Key Points
- Federal baseline remains 75 total training hours, including 16 clinical hours.
- Illinois Senate Bill 3766 lets assisted living centers host CNA clinicals.
- No state fully approves online CNA training without in-person clinical hours.
CNA Training Requirements by State: What's Changing for 2026
Compare hours, clinicals, and new 2026 laws by state so you can pick the right CNA program.
Illinois Senate Bill 3766, signed into law, allows assisted living and supportive living facilities to host CNA clinical training starting January 1, 2026. That change expands training options beyond traditional nursing homes and hospitals.
Federal rules set a floor of 75 total hours, including 16 clinical hours, but states routinely require more and decide where clinicals may occur. Those differences affect CNA programs, including length, cost, online allowances, reciprocity, and CNA salary by state. A CNA credential is only as portable as the state rules behind it.
Federal Minimums Vs. State-Specific CNA Training Rules
Federal rules set a floor, not a ceiling. Since 1987, approved nursing assistant programs must provide at least 75 hours of total training: a baseline for how many hours is cna training. At minimum, 16 of those hours are supervised clinical work in a patient-care setting, not classroom time. The intent is to protect residents, but it was never meant to be a universal cap.
States can and often do go higher. Many states require 80 to 180 total hours or more, according to cna training hours by state, frequently raising the clinical portion above the federal 16-hour minimum. For example, California approved programs commonly require around 150 hours, including a substantial clinical block, while Texas sets a 100-hour total with dedicated hands-on clinical training. Some states also specify how many hours must be direct patient care versus CNA skills lab, and a few allow online theory hours while keeping clinical hours in person.
That variation is the key takeaway. Your program length, clinical placement, exam eligibility, and even future CNA endorsement requirements by state depend on where you plan to be certified. A school in a neighboring state may look similar but meet a different hour threshold. State nursing boards update these minimums, so requirements can shift between enrollment and graduation. Before you enroll, check the current rules for your specific state rather than relying on a national summary.
2026 Legislative Updates: New Laws Affecting CNA Training
Which new state laws are actually changing CNA certification requirements in 2026, and how will they affect where you complete clinical hours?
Illinois: Assisted living and supportive living clinicals
Illinois Senate Bill 3766, known as the Belt Law, was signed in 2026 and takes effect January 1.1 It changes where CNA students can complete the supervised clinical portion of their CNA training program. Previously, clinical training was tied more closely to skilled nursing settings. Under SB 3766, assisted living and supportive living facilities can host those supervised clinical experiences if they meet Illinois Department of Public Health rules and resident acuity requirements. Programs can also use an approved affiliation agreement with a licensed skilled nursing or intermediate care facility.
If you live near an assisted living community, you may no longer need to commute to a skilled nursing facility for clinicals. The law also requires the Illinois Health Care Worker Registry to identify where an individual completed clinical training. For students, that means employers can quickly verify your hands-on training site, which may help reduce time to hire.
Illinois total training hours remain 75 total with 16 clinical hours4, so SB 3766 expands training site options without changing the hour floor.
Massachusetts: A new curriculum framework
Massachusetts is taking a different approach. The Department of Public Health announced a new CNA Curriculum Framework raising the minimum from 75 hours to 87 total hours, including 21 hours of supervised practical training.2 The exact effective date within 2026 is not yet published, so check with your program before enrolling.
A federal shift, not a state statute
At the federal level, a 2026 CMS memo expands approved training locations to include hospitals and vocational settings.3 That federal flexibility keeps the national minimum at 75 total hours and 16 supervised practical hours, but it gives states another opening to approve non-nursing-home sites. Beyond Illinois and Massachusetts, no other 2026 state statutes altering CNA hours or clinical sites are established in available research.
Nursing assistant employment is projected to grow 2.3% from 2024 to 2034, adding 204,100 jobs, according to the Bureau of Labor Statistics. That growth is slower than the all-occupation average, but it still means steady demand in long-term care.
State-By-State CNA Training Hours and Clinical Requirements
State CNA training hour minimums are the total classroom and supervised clinical hours you must finish before you can schedule the CNA skills exam. The federal baseline is 75 total hours with at least 16 clinical hours, but many states raise that floor considerably, as documented in the Nurse Aide Training Requirements summary.
Federal Baseline vs. Higher State Bars
A state can require more hours than the federal minimum, and many do. Because secondary compilations conflict and only a few states have clear official figures, treat the sample below as published summaries and confirm with your state's nurse aide registry before enrolling.
Representative State Minimums
- Alabama: 75 total (16 clinical)
- Alaska: 140 total (80 clinical)
- California: 150 total (100 clinical)
- Florida: 120 total (40 clinical)
- Illinois: 120 total (40 clinical)
- Maine: 180 total (70 clinical)
- Missouri: 175 total (100 clinical)
- New Jersey: 90 total (50 classroom, 40 clinical)1
- Oregon: 155 total (75 clinical)
- Pennsylvania: 80 total (37.5 clinical)
- Texas: 100 total (40 clinical)
- Virginia: 120 total (40 clinical)
- Washington: 85 total (50 clinical)
- Massachusetts: 87 total (21 clinical) 2026 increase2
Highest, Lowest, and 2026 Changes
Maine and Missouri have the highest totals here at 180 and 175 hours; Alabama sits at the federal floor of 75. Massachusetts is increasing its minimum to 87 total hours with 21 clinical hours under its new curriculum framework.2 Illinois' 2026 law does not change hour totals, but it expands where clinical hours can be completed, including assisted living and supportive living settings.
CNA Program Admission Prerequisites and Eligibility by State
Two applicants can meet CNA training requirements very differently: a 16-year-old in Connecticut exploring CNA training for high school students may need a parent or guardian waiver for clinicals, while a career changer in Indiana can enter a 105-hour training route without a state minimum age or diploma requirement.
Common Baseline
Most CNA programs ask for age 16 to 18, a high school diploma or GED (often program-level rather than state law), ability to read and write English, and clinical clearance.1 Background checks are required in most states, though offenses are evaluated case by case under CNA background check requirements.1 Reading and math placement tests may appear in place of a diploma or GED at some schools.
State-Specific Twists
- Indiana: No age or education requirement for the training-program route; you need 105 hours.2
- Connecticut: Age 16 by class start; under-18 clinicals often require parent or guardian waiver; COVID-19 vaccine may be listed.3
- Alabama: High school diploma or GED, TB skin test, hepatitis B, and CPR before clinicals are common.4
- Maryland: Some nursing entry routes ask for first-semester coursework from an approved program.4
Health and Clearance
Immunizations often include TB, MMR, varicella, hepatitis B, Tdap, and sometimes COVID-19.1 A physical exam, CNA drug screen, and CPR/BLS may also be required before clinicals. Because exact training hours, exam providers, background-check rules, and renewal differ by state, confirm with your state nurse aide registry.
Before enrolling, treat the program checklist as a minimum, not a guarantee. A state registry may set stricter standards, and individual schools can add their own health or placement requirements. If you are missing a document, ask the program coordinator whether a reading test, official transcript, or waiver can substitute.
CNA Training Costs: Tuition, Fees, and Exam Fees by State
CNA training costs vary widely by state and provider. Community colleges and Red Cross programs generally fall between $500 and $2,000, while private schools can run higher. Exam fees and add-on costs such as books, uniforms, background checks, and health screenings can add several hundred dollars, and many employers offer free or low-cost training in exchange for a work commitment.
| State | Program Cost Range | Exam Fee | Notes |
|---|---|---|---|
| Alabama | Tuition typically $500 to $1,500; total program costs often $700 to $2,500 or more depending on provider | Prometric $40 written/oral plus $45 clinical skills; NNAAP $55 written/oral plus $80 skills | No state application fee; some approved nursing homes offer free training |
| Alaska | Often $1,000 to $2,000 or more depending on provider | Credentia NNAAP exam $260 to $335 total depending on test combination | Employer tuition assistance may be available; total testing and related fees can range from $20 to $310 |
| Arkansas | One program lists $800 for 90 hours in person; total program cost $1,126 including fees | $90 skills exam; $30 knowledge exam; $10 extra if proctor reads the exam | Exams are administered by a third party and paid directly to that party |
| Arizona | Typically $500 to $1,500; one provider lists $2,050 total | Board of Nursing licensure exam fee $130 | Costs vary among community colleges, private schools, and employer sponsored options; some facilities offset tuition for work commitments |
| California | Sample community college program $1,465 for one semester of nurse aide coursework | Typically $115 to $200 or more depending on written and skills portions | Additional costs may include uniforms, background checks, and health clearances; some employers offer low-cost or free training |
| Colorado | Roughly $500 to $1,500 depending on provider | Typically $100 to $200 combined | Community colleges may be lower; private vocational schools higher; employer sponsored programs can reduce out-of-pocket costs |
| Connecticut | Commonly $600 to $1,500 depending on provider | $118 for both written and skills parts | Exam price applies when both sections are taken together |
| Delaware | Typically $500 to $1,500 | $30 application or processing fee plus exam charges | $30 fee is in addition to training and exam costs |
| District of Columbia | Roughly $600 to $1,500 depending on school | $15 application processing fee plus separate exam fees | Modest $15 fee tied to application or certification processing |
| Florida | Tuition $550 to $1,100; supplies about $100 or more; TB/physical about $150; total approximately $800 to $1,350 | Typically $130 to $180, often covering written and skills | Technical colleges may be lower cost; long-term care employers may sponsor training in exchange for employment |
| Georgia | Often $500 to $1,000 depending on provider | Typically $100 to $200 combined | Employer sponsored or low-cost programs may reduce or waive tuition for post-training employment |
| Hawaii | Often $1,000 to $2,000 or more depending on institution | $216 combined exam; $25 mail-only processing fee | Applicants apply by mail with $25 fee in addition to exam charges |
| Idaho | Typically $500 to $1,200 | Typically $100 to $200 combined | Community college programs may be lower cost; some healthcare employers sponsor students |
| Illinois | Tuition $500 to $900; supplies about $120; exam fee $120; total approximately $740 to $1,140 | Typical exam fee about $120; $25 state fee also applies | Illinois candidates pay a $25 state fee in addition to exam charges |
| Indiana | Generally $500 to $1,000 depending on school type | $65 state application/certification fee plus exam charges | Exam providers may add separate testing charges |
| Iowa | Typically $500 to $900 depending on provider | Typically $100 to $200 combined | Reduced-cost programs may be available; potential reimbursement if hired by Medicare-certified facilities |
| Kansas | Typically $500 to $1,000; Salina Area Technical College program $946 | $20 processing fee plus testing charges | Applicants pay a $20 processing fee; exam providers charge additional fees |
| Kentucky | Typically $500 to $1,000 | Typically $100 to $200 combined | Technical schools and long-term care facilities may offer training; some employers offset costs |
| Louisiana | Typically $500 to $1,000 | $125 combined exam; $35 state fee also applies | Candidates pay $35 state fee on top of the $125 combined exam cost |
| Maine | Typically $600 to $1,200 | Typically $100 to $200 combined | Some healthcare employers offer subsidized training in exchange for work commitments |
| Maryland | Generally $600 to $1,300 depending on school | $20 application fee plus fingerprint fees and exam charges | Separate fingerprinting charges apply in addition to training and exam costs |
| Massachusetts | Typically $700 to $1,500 depending on provider | Typically $100 to $200 combined | Private schools may charge more; some employers offer tuition assistance or reimbursement |
| Michigan | Tuition $650 to $1,300; TB/health clearance about $150; CPR about $60; total approximately $860 to $1,510 | $20 state list fee plus testing charges | Additional health screening and CPR costs apply; some long-term care employers offer free or low-cost training |
| Minnesota | Generally $600 to $1,200 depending on provider | Typically $100 to $200 combined | Some employers provide reduced-cost or free training in exchange for post-training employment |
| Mississippi | Often $500 to $900 | $26 application/processing fee plus exam costs | $26 fee is in addition to exam and training costs |
| Missouri | Commonly $500 to $1,000 depending on provider | Variable depending on testing provider | Exam fees are not fixed and application-related costs may also apply |
| Montana | Generally $600 to $1,200 | Typically $100 to $200 combined | Candidates may have access to employer sponsored or reimbursed training |
| Nebraska | Usually $500 to $1,000 depending on provider | $20 online abuse class fee plus exam/testing charges | Pay $20 for an online abuse class as part of certification requirements |
| Nevada | Typically $700 to $1,500 depending on school | $50 application fee plus $51.25 fingerprinting plus exam charges | Application and fingerprint fees are additional to exam charges |
| New Hampshire | Often $600 to $1,200 | $82 certification-related fee plus exam and tuition costs | $82 fee is related to certification |
| New Jersey | Typically $700 to $1,500 depending on provider | $30 state fee plus exam fees | Applicants must call a specified number to complete their application |
| New Mexico | Generally $500 to $1,000 | Typically $100 to $200 combined | Some healthcare employers and workforce programs offer funding assistance |
| New York | Tuition $600 to $1,700; uniforms about $80; CPR about $50; background checks about $75; total approximately $900 to $2,100 | Typically $125 to $190 depending on vendor; $50 state fee also applies | Some employers and unions offer subsidized or free programs |
| North Carolina | Typically $500 to $1,000 depending on provider | $120 exam/application fee | Some community colleges and employers offer low-cost training |
| North Dakota | Generally $600 to $1,200 | Typically $100 to $200 combined | Some long-term care facilities offer free training in exchange for work commitments |
| Ohio | Tuition $500 to $1,000; books about $100; CPR about $65; fingerprinting about $60; total approximately $725 to $1,225 | Typically $100 to $150 | Also budget for background checks and health screenings; some employers reimburse training costs |
| Oklahoma | Typically $500 to $900 depending on provider | Typically $100 to $200 combined | Some employers offer reduced or no-cost training when students agree to work after certification |
| Oregon | Generally $700 to $1,500 depending on school | Typically $100 to $200 combined | Additional costs may include scrubs, supplies, and background checks; some healthcare systems sponsor training |
| Pennsylvania | Typically $600 to $1,300 depending on provider | Typically $100 to $200 combined | Reimbursement may be possible for those who work in Medicare-certified nursing homes after certification |
| Rhode Island | Typically $700 to $1,400 depending on provider | $35 state fee plus exam charges | State fee applies along with exam and training costs |
| South Carolina | Generally $500 to $1,000 depending on provider | Typically $100 to $200 combined | Long-term care employers may offer free or low-cost training tied to employment agreements |
| South Dakota | Typically $500 to $1,000 | Typically $100 to $200 combined | Nursing homes and facilities may sponsor trainees in exchange for work commitments |
| Tennessee | Typically $500 to $1,000 depending on school | $20 state fee plus exam vendor charges | Additional exam costs apply through testing vendors |
| Texas | Tuition $800 to $1,200; books about $150; CPR about $60; fingerprinting about $60; total approximately $1,070 to $1,470; Northeast Texas Community College program $750 | Typically $120 to $160 depending on vendor such as Pearson VUE or Prometric | Additional fingerprint and CPR costs apply; some long-term care facilities and hospitals offer free training |
| Utah | Typically $500 to $1,000 depending on provider | $30 state fee plus exam charges | State fee applies in addition to exam and training costs |
| Vermont | Generally $600 to $1,200 depending on school | Typically $100 to $200 combined | Some healthcare employers and workforce programs subsidize training costs |
| Virginia | Typically $600 to $1,300; Danville Community College program $3,495 | Typically $100 to $200 combined | Program costs vary widely; some intensive programs list much higher totals |
| Washington | Wenatchee Valley College tuition $1,235.80 for one quarter plus $30 quarterly registration fee | Typically $100 to $200 combined | Additional supplies, uniforms, background checks, and health screenings may apply |
| West Virginia | Typically $500 to $1,000 depending on provider | Typically $100 to $200 combined | Some nursing homes provide training in exchange for work commitments, reducing up-front tuition |
| Wisconsin | Typically $600 to $1,200 depending on provider | Typically $100 to $200 combined | Some employers reimburse training and exam costs after a set work period |
| Wyoming | Typically $500 to $1,000 depending on school | Typically $100 to $200 combined | Long-term care facilities may offer low or no-cost training in exchange for employment |
Online and Hybrid CNA Programs: What’s Allowed in Your State
Hybrid CNA programs have become the practical norm in 2026: most states permit some online theory, but no state currently accepts fully online certification that skips in-person clinical hours.
What States Are Allowing
Oregon offers the clearest online allowance. Under state administrative rules, an online nursing assistant program must total at least 105 hours, with 37 hours of online didactic work and 28 hours of supervised lab delivered no later than two weeks after the online portion. Clinical training still must be in person.1
California does not approve fully online CNA programs.2 Online continuing education and in-service training are allowed for some licensed personnel,3 and approved online CNA providers must still arrange a clinical site.
Massachusetts is rolling out online learning modules for its CNA curriculum during 2026, but this does not authorize online clinicals.4 Texas continues to require 40 hours of clinical training plus testing, which keeps hands-on work in person.5
Clinical Settings That Count
Clinical hours cannot be completed online. Some states are expanding where those in-person hours can happen. Illinois, for example, now allows assisted living and supportive living facilities to host supervised clinical experiences under Senate Bill 3766. That creates more placement options without making the clinical component virtual.
Verify Before You Enroll
Because approval rules vary and change frequently, contact your state nurse aide registry or board of nursing before paying for a program. A course labeled "online CNA" may still require an approved in-person clinical site. Ask whether the online theory hours are part of state-approved online CNA programs and where the clinical rotation will be completed.
CNA Exam, Renewal, and Reciprocity Rules by State
CNA exam vendors, renewal cycles, and reciprocity timelines vary so much by state that your next move depends almost entirely on where you hold or plan to hold certification.
Exam Providers and Renewal Basics
Several national vendors dominate state testing, but assignments differ. Credentia administers the CNA exam in about 29 states, including Alabama, California, Maryland, and Tennessee. Prometric handles testing in Texas, Florida, Connecticut, New York, Kentucky, and New Jersey. Headmaster/D&S Diversified Technologies covers Arizona, Arkansas, Idaho, Kansas, Maine, Missouri, and Ohio.1
Renewal frequency is most often every 2 years, but continuing education hours differ widely. Among states with published 2026 data: - Alabama: Credentia and Prometric; 2 years, 12 CE hours. - Arkansas: Headmaster; 2 years, 12 CE hours. - California: Credentia; 2 years, 48 CE hours. - Maine: Headmaster; 24 months, 12 CE hours. - Maryland: Credentia; 2 years, 12 CE hours. - Texas: Prometric; 2 years, 24 CE hours.1
What Reciprocity Typically Requires
If you already hold an active CNA certification in one state, transferring to another usually requires verification of your active registry listing, proof of identity, and sometimes a new background check. Some states also ask for recent paid work or continuing education. Processing times range from about one week in Tennessee2 to 14 business days for Georgia's online verification3. Plan for 2 to 8 weeks in many states, and do not let your current certification lapse while waiting.
Check with the destination state's nurse aide registry before moving.
How to Stay Updated on Changing CNA Requirements
Start With Your State's Nurse Aide Registry
Bookmark the official nurse aide registry website for your state. This is the central source for current training hour minimums, approved program lists, exam provider details, and renewal deadlines. Many states update registry pages before other public resources, so check it first whenever you need confirmation.
Subscribe to Official Updates and Associations
Sign up for email alerts from your state health department or board of nursing. These agencies post notices when new laws take effect or clinical hour requirements change. Joining a state professional association for nursing assistants or long-term care workers adds another layer, since associations often summarize policy changes in plain language.
Review New Legislation Every Year
CNA rules are not static. Set a reminder to check for newly signed legislation at least once a year, especially before you enroll in the best CNA programs. A bill passed in one session can expand clinical training settings like CNA partnership programs, adjust reciprocity rules, or change exam vendors. If you see a proposed change, follow its progress rather than assuming it will become law.
This article reflects information available as of August 2026. Requirements shift, so always confirm with your state agency before paying for a program or relying on older advice.
CNA Salary and Job Outlook: How Your State’s Requirements Affect Your Career
Nursing assistant pay varies widely by state, but the highest wages often reflect higher living costs rather than tougher training rules. These 2025 BLS estimates show median annual wages and total employment for nursing assistants. Oregon, Washington, New York, New Hampshire, and the District of Columbia report the top five medians, while Delaware, Virginia, Maryland, Pennsylvania, and Arizona sit at the lower end.
| State | Total Employment | Median Annual Wage | Mean Annual Wage |
|---|---|---|---|
| Oregon | 14800 | 49830 | 52160 |
| Washington | 30270 | 49180 | 52230 |
| New York | 87990 | 48590 | 48800 |
| New Hampshire | 7810 | 47870 | 49290 |
| District of Columbia | 3490 | 47700 | 47930 |
| California | 110060 | 47630 | 50190 |
| Colorado | 22240 | 47380 | 47400 |
| Vermont | 3030 | 47130 | 46850 |
| Maine | 8540 | 47070 | 47510 |
| New Jersey | 32400 | 46830 | 46810 |
| Minnesota | 29120 | 46680 | 46030 |
| Massachusetts | 38130 | 46680 | 47700 |
| Rhode Island | 10220 | 46440 | 46360 |
| Alaska | 2060 | 46370 | 48920 |
| Illinois | 68640 | 45960 | 45230 |
| North Dakota | 6840 | 45820 | 43330 |
| Nevada | 8100 | 45490 | 44900 |
| Hawaii | 5050 | 45350 | 45710 |
| Wisconsin | 28370 | 45130 | 44600 |
| Connecticut | 21380 | 44790 | 45440 |
| Arizona | 20320 | 44780 | 44820 |
| Pennsylvania | 67740 | 44590 | 43960 |
| Maryland | 27720 | 43240 | 43310 |
| Virginia | 40580 | 43200 | 42160 |
| Delaware | 5530 | 42030 | 42290 |
National CNA Median Wage
Illinois now lets assisted living facilities host CNA clinical training, but every state's rules are shifting in 2026, so verify yours before you enroll.
