Texas requires 100 hours of CNA training — the federal minimum — split into 75 hours of classroom instruction, 24 hours of supervised clinical practice, and 1 hour dedicated to a skills demonstration. The Texas Health and Human Services Commission (HHSC) administers the state's nurse aide registry, making Texas one of a handful of states where the registry is managed outside the Board of Nursing. CNA certification exams in Texas are administered by Prometric. With over 100,000 working CNAs across its 254 counties and a rapidly aging population driving demand, Texas offers strong job stability for certified nursing assistants despite median wages of $28,000–$36,000 that sit below the national average.
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.
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.
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.
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.
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.
The Dallas–Fort Worth Metroplex is Texas's second-largest CNA market and the fastest-growing. Baylor Scott & White (the largest not-for-profit health system in Texas), Texas Health Resources, and Methodist Health System all sponsor CNA CNA training programs for prospective employees. Dallas College, Tarrant County College, and the University of North Texas at Dallas offer community college-based programs for $900–$2,200. Fort Worth job seekers will find strong demand in Encompass Health rehabilitation facilities, with starting wages of $14–$17/hour. DFW's explosive population growth has created a persistent CNA shortage, meaning qualified candidates often receive hiring bonuses of $500–$1,500. The CNA scholarships through Workforce Solutions Greater Dallas cover full tuition for income-qualifying applicants.
San Antonio has the highest concentration of military-affiliated healthcare in Texas, with Brooke Army Medical Center and SAMMC employing CNAs who hold civilian contractor positions. University Health (Bexar County's safety-net system) and Baptist Health System are the largest CNA employers. San Antonio College and St. Philip's College offer HHSC-approved programs with some of the lowest tuition in the state ($700–$1,500). San Antonio's large military retiree population creates particularly high demand in memory care and geriatric settings. The Hill Country region around Kerrville, Boerne, and Fredericksburg has significant elder care facilities due to its retirement community concentration — but fewer programs, meaning San Antonio is typically the training hub. VA facilities in San Antonio also employ CNAs through USAJOBS listings at competitive federal pay scales of $17–$21/hour.
Austin is Texas's fastest-growing major city, and healthcare demand has not kept pace with population growth — creating significant CNA shortages. Ascension Seton and St. David's HealthCare are the dominant hospital systems. Austin Community College runs a highly regarded HHSC-approved CNA program ($1,100–$1,400) with flexible scheduling. Round Rock, Cedar Park, and Pflugerville are suburban growth areas with newer skilled nursing facilities and home health agencies actively recruiting. Austin's tech-economy cost of living is now among the highest in Texas, which puts pressure on CNA wages — many experienced CNAs in Austin have shifted to private duty cna and home health roles where $18–$22/hour is achievable. Seton and St. David's both offer employer-sponsored free CNA classes programs tied to 12-month employment contracts.
El Paso is the largest city on the Texas–Mexico border, with a predominantly Spanish-speaking patient population. Bilingual (English/Spanish) CNAs are in especially high demand and can command a $1–$2/hour premium. El Paso Community College (EPCC) runs one of the most accessible HHSC-approved CNA programs in West Texas ($600–$1,000). University Medical Center and The Hospitals of Providence (HCA) are the primary CNA employers. El Paso's proximity to the border means some candidates complete CNA training on the New Mexico or Mexican side — only HHSC-approved Texas programs or endorsed out-of-state certifications qualify for the Texas registry. West Texas outside El Paso (Lubbock, Midland, Odessa, Amarillo) has significant healthcare access gaps, and CNA positions in those markets often pay $1–$3/hour above Dallas or Houston rates to attract workers to lower-cost but more isolated locations.
Visit hhs.texas.gov to search the official list of HHSC-approved CNA training programs in your county. Texas has hundreds of approved programs statewide — community colleges, career schools, and hospital-sponsored options. Verify the program appears on the current approved list before enrolling.
Complete a TB test (within 12 months), physical examination, hepatitis B vaccination series (or signed declination), and CPR/BLS certification. Begin your DPS background check early — processing can take 2–3 weeks and is required before clinical rotations at most facilities.
Attend your HHSC-approved program: 75 hours of classroom instruction covering nursing skills, anatomy basics, infection control, resident rights, and communication, plus 24 hours of supervised clinical practice at an approved long-term care facility, plus a 1-hour skills demonstration.
Your training program submits your completion record to HHSC, which authorizes your Prometric exam. Register at prometric.com/cna for your Texas exam. The combined fee is $101 for both the written test and clinical skills evaluation. Schedule your exam as soon as authorized — popular testing centers in Houston and DFW book up 2–3 weeks in advance.
Take the 70-question written knowledge exam (90 minutes, 70% passing score) and the clinical skills evaluation (5 randomly selected skills). Both parts must be passed to receive Texas CNA certification. If you fail one part, you can retake just that component within 12 months of program completion.
After passing both exam components, Prometric notifies HHSC and your name is added to the Texas Nurse Aide Registry within 2–3 weeks. You will receive a certification card by mail. Registry status can be verified online at hhs.texas.gov. Some employers allow you to begin work once you have written exam passage confirmation.
Apply to Texas hospitals, SNFs, home health agencies, VA facilities, or staffing companies. Most Texas employers verify HHSC registry status before your first shift. Having your registry ID number ready speeds the hiring process. Renewal is due every 2 years with proof of 8 hours of paid employment as a CNA and 12 hours of in-service training.
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:
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 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 2026 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.