How to get a Certified Nurse Assistant (CNA) license in Missouri

Missouri nursing assistant licenses

Missouri issues 3 nursing assistant credentials. Each has its own section below; the table shows what each one covers and its headline requirements.

Applies to every license level

These rules are the same for every Missouri nursing assistant license on this page, so they are shown once here. Each license's own section lists only what differs.

Requirements

Minimum age

18 years old¹⁴

Who needs a Certified Nurse Assistant (CNA) license

Employee of a skilled nursing or intermediate care facility, unit or hospital who has completed the training and passed the certification exam and gives or helps give direct resident care under the supervision of a licensed nurse.⁷

Work that does not need this license:

• The CNA requirement does not apply to people otherwise licensed for health care in Missouri, or to unpaid volunteers and members of religious or fraternal orders that run the facility.⁷

Other rules on who may do this work:

• A facility may hire you before you are certified, but you must start the first available approved course within 90 days and finish it within four months of employment; before finishing the 75 classroom hours you may give direct care only under a licensed nurse's direct supervision.⁷

Requirements for a Certified Nurse Assistant (CNA) license

The rules this license shares with every other level are under Applies to every license level.

Education or training

At least 175 clock hours²
State-approved basic course: at least 75 hours of classroom instruction plus 100 hours of supervised on-the-job (clinical) training, given by a DHSS-approved training agency, followed by a two-part final exam.³

Exam

Missouri CNA final examination: knowledge (written or oral) test and skills (practicum) evaluation, given by the department-approved third-party test administrator³
Given by: Headmaster D&S (D&SDT-Headmaster), via the TMU system³
Passing score: Knowledge: at least 80%; skills: 100%¹
When you can take it: After finishing the 75 classroom and 100 on-the-job hours and passing at least three in-course tests with 80% or more (or with a DHSS challenge approval letter).¹
Knowledge exam: 75 questions⁴
Skills evaluation (practicum) proctored by the third-party test administrator¹
Retakes: Two retakes within 90 calendar days of the first attempt; after a third failure the whole course must be retaken. Challenge candidates get one attempt only.¹
Time limit: Test within 1 year of the course start date.⁴
Exam waived: Active CNAs from another state's registry are added without the exam (reciprocity).¹

Background check

Background check required⁴
You cannot enroll if you are on the DHSS Employee Disqualification List or have certain convictions/pleas (class A or B felony violations of RSMo chapters 565, 566 or 569, 198.070.3 or 568.020) unless the department grants a good cause waiver; employers must also check the registry for federal indicators.⁴

Social Security number

Social Security number is part of the registry/challenge/reciprocity request.¹

How much a Certified Nurse Assistant (CNA) license costs

Each line is a separate charge as the board lists it. The board does not publish a combined total, so none is shown here.

How to apply

1. Enrol with a DHSS-approved facility or school training agency and complete 75 classroom hours and 100 supervised on-the-job hours.³
2. Your instructor enters you in TMU; log in and schedule the knowledge and skills test with Headmaster D&S (within 1 year of your course start).⁴ mo.tmutest.com⁹
3. Pay the $135 exam fee ($32 knowledge + $103 skills) and pass both parts (80% knowledge, 100% skills).⁴
4. On passing, your name goes on the Missouri CNA active registry; employers verify you there.¹

Apply online

mo.tmutest.com⁹

Temporary or provisional license

Working before certification: you may work in a facility while training but must be certified within 120 days (4 months) of your start date.⁴

Processing time

Reciprocity documents are reviewed in the order received by the Health Education Unit; no time frame published.⁵

Renewal and continuing education

How often

Every 24 months¹

When it expires

Stay active by documenting at least one day (e.g. 8 hours) of work in nursing or nursing-related services in each 24-month period: in TMU enter your employment, upload a paystub, W-2 or employer letter on company letterhead and pay the $20 renewal fee; your employer then verifies the work.⁴

Renewal fee

$20¹⁰ (Each 24-month work-verification renewal)

Required topics

12 hours of facility in-service per year while working in a long-term care facility (facility obligation).⁴

If it expires

Inactive (2-year break in nursing work): if you have worked, renew with work proof; if not, challenge the exam to return to active status.⁴
Inactive under 5 years with no proof of work: retake and pass the final exam; with proof of work, file the CNA Inactive/Expired form in TMU.⁹
Expired (5-year break): you must retake the entire course before returning to the active registry.¹⁰

Renew online

mo.tmutest.com⁴

Moving to Missouri with a license from another state

These are the routes the Missouri Department of Health and Senior Services publishes for the Certified Nurse Assistant (CNA) license. The other nursing assistant licenses have their own routes in their sections below.

Certified Medication Technician (CMT)

Gives non-injectable (nonparenteral) medications in intermediate care and skilled nursing facilities, assisting LPNs or RNs; insulin only with the separate Insulin Administration certification.⁶

Requirements

High school diploma or GED

Required⁶

Education or training

DHSS-approved CMT course: at least 60 classroom hours plus at least 8 hours of supervised clinical practice.⁶

Experience

At least 6 months¹
Six months of employment as an active Missouri CNA before enrolling.¹

Exam

CMT final written examination and practicum examination⁶
Given by: Administered by the DHSS-approved CMT instructor/examiner (written test accessed through www.cmttest.org)¹
Passing score: At least 80% on the written exam¹
Written: 50 multiple-choice questions¹
Practicum: minimum two hours, preparing and administering medications by all non-parenteral routes¹
Retakes: One retake within 90 days of the first failure without repeating the course; a challenge exam may be taken once.¹
Exam waived: Course (not exam) may be skipped by nursing students who completed medication administration, nursing graduates who failed the NCLEX in the last 5 years, DMH-trained medication aides, and medication aides/technicians certified in another state.⁴

Background check

Background check required⁴
Not on the EDL, no federal indicator on any CNA registry, and no disqualifying conviction/plea (class A or B felony equivalents).¹

Also required

Your CMT status follows your CNA status: if the CNA goes inactive or expired, so does the CMT.⁶

How to apply

1. Be an active Missouri CNA for at least six months, age 18, with a high school diploma or GED and an employer recommendation letter.⁴
2. Take the 60-hour classroom + 8-hour clinical CMT course at an approved educational training agency.⁶
3. Pass the written and practicum final exams; the training agency reports you to an approved certifying agency, which issues the certificate, and you are added to the registry.¹
4. If you qualify to challenge (e.g., certified medication aide in another state), email the request and documents to [email protected].⁶

Renewal

When it expires

Stays active while your CNA is active; regaining active CNA status reactivates the CMT.¹⁰

If it expires

If your CNA is inactive/expired, the CMT is too.⁶

From another state

The rules this license shares with every other level are under Applies to every license level.

Level I Medication Aide (LIMA)

Gives medications in licensed residential care and assisted living facilities by oral, rectal, vaginal, otic, ophthalmic, nasal, topical, transdermal, buccal, sublingual, aerosol, nebulizer and oral metered-dose inhaler routes.⁸

Requirements

Education or training

At least 16 clock hours¹
DHSS-approved LIMA course: at least 16 hours of instruction and supervised practice with an approved instructor.⁸

Exam

LIMA final written and practicum examination¹
Given by: Approved LIMA instructor (no outside vendor)¹
Passing score: Written at least 80%; practicum 100% accuracy¹
Written: 25 questions¹
Practicum: at least 10 medications (no more than 5 oral) in an RCF, ALF or DMH facility¹
Retakes: One retake within 90 days of the first failure without repeating the course; failed challengers must take the course.¹

Background check

Background check required¹¹
You must meet the employability criteria in 19 CSR 30-86.042, 30-86.043 or 30-86.047. Under 19 CSR 30-86.042 no one on the DHSS Employee Disqualification List may work in the facility, the facility must request a criminal background check before you have resident contact, and a finding of guilt of a class A or B felony violation of RSMo chapters 565, 566 or 569, any violation of 198.070.3 or of 568.020 bars resident contact unless DHSS grants a good cause waiver.¹¹

How to apply

1. Take the 16-hour LIMA course from an approved instructor (age 18 and employable in an RCF/ALF).⁸
2. Pass the written (25 questions, 80%) and practicum (100%) exams; you may not give medications alone until you pass and have your score sheet.⁸
3. The certifying agency issues the certificate and DHSS lists you on the LIMA registry; to challenge, email the request with transcript and endorsement letter to [email protected].⁸

Renewal

How often

Every 2 years⁸

When it expires

Send DHSS the completed Biennial Training form by each two-year anniversary of your original LIMA certificate.⁸

Continuing education

At least 4 hours each renewal period⁸

Required topics

Medication administration training, documented on form MO 580-2973⁸

Approved courses

Offered by an approved instructor⁸

If it expires

Miss the biennial update and you become inactive; reinstate at any time with proof of a completed update. Off the active registry more than 5 years (no update form received over a 7-year period) = expired: retake the course, or challenge the exam if you meet the challenge requirements.⁸

The rules this license shares with every other level are under Applies to every license level.

City and county rules

Certified Medication Technician (CMT)No local license: the Missouri Department of Health and Senior Services keeps the statewide CNA registry.¹⁰

Check a license or report a problem

Before you hire a nursing assistant in Missouri, you can confirm the license is current on the board's own search. Every board we cover in Missouri is on the Missouri license lookup page.

Look up a license

mo.tmutest.com⁹

Laws and rules

The requirements above come from these laws and board rules.

• RSMo 198.082
• 19 CSR 30-84.010
• 42 CFR 483.151-483.158
• 19 CSR 30-84.020
• 19 CSR 30-84.030

Common questions

Certified nursing assistant (CNA) licenses in other states

• Alabama
• Alaska
• Arizona
• Arkansas
• California
• Colorado
• Connecticut
• Delaware
• District of Columbia
• Florida
• Georgia
• Hawaii
• Idaho
• Illinois
• Iowa
• Kentucky
• Louisiana
• Maine
• Maryland
• Massachusetts
• Michigan
• Minnesota
• Mississippi
• Montana
• Nebraska
• Nevada
• New Hampshire
• New Jersey
• New Mexico
• New York
• North Carolina
• North Dakota
• Ohio
• Oklahoma
• Oregon
• Pennsylvania
• Rhode Island
• South Carolina
• South Dakota
• Texas
• Utah
• Virginia
• Washington
• West Virginia
• Wyoming