How to get a Certified Nurse Aide (CNA) license in Texas

Texas nursing assistant licenses

Texas issues 2 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 Texas nursing assistant license on this page, so they are shown once here. Each license's own section lists only what differs.

How to apply

Apply online

tulip.hhs.texas.gov¹⁷

Renewal

Renew online

tulip.hhs.texas.gov¹¹¹²

Who needs a Certified Nurse Aide (CNA) license

Nursing or nursing-related services as a nurse aide in Texas nursing facilities and skilled nursing facilities licensed by HHSC.¹

Other rules on who may do this work:

• A trainee enrolled in a NATCEP may work in a nursing facility for up to four months before being listed on the registry (federal 4-month rule).⁵

Requirements for a Certified Nurse Aide (CNA) license

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

High school diploma or GED

Not required⁵

Education or training

At least 100 clock hours²
Complete an HHSC-approved Nurse Aide Training and Competency Evaluation Program (NATCEP) of 100 hours: 60 hours classroom and 40 hours clinical (1 instructor per 10 trainees). At least 16 introductory hours and 8 hours of infection control/PPE come before any resident contact. The 60-hour classroom part may be done through HHSC's free online computer-based training (CBT), followed by the 40 clinical hours at an approved NATCEP.¹³
Who may teach it: Training must be at an HHSC-approved NATCEP (directory published by HHSC); non-facility-based NATCEPs also need Texas Workforce Commission approval. A nursing facility may not charge a trainee it employs or has offered a job for any part of the NATCEP, including books.²
Alternative: Exam-only route (no Texas training) for: people who finished at least 100 hours of NATCEP training in another state within the preceding 24 months but did not test or get listed; at least 100 hours of equivalent military training on or after July 1, 1989; RN/LVN graduates of a US accredited school within 24 months who are not Texas-licensed and have no revoked license; and current or recent (24 months) nursing students who show basic nursing skills competency.¹⁴

Exam

Texas Nurse Aide Competency Evaluation (skills demonstration plus written or oral examination)³
Given by: Prometric (HHSC contractor that develops, scores and reports the Nurse Aide Examination)¹
When you can take it: After the program director confirms completion of the NATCEP training (or HHSC approves an exam-only route); the trainee applies in TULIP and receives a link to register with Prometric.³
Skills demonstration: five randomly selected skills from a pool of nurse-aide skills (HHSC FAQ: drawn from a list of 34 skills).¹⁵
Written or oral examination: 60 scored multiple-choice questions under the rule; the HHSC NATCEP FAQ describes the written exam as 70 multiple-choice questions. The exam may be taken orally on request.¹⁵
Retakes: Up to three attempts: a trainee who fails either part may retest twice; after three failures the training must be repeated.³
Time limit: The competency evaluation must be taken within 24 months after completing the training portion of the NATCEP.³
Exam waived: Training and testing may both be waived for a nurse aide who completed a training course of at least 100 hours before July 1, 1989 and has worked for pay at least once every two years since then (Forms 5506 and 5507).¹⁴

Background check

Background check required⁴
No fingerprints required¹
Convictions listed in Health and Safety Code 250.006 bar employment; HHSC may deny or revoke certification or deny testing for such a conviction (Chapter 53, Occupations Code, does not apply).¹⁶

Social Security number

Reciprocity and pre-1989 waiver applicants upload a Social Security card with a government photo ID in TULIP.⁴

Also required

Applicant must not be listed on the Search Engine for Multi-Agency Reportable Conduct (SEMARC), which HHSC must use from August 3, 2026 under Senate Bill 1849 (88th Legislature, 2023).¹

How to apply

1. Complete an HHSC-approved 100-hour NATCEP (60 classroom + 40 clinical hours), or HHSC's free 60-hour online classroom CBT plus 40 clinical hours with an approved NATCEP.⁴
2. Create a TULIP account and submit a "New Nurse Aide by Examination" application (Eligibility Route: New Nurse Aide).⁴ tulip.hhs.texas.gov¹
3. Your training program director approves your training in TULIP; you then get an email with a link to register for the exam with Prometric.⁴
4. Schedule and pass the written (or oral) and skills exams with Prometric (800-488-5787).⁴
5. Prometric sends scores to TULIP, HHSC issues the certificate, and you print it from TULIP.⁴

Application form

fhb.hhs.texas.gov¹⁷

Temporary or provisional license

No temporary certificate; a trainee enrolled in a NATCEP may work in a nursing facility for up to four months.⁵

Processing time

After passing the exam, results reach TULIP in about a week; the rule requires HHSC to issue the certificate and update the registry within 30 days.⁵

Renewal and continuing education

How often

Every 2 years⁵

When it expires

Expires 24 months after issue or 24 months after the last verified nurse-aide employment, whichever is earlier. Renewal needs a Form 5506-NAR showing paid nursing or nursing-related work, the annual HHSC infection control/PPE course and 24 hours of in-service education every two years. Renewal can be filed from three months before expiry, by the aide or by the employer.⁶

Continuing education

At least 24 hours each renewal period⁶

Required topics

In-service education must include geriatrics and care of residents with a dementia disorder, including Alzheimer's disease.⁶
An HHSC course in infection control and proper use of PPE every year.⁶

Approved courses

In-service education must come from a nursing facility, an approved NATCEP, HHSC, or (for no more than 12 of the 24 hours) another health care entity licensed or certified by HHSC, DSHS or the Texas Board of Nursing. HHSC's free online modules give 2 hours each with a score of at least 70%.⁶

Exemptions

A military service member may get two additional years to complete the in-service education if the request is filed before the certificate expires.¹⁸

If it expires

Status changes to expired after 24 consecutive months without paid nurse-aide work and no renewal; to reactivate, the aide must complete a NATCEP or a competency evaluation (HHSC renewal options 3 and 4: retrain and retest, or retest only).¹⁹
Military service members, veterans and spouses may renew an expired certificate without retesting within five years of expiry.¹⁸

Moving to Texas with a license from another state

These are the routes HHSC publishes for the Certified Nurse Aide (CNA) license. The other nursing assistant licenses have their own routes in their sections below.

Medication Aide (MA) permit

Requirements

Minimum age

18 years old⁸

High school diploma or GED

Required⁸

Education or training

At least 140 clock hours⁷

The board's words

“Complete MA training: Applicant successfully completes a state-approved medication aide training program (140 hours).”

Who may teach it: Training must be an HHSC-approved medication aide training program; the applicant must apply in TULIP within 20 days of enrolling.¹⁰
Alternative: Nursing students and graduates (not licensed as RN/LVN) who attended or graduated no earlier than January 1 of the previous year meet the training requirement, then pass an HHSC open-book exam and the written exam.⁸

Experience

At least 90 days⁸
Must be working as a nurse aide or non-licensed direct care staff on the first day of training, and have worked as a nurse aide in a Medicare/Medicaid nursing facility, or 90 days as non-licensed direct care staff in the 12 months before training.⁸

Exam

HHSC Medication Aide written examination⁹
Given by: HHSC (regional exam proctor scheduled through the training school)⁷
When you can take it: After completing the training program (or meeting the nursing student/graduate or reciprocity route).⁹
100 multiple-choice questions on accurate and safe drug therapy.²⁰
Retakes: One free retest; after failing the retest, another training program is required.⁹
Time limit: The retest must be taken by the date in the failure notice; HHSC FAQ says within 45 days.²⁰
Exam waived: Nursing-student/graduate and out-of-state routes take an HHSC open-book exam plus the written exam, with no retake allowed.⁸

Background check

Background check required¹⁰
Fingerprints required²¹

Also required

Must read, write, speak and understand English and be free of communicable disease and in suitable physical and emotional health.⁸

Fees

You pay HHSC (application fee) and Texas Department of Public Safety fingerprint vendor (FBI background check).

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

The board's pages we cite do not list the exam fee.

How to apply

1. Confirm eligibility (age 18, diploma/GED, English, current nurse aide or direct-care job, prior employment) and enroll in an HHSC-approved 140-hour medication aide program.⁷
2. While still in training (within 20 days of enrolling), submit the initial MA application in TULIP with a notarized diploma copy and Form 5523, and pay the $25 application and exam fee.⁷ tulip.hhs.texas.gov²¹
3. Complete FBI fingerprinting through the DPS vendor using the link HHSC sends.⁷
4. Your school submits its roster; HHSC schedules the written exam through the regional proctor and the school tells you the date.⁷
5. Pass the exam; the permit is issued in TULIP within 30 days and you print it.⁷

Processing time

Permits are issued within 30 days of the exam date for passing candidates.⁷

Renewal

How often

Every year²²

When it expires

Initial permit valid 12 months from issue; renew every year before expiry.²²

Renewal fee

$15¹⁰

Approved courses

CE must be an HHSC-approved seven-hour continuing education program.²²

Exemptions

No CE is required for the first renewal.²²

Late renewal

Late renewal fee: $22.50¹⁰ (expired 1-90 days)
Late renewal fee: $30¹⁰ (expired 91 days to 1 year)
Reinstatement fee: $30¹⁰ (former Texas MA holding another state's permit with 2 years recent practice)

If it expires

A permit expired less than one year can be renewed with all accrued fees, the late fee and 7 CE hours for each year expired; after one year or more a new application and exam are required.²²

From another state

Military service members, veterans and spouses: HHSC waives application and permit fees for qualifying military service members, veterans and military spouses (approval needed before submitting the TULIP application); military renewals are prioritized.⁷

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

City and county rules

Certified Nurse Aide (CNA): certificate of registration and active listing on the Texas Nurse Aide Registry (NAR)No local license: the credential is issued statewide by Texas HHSC.¹

Check a license or report a problem

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

Look up a license

tulip.hhs.texas.gov¹

Laws and rules

The requirements above come from these laws and board rules.

• Tex. Health & Safety Code ch. 250 (incl. § 250.0035, § 250.006)
• 26 TAC ch. 556 (Nurse Aides), §§ 556.3, 556.6, 556.9-556.12, 556.14
• 42 CFR 483.35(d) (4-month rule)
• Tex. Health & Safety Code ch. 242, subch. N (§§ 242.601-242.614)
• 26 TAC § 557.109
• 26 TAC ch. 557 (Medication Aides), §§ 557.107, 557.111, 557.113, 557.115

Rule changes since January 2024

• August 3, 2026: HHSC began using the Search Engine for Multi-Agency Reportable Conduct (SEMARC) under SB 1849 (88th Leg.).¹
• July 30, 2026: 26 TAC 556.3 (NATCEP requirements), 556.12 (waiver, reciprocity, exemption) and 556.14 (military) amended, effective July 30, 2026, 51 TexReg 4890.¹⁴
• July 30, 2026: 26 TAC 557.107, 557.113 and 557.115 amended, effective July 30, 2026 (51 TexReg 4895).²²

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
• Missouri
• 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
• Utah
• Virginia
• Washington
• West Virginia
• Wyoming