job market with over 100,000 CNA positions and consistent demand from aging population
- +Texas Medical Center in Houston is the world's largest medical complex — unmatched clinical career opportunities
- +HHSC reciprocity is straightforward — no additional training required for standard out-of-state certifications
- +VA facilities in San Antonio, Houston, Dallas, and Temple offer federal pay scale and exceptional benefits
- +Travel CNA market is strong — Texas assignments consistently pay $22–$30/hour with housing stipends
- +100-hour training is the federal minimum — faster and cheaper entry-to-career than many other states
- −CNA wages ($28K–$36K/yr) are below the national average and significantly below California or New York
- −Texas summers (100°F+) make outdoor transit to multiple home health clients physically demanding
- −Texas has not expanded Medicaid under the ACA — many patients lack coverage, affecting facility budgets
- −Staffing ratios in Texas SNFs can be challenging — 1:12 or higher during nights and weekends
- −Rural Texas has significant healthcare access gaps — CNA positions exist but support services are limited
- −No state-mandated nurse aide minimum staffing ratios, leaving working conditions more variable than states like California
- −Limited union presence outside of a few hospital systems — wages more dependent on individual negotiation
- −Renewal requires documented employment hours — inactive CNAs must retrain if registry lapses beyond 24 months
Why Texas CNA Demand Stays High
Texas has the second-largest population of any state and a disproportionately fast-growing senior demographic. The U.S. Census Bureau projects Texas's 65+ population will double between 2020 and 2040 — adding over 2 million elderly residents who will require skilled nursing, memory care, and home health services. This demographic shift creates a structural demand floor for CNA careers that persists regardless of economic cycles.
Unlike California or New York, Texas chose to meet the federal minimum 100-hour training requirement rather than exceed it. This means faster entry into the workforce and lower training costs — the average Texas CNA can complete training and pass the CNA practice test exam in under 8 weeks, compared to 12–18 weeks in California's 160-hour system. For candidates who need to begin earning quickly, Texas's streamlined pathway is a meaningful advantage.
The HHSC registry system means all employer verification goes through a single state database — making Texas CNA verification faster than states with fragmented systems. Employers verify status at hhs.texas.gov within seconds. For working as a CNA in multiple settings through a staffing agency, this centralized verification speeds placement. Texas also allows CNAs from other states to begin work during the HHSC endorsement process if they can show active out-of-state certification and a pending application — check with individual employers for their policy.
Texas's healthcare employer landscape is dominated by large systems. HCA Healthcare operates more than 60 hospitals and surgical sites across Texas, making it the single largest private-sector CNA employer in the state. Baylor Scott & White Health is the largest not-for-profit system in Texas with 51 hospitals. Both systems have active workforce development programs that fund free CNA classes in exchange for employment commitments. Encompass Health runs Texas's largest network of inpatient rehabilitation facilities — a specialized CNA role that typically pays $1–$3/hour above standard SNF rates.
For CNAs interested in career advancement, Texas has strong pathways. The CNA to RN track is accessible through Texas's extensive community college system — Austin Community College, San Jacinto College, El Centro College, and dozens more. Many programs provide priority admission to applicants with active CNA certification and clinical experience. State scholarships through the Texas Higher Education Coordinating Board (THECB) provide up to $5,000 annually for nursing students — and most CNA-to-RN bridge students qualify. The CNA scholarships guide has full details on Texas workforce development funding.
About the Author
Registered Nurse & Healthcare Educator
Johns Hopkins University School of NursingDr. Sarah Mitchell is a board-certified registered nurse with over 15 years of clinical and academic experience. She completed her PhD in Nursing Science at Johns Hopkins University and has taught NCLEX preparation and clinical skills courses for nursing students across the United States. Her research focuses on evidence-based exam preparation strategies for healthcare certification candidates.