CNA Requirements in Missouri
Step-by-step guide to becoming a Certified Nursing Assistant in Missouri: the training, exam, background check, and timeline you need to plan for.
Find Missouri CNA Training ProgramsMissouri CNA Requirements at a Glance
Minimum Age
16
Training Hours
175 hours minimum (well above the federal 75)
(Federal minimum: 75)
Time to Certification
8-14 weeks (175-hour program completion plus 7-10 business days for TMU processing after exams pass)
Exam Vendor
D&SDT-Headmaster (TMU)
Becoming a CNA in Missouri
Missouri's CNA pathway is regulated by the Department of Health and Senior Services (DHSS) Section for Long Term Care Regulation, which approves every nurse aide training program and maintains the official CNA, CMT, and Insulin Registry. Unlike most states that mirror the federal 75-hour OBRA minimum, Missouri requires 175 total hours of training - 75 classroom hours and 100 hours of supervised on-the-job clinical practice in a licensed nursing facility - making it one of the most rigorous CNA pathways in the country.
The state contracts with D&SDT-Headmaster (Diversified & Standardized Test Master) to deliver the two-part certification exam through the Missouri TMU portal at mo.tmutest.com, rather than using the more common NNAAP exam administered by Credentia. The state-specific test was designed to align directly with Missouri's expanded 175-hour curriculum and includes both a written/oral knowledge component and a hands-on skills practicum scored by a Headmaster evaluator.
CNAs in Missouri serve as essential caregivers in skilled nursing facilities, residential care facilities, assisted living, ICF/IID settings, and home health agencies. With the state's aging population and a chronic shortage of long-term-care workers, many Missouri employers - especially nursing-home corporations participating in the Medicaid CNA training reimbursement program - cover the full cost of the 175-hour course and the Headmaster exam fee in exchange for a short post-certification work commitment.
Detailed Missouri CNA Requirements
Regulatory Body
Missouri Department of Health and Senior Services (DHSS) - Section for Long Term Care Regulation
Minimum Age
You must be at least 16 years old to begin CNA training in Missouri.
Education Requirement
No statewide high school diploma or GED requirement, but candidates must be able to read, write, and follow instructions in English; individual programs may set additional requirements.
Training Hours
175 hours minimum (well above the federal 75) required.
75 hours classroom + 100 hours on-the-job clinical training at an approved nursing facility
Background Check
Family Care Safety Registry (FCSR) background screening plus Employee Disqualification List (EDL) check are required before clinical placement
Competency Exam
Administered by D&SDT-Headmaster (TMU). Two-part Missouri CNA exam: a written (or oral) knowledge test plus a hands-on skills practicum, both administered by D&SDT-Headmaster through the TMU portal at mo.tmutest.com
Cost: $125 total ($95 written + $30 skills)
Application Fee
Included in the Headmaster testing fee; the state DHSS does not charge a separate initial application fee
Total Cost Estimate
$700-$1,500 depending on whether the candidate uses a free employer-sponsored program or a paid community college / private school
Where You Can Work
Skilled nursing facilities, residential care facilities (RCFs), assisted living facilities (ALFs), Intermediate Care Facilities for the Intellectually Disabled (ICF/IID), home health agencies and hospitals throughout Missouri
What's Different About Missouri
Missouri requires 175 total training hours (one of the highest CNA requirements in the country) and is one of the few states that runs its own state-specific competency exam through D&SDT-Headmaster instead of the NNAAP.
How to Become a CNA in Missouri: Step by Step
Confirm eligibility with DHSS
Verify you are at least 16 years old, can read and write in English, and have no disqualifying findings on the Missouri Family Care Safety Registry or Employee Disqualification List. The Missouri Department of Health and Senior Services posts current eligibility rules at health.mo.gov/safety/cnaregistry and lists disqualifying offenses under 19 CSR 30-84.
Enroll in a DHSS-approved 175-hour CNA program
Choose a program approved by the DHSS Section for Long Term Care Regulation. The curriculum must include 75 hours of classroom and lab instruction plus 100 hours of supervised on-the-job training in a Missouri nursing facility. Many high school career centers, community colleges, hospital systems, and nursing-home employers run free or low-cost programs because Medicaid reimburses CNA training for new hires.
Complete the full 75/100 hour curriculum within one year
Missouri requires you to finish the program and take the certification exam within 12 months of the program start date or you must retake the entire 175 hours. Topics include resident rights, infection control, vital signs, restorative care, mental health, communication, dementia care and the specific skills listed in the Headmaster Missouri Skills Manual.
Register for the Headmaster exam through TMU
Create an account at mo.tmutest.com (the Missouri TMU portal operated by D&SDT-Headmaster) and submit your training completion documentation. Pay the $125 testing fee (approximately $95 for the knowledge test and $30 for the skills evaluation) and select a regional test site.
Pass the written and skills exam
Take the Missouri-specific written test (or the oral version if requested for reading accommodations) covering basic nursing skills, resident rights, and infection control. The skills portion requires you to demonstrate randomly selected hands-on tasks for a Headmaster evaluator. Scores are typically posted to TMU within 24 hours.
Get added to the Missouri CNA Registry
Once both portions are passed, D&SDT-Headmaster reports your results to DHSS and your name is added to the Missouri CNA, CMT and Insulin Registry within 7-10 business days. Employers can then verify your active status through the public TMU search before hiring.
Maintain certification every 24 months
To stay active, you must perform at least 8 hours of paid nursing or nursing-related services in each 24-month period and submit a renewal with documentation (paystubs, W-2, or employer letter) plus a small renewal fee through TMU. Long-term care employers must also provide 12 hours of in-service education annually.
Frequently Asked Questions
Why does Missouri require 175 training hours instead of the federal 75-hour minimum?
Missouri's 175-hour requirement is set in state regulation 19 CSR 30-84 by the Department of Health and Senior Services. The DHSS expanded beyond the federal OBRA 75-hour floor specifically to add 100 hours of on-the-job clinical training in a real nursing facility, which the state determined was necessary for resident safety in long-term care. Even though the federal minimum is 75 hours, Missouri facilities cannot legally employ a CNA who completed only a 75-hour program from another state without first verifying reciprocity through DHSS.
How much does the Missouri CNA exam cost through D&SDT-Headmaster?
The Missouri TMU testing fee is approximately $125 total - around $95 for the written (or oral) knowledge exam and $30 for the skills evaluation - paid directly to D&SDT-Headmaster through mo.tmutest.com when you register. Some employer-sponsored programs pay this fee on the candidate's behalf, and confirmation of the current fee should be checked at mo.tmutest.com before registering.
Can I transfer my out-of-state CNA license to Missouri?
Yes. Missouri offers free reciprocity for CNAs in good standing from other state registries. You apply through the TMU portal and submit a copy of your out-of-state certificate, proof of identity, and documentation of at least 8 hours of paid nursing-related work in the prior 24 months. Alabama applicants must additionally submit 8-hour work proof. DHSS typically processes the reciprocity request within 7-10 business days and adds you to the Missouri CNA Registry without requiring you to retake the Headmaster exam.
How long do I have to take the Headmaster exam after finishing training?
Missouri requires you to complete the certification exam within one year of the start date of your DHSS-approved training program. If you exceed the 12-month window, you must retake the entire 175-hour course before you can sit for the Headmaster written and skills tests. Most candidates schedule the exam through mo.tmutest.com within a few weeks of finishing class to keep the material fresh.
How do I keep my Missouri CNA certification active?
Renewal in Missouri is every 24 months. You must document at least 8 hours of paid nursing or nursing-related services within the 24-month cycle and submit pay stubs, a W-2, or a signed employer letter through the TMU portal, along with the renewal fee. CNAs employed in long-term care facilities are also required to complete 12 hours of in-service continuing education each year provided by their employer.
Can I take Missouri CNA training fully online?
No. Missouri does not allow fully online CNA certification programs because the state requires 100 hours of hands-on, on-the-job clinical training inside a licensed nursing facility under instructor supervision. Some DHSS-approved programs offer hybrid formats where lecture content is delivered online, but all skills lab work and clinical hours must be completed in person to count toward the 175-hour total.
Free Study Materials for the Missouri CNA Exam
The D&SDT-Headmaster (TMU) exam used by the Missouri Department of Health and Senior Services (DHSS) - Section for Long Term Care Regulation tests both knowledge and hands-on skills. Use these free study guides to prepare for the topics most commonly tested in Missouri:
Infection Control
Standard precautions, PPE, hand hygiene, transmission-based precautions, and biohazard handling for the Missouri CNA exam.
Basic Nursing Skills
Vital signs, intake/output, positioning, transfers, and range of motion — the largest block on the D&SDT-Headmaster (TMU) skills test.
Personal Care & Elimination
Bathing, peri-care, oral care, toileting, and incontinence management — heavily tested D&SDT-Headmaster (TMU) skills in Missouri.
Safety & Emergencies
RACE/PASS fire safety, fall prevention, choking, CPR, and seizure care — required knowledge for Missouri CNA candidates.
Communication Skills
SBAR handoff, therapeutic communication, and adaptations for hearing, vision, and dementia residents — tested throughout the D&SDT-Headmaster (TMU) exam.
Patient Rights
OBRA '87 resident rights, HIPAA, advance directives, and freedom from restraints — graded on every Missouri CNA practical exam skill.
Data Collection & Reporting
Objective vs subjective data, pain scales, what to report immediately, and documentation rules used on the Missouri exam.
Body Systems & Conditions
Cardiovascular, respiratory, nervous, and endocrine basics, plus pressure-injury staging — frequently tested on the Missouri written exam.
End-of-Life Care
Hospice vs palliative care, Kübler-Ross stages, and postmortem care for Missouri CNAs working in long-term care.
Mental Health & Dementia
Delirium vs dementia, sundowning, validation therapy, and de-escalation — frequently tested on the D&SDT-Headmaster (TMU) written exam in Missouri.
Legal & Ethical Issues
Scope of practice, the four elements of negligence, mandatory reporting, and ethical principles every Missouri CNA must know before working.
Test yourself for the Missouri CNA exam
Free D&SDT-Headmaster (TMU) Practice Tests
The D&SDT-Headmaster (TMU) written exam used in Missouri has 60 scored multiple-choice questions. Drill our free NNAAP-style practice tests until you can consistently score above 80%, then walk into the testing center confident.
Ready to Start Your Missouri CNA Career?
Find approved training programs, free study materials, and license verification tools for Missouri.