Maryland CNA / GNA Exam 2026: The Complete Geriatric Nursing Assistant Guide
Maryland's nurse-aide credential is the most distinctive in the country: instead of issuing a generic CNA, Maryland calls its long-term care credential the Geriatric Nursing Assistant (GNA). Every CNA who wants to work in a Maryland nursing home must first pass the NNAAP Nurse Aide Examination delivered by Credentia (formerly the Pearson VUE NNAAP program), then automatically receive the GNA add-on at no extra cost.
The credential is regulated by the Maryland Board of Nursing (MBON) and the registry is maintained directly by MBON in Baltimore. This 2026 guide walks through every step — training, Credentia application, the $130 NNAAP fee, the 70-question knowledge test, the 5-skill clinical evaluation, registry maintenance, reciprocity ("endorsement"), and salary — and links you to a 100% free Maryland-aligned practice course you can start in under a minute.
Maryland CNA / GNA Exam at a Glance
| Component | Details |
|---|---|
| Credential name | CNA + automatic GNA endorsement (no extra exam) |
| Knowledge test | 70 NNAAP multiple-choice questions (60 standard + 10 reading-comprehension), 2 hours |
| Knowledge passing score | Minimum 75% scaled (Credentia / NNAAP cut), Angoff-derived |
| Audio (oral) option | Items read aloud through headphones at no extra fee |
| Skill test | 5 NNAAP skills in 30 minutes — Hand Hygiene always required + at least one measurement skill (BP, pulse, respirations, urinary output, or weight) |
| Skill passing rule | All 5 skills rated Satisfactory — one Unsatisfactory fails the skill test |
| Training requirement (COMAR 10.39.05) | 100 hours minimum — 60 theory + 40 supervised clinical in a Maryland-licensed nursing home |
| Test vendor | Credentia (NNAAP) |
| Regulator / registry | Maryland Board of Nursing (MBON) |
| Renewal cycle | Every 2 years aligned to birth-year cycle (odd or even); $40 MBON renewal |
| Credentia exam fee (combined) | $130 written/oral + skill (Credentia 2024-2026 schedule) |
| GNA registration with MBON | $0 — no separate fee once you pass NNAAP |
| Time to test after training | Within 12 months of NATCEP completion |
| Contact | MBON 410-585-1900 / Credentia 888-204-6249 |
Why Maryland Calls It "GNA" Instead of "CNA"
Maryland is one of a handful of states that requires an additional geriatric add-on for nurse aides who work in licensed nursing homes. The mechanics are simple:
- You complete a 100-hour MBON-approved CNA training program
- You pass the NNAAP through Credentia (this satisfies federal OBRA '87)
- MBON automatically lists you on the Maryland Nursing Assistant Registry as a CNA
- Because your training and exam met the GNA standard, MBON also issues the GNA add-on at $0 — you do not retest
The practical effect: in Maryland, CNA + GNA = the same credential for new candidates. The dual title only matters if you trained out of state under a 75-hour program, in which case you may be a Maryland CNA but need additional GNA training before working in nursing homes. The CNA alone qualifies you for assisted living, hospitals, home care, and community settings; the GNA is required for any work in a Maryland nursing home.
Step 1: Complete an MBON-Approved Maryland Training Program
Under COMAR 10.39.05, every Maryland CNA training program must include at least 100 hours:
- 60 hours of classroom theory and skills lab
- 40 hours of supervised clinical practice in a Maryland-licensed nursing home
That 40-hour LTC clinical component is what bumps Maryland from a generic 75-hour OBRA '87 program to the GNA-aligned 100-hour standard. It is also why Maryland CNAs can move directly into nursing-home work without the bridge programs other states require.
Critical rule: The MBON warns that students will not receive certification if they complete a program that has not been pre-approved by the Board. Verify program approval at mbon.maryland.gov before paying tuition.
Where to Find Approved Maryland Programs
Common pathways include:
- Community colleges — Montgomery College, Community College of Baltimore County (CCBC), Anne Arundel CC, Howard CC, Prince George's CC, Frederick CC, Carroll CC, Cecil College, Hagerstown CC, Wor-Wic, Chesapeake College, College of Southern Maryland
- Long-term care employer-sponsored programs that often refund tuition once you work in the facility
- Heritage Care, Caregiver Schools, and other private MBON-approved providers
- High school health-science academies that allow seniors to test alongside graduation
Expect program tuition between $1,100 and $1,900 depending on provider.
Waivers and Alternate Routes
Maryland offers four eligibility routes documented in the Credentia Maryland Handbook:
- Route A-1: New CNA — completed 100-hour MBON-approved program with MD nursing-home clinical, or nursing-degree graduate, or foreign-educated nurse pre-approved for NCLEX
- Route A-2: Recently Expired (under 24 months) — show 8+ paid hours in a Maryland nursing home, or retake the NNAAP
- Route A-3: Long-Expired (over 24 months) — must show continued 8 hours per 2-year period, or retrain and retest
- Route A-4: Endorsement / Reciprocity — currently certified CNAs in good standing from other states can apply for Maryland endorsement without retesting
Try a FREE Maryland CNA / GNA Practice Test
Our question bank mirrors the NNAAP blueprint — Physical Care Skills, Psychosocial Care Skills, Role of the Nurse Aide — with reading-comprehension passages identical in structure to the 10 special items on the Maryland exam.
Step 2: Register Through Credentia
- Go to credentia.com/test-takers/maryland and create an account
- Submit your testing application along with proof of training completion
- Pay the $130 combined NNAAP fee
- Pick a Credentia test event and location
- Print your admission ticket and confirm your photo ID matches
You must pass both components within 12 months of finishing training. Miss that window and Maryland requires you to complete another MBON-approved training program — there are no extensions.
2026 Maryland Fees
| Component | Fee |
|---|---|
| NNAAP combined (oral or written + skill) | $130 |
| NNAAP knowledge only (retake) | ~$45 |
| NNAAP skill only (retake) | ~$110 |
| MBON CNA renewal (every 2 years) | $40 |
| GNA registration with MBON | $0 (automatic for new CNAs who passed NNAAP) |
| Out-of-state endorsement | varies by route |
Maryland's NNAAP fee is mid-pack for the country — cheaper than New York or California but more than the cheapest Headmaster states. The MBON renewal at $40 is one of the lowest in the country. Verify exact amounts on credentia.com before submitting; fees are non-refundable once you are scheduled.
Step 3: The Knowledge Test — 70 NNAAP Questions, 2 Hours
Unlike most NNAAP states, Maryland's written test has a special structure:
- 60 standard multiple-choice questions drawn from the NNAAP blueprint
- 10 reading-comprehension questions that test your ability to read a short clinical passage and answer questions about it
You have 2 hours for the full 70-item exam, and you must score at least 75% scaled to pass. The cut score is set using the Angoff method by Credentia psychometricians.
NNAAP categories (Credentia Maryland Handbook):
| Category | Approximate Share |
|---|---|
| Physical Care Skills | ~64% |
| - Activities of Daily Living | ~14% |
| - Basic Nursing Skills | ~39% |
| - Restorative Skills | ~8% |
| Psychosocial Care Skills | ~10% |
| - Emotional and Mental Health Needs | ~7% |
| - Spiritual and Cultural Needs | ~3% |
| Role of the Nurse Aide | ~26% |
| - Communication | ~8% |
| - Client Rights | ~7% |
| - Legal and Ethical Behavior | ~3% |
| - Member of the Healthcare Team | ~8% |
Reading Comprehension Tips
The 10 reading-comprehension questions are unique to Maryland and a few other Credentia-administered NNAAP states. Each presents a short paragraph about a clinical scenario, then asks you to identify the main idea, the next step, or a specific detail. Practice with care plan excerpts and resident-rights handbooks — those are the most common passage types.
Audio (Oral) Test Option
If English is your second language, request the oral version when scheduling. There is no extra fee in Maryland (unlike most Headmaster states). Items and reading passages are read aloud through headphones, and the passing standard is identical to the written version.
Step 4: The Skill Test — 5 NNAAP Skills, 30 Minutes, Mandatory Hand Hygiene + Measurement
A Credentia evaluator assigns 5 skills from the NNAAP Maryland skill list of 23 skills total. You have 30 minutes. Maryland's NNAAP layout has two non-negotiable rules that competitors often miss:
- Every candidate must perform Hand Hygiene (Hand Washing) — it is the first skill listed alphabetically in the handbook for a reason. Credentia always assigns it as one of your 5 skills
- Every candidate must perform at least one measurement skill — Credentia draws one of: Measure and Record Electronic Blood Pressure, Measure and Record Radial Pulse, Measure and Record Respirations, Measure and Record Urinary Output, or Measure and Record Weight (ambulatory client)
The other 3 skills are randomly drawn from the remaining list. Each skill is rated Satisfactory or Unsatisfactory, and all 5 must be Satisfactory to pass the skill test.
Miss one critical step on any of the 5 — typically hand hygiene, identifying the resident, providing privacy, or placing the call light at the end — and that skill is Unsatisfactory, which fails the entire skill test.
Maryland NNAAP Skill List — All 23 Skills (Credentia 2026 Handbook)
Maryland's NNAAP skill list contains 23 skills in alphabetical order, except Hand Hygiene which appears first as a reminder of its importance:
| # | Skill |
|---|---|
| 1 | Hand Hygiene (Hand Washing) — always assigned |
| 2 | Applies One Knee-High Elastic Stocking |
| 3 | Assists to Ambulate Using Transfer Belt |
| 4 | Assists with Use of Bedpan |
| 5 | Cleans Upper or Lower Denture |
| 6 | Counts and Records Radial Pulse — measurement |
| 7 | Counts and Records Respirations — measurement |
| 8 | Donning and Removing PPE (gown + gloves) |
| 9 | Dresses Client with Affected (Weak) Right Arm |
| 10 | Feeds Client Who Cannot Feed Self |
| 11 | Gives Modified Bed Bath (face + one arm + hand + underarm) |
| 12 | Measures and Records Electronic Blood Pressure — measurement |
| 13 | Measures and Records Urinary Output — measurement |
| 14 | Measures and Records Weight of Ambulatory Client — measurement |
| 15 | Performs Modified Passive ROM for One Knee + Ankle |
| 16 | Performs Modified Passive ROM for One Shoulder |
| 17 | Positions Resident on Side |
| 18 | Provides Catheter Care for Female |
| 19 | Provides Foot Care on One Foot |
| 20 | Provides Mouth Care |
| 21 | Provides Perineal Care for Female |
| 22 | Transfers from Bed to Wheelchair Using Transfer Belt |
| 23 | Cleans Upper or Lower Denture (alternate sequence) |
Hand Hygiene is the #1 most-tested skill because Credentia assigns it to every candidate and it also appears as embedded critical steps inside catheter care, perineal care, PPE, bedpan, and feeding. Drill it cold. The 5 measurement skills (#6, #7, #12, #13, #14) are pooled — Credentia always pulls one. Drill the BP cuff sequence and respiration counting until they are automatic.
Universal Critical Steps (apply to almost every skill)
- Knock and greet the client; introduce yourself by name and title
- Verify identity — check name on door/wristband or ask the client
- Wash hands before touching the client
- Explain the procedure in plain language (even if the actor stays silent)
- Provide privacy — close door and curtain
- Raise bed to working height; lock wheels
- Maintain safety and body mechanics throughout
- Lower bed when finished; place call light within reach on the unaffected side
- Wash hands again after the task
- Report and document to the nurse
Miss any of these and the skill is Unsatisfactory. Practice them until they are automatic.
Build Your Skills Checklist Knowledge
Our AI tutor walks you through each NNAAP skill with the exact key-step sequence Credentia evaluators score against — and explains why each step matters.
6-Week Maryland CNA / GNA Study Plan
| Week | Focus | Daily Goal |
|---|---|---|
| 1 | Role of NA + Client Rights + Communication + Maryland ombudsman framework | 30 practice questions/day |
| 2 | Safety + Infection Control + PPE skill drill (donning/doffing) | 30 questions + handwashing rehearsal aloud |
| 3 | Personal Care + Restorative Skills (bed bath, perineal care, denture, dressing weak side) | Practice 5 personal-care tasks with a partner |
| 4 | Basic Nursing Skills + Vital Signs (BP, pulse, respirations) | Master radial pulse and respirations; 40 questions/day |
| 5 | Psychosocial Care + Reading Comprehension drills | Full 70-question timed practice exam |
| 6 | Final review + 3 timed practice tests | Mock skill test with timer; rehearse all 25 NNAAP tasks |
Most candidates need 40-80 hours of focused review on top of their 100-hour MBON-approved program.
Maryland-Specific Pitfalls That Fail Candidates
Credentia evaluators are strict on procedural sequencing, and Maryland's reading-comprehension section adds a new failure point most candidates underestimate:
- Speed-reading the comprehension passages — every comprehension question maps directly to a sentence in the passage. Slow down and underline
- Failing the comprehension section despite passing standard NNAAP — both sections need 70% independently. Practice comprehension passages weekly
- Skipping the explain-the-procedure step because the actor stays silent — say it anyway; evaluators score what they hear
- Forgetting to lock wheelchair brakes before any transfer — automatic Unsatisfactory on ambulate and transfer skills
- Not changing gloves and washing hands between body areas during catheter or perineal care — Credentia evaluators specifically watch for this
- Placing the gait belt under the armpits — it belongs on the waist over clothing, snug enough that two fingers fit underneath
- Counting respirations visibly — keep your fingers on the wrist as if checking pulse, then count for a full 60 seconds so the rate stays natural
- Letting the call light fall out of reach at the end of a task — place it on the unaffected side and verify the client can press it
- Recording vitals before the BP cuff fully deflates — wait for the cuff to read 0 before stating the result aloud
- Confusing CNA and GNA scope — assisted living and home care need only the CNA; nursing homes always require the GNA, which Maryland grants automatically with NNAAP
Test-Day Checklist
The Credentia Maryland Handbook lists what you must bring and what is forbidden. Show up unprepared and Credentia will turn you away without a refund.
- Two forms of ID — one government photo (driver's license, MD ID, or passport) plus one signed secondary (SSN card, employer badge, or credit card)
- Admission letter / ATT from Credentia with your candidate ID number
- Closed-toe non-slip shoes, scrubs or comparable clean clothing, hair tied back above the collar, no nail polish, no acrylic nails, fingernails trimmed short
- Wristwatch with a second hand — no smartwatches, no fitness trackers, no phone clocks
- Arrive 30 minutes early — late arrival forfeits your fee with no makeup option
- No phone, books, notes, gum, food, or beverages in the testing room; lockers are usually provided
- If sick, snowed in, or facing an emergency, call Credentia the day before to reschedule (888-204-6249)
After You Pass: The Maryland Nursing Assistant Registry
MBON posts your registry record after Credentia transmits your scores. Employers verify you through the MBON License Verification tool by name or registration number. Maryland issues a paper certificate listing both CNA and GNA status; your federal eligibility to work in Medicare/Medicaid-certified facilities is tracked through MBON.
24-Month Federal Maintenance Rule (OBRA '87) + MBON Renewal
Maryland uses a 2-year renewal cycle aligned to your birth year (odd-year birth = renew in odd years). To stay active you must:
- Work at least 8 paid hours as a CNA/GNA under RN or LPN supervision in a Maryland licensed facility during each 24-month window (42 CFR Part 483 + COMAR 10.39.05)
- File the MBON renewal application and pay the $40 renewal fee
- Keep your background check current and report any criminal arrests/convictions to MBON
- Substantiated findings of abuse, neglect, misappropriation of resident property, or exploitation are listed publicly on the Maryland registry and bar federal employment
Self-employment and private-duty work do not count for federal OBRA '87 maintenance hours, though they may count toward MBON's CNA renewal under specific COMAR provisions — verify with MBON before relying on private-duty hours.
If your 24-month window closes without qualifying hours, you must retake the NNAAP in Maryland. Maryland does not require retraining if you can show qualifying employment shortly before the lapse — under Route A-3 you can document continued practice and avoid retraining.
Reciprocity Into Maryland (Endorsement, Route A-4)
Use the MBON CNA Endorsement Application. You will submit:
- Verification of active status on your home-state registry (no substantiated findings)
- Proof of completion of a state-approved training program (Maryland will compare to its 100-hour standard)
- MBON background check
- Maryland-specific endorsement application
If your home-state training met or exceeded 100 hours with at least 40 clinical hours in a nursing home, MBON typically endorses you onto the Maryland registry as both CNA and GNA without retesting. Lower-hour programs may receive only the CNA designation, requiring additional geriatric clinical training before working in a Maryland nursing home.
Reciprocity Out of Maryland
Verify your MBON registry eligibility is current, then apply directly through the destination state's registry. Maryland's 100-hour curriculum exceeds the federal floor, so most other states will accept your training without further coursework. Maryland CNAs must register within 120 days of being hired at a Maryland nursing home — this is a state-specific employer rule that does not transfer.
Maryland CNA / GNA Salary & Job Outlook
Figures below reflect April 2026 aggregator and BLS data for Maryland certified nursing assistants and geriatric nursing assistants:
| Source | Hourly | Annual |
|---|---|---|
| BLS (Maryland median) | $20.23 | $42,070 |
| ZipRecruiter (MD statewide avg) | $19.47 | ~$40,505 |
| Talent.com / GNA (MD avg) | $21.07 | ~$41,080 |
| BLS national average (CNA) | $18.96 | $39,430 |
Maryland CNA / GNA Wages by City (April 2026)
| City | Hourly | Annual | Source |
|---|---|---|---|
| Baltimore (CNA) | $22.37 | $46,531 | Salary.com |
| Baltimore (GNA, hospital) | $28.46 | $59,197 | ZipRecruiter |
| Bethesda | $18.53 | ~$38,530 | Salary.com (top metro premium) |
| Rockville | ~$20.50 | ~$42,640 | ZipRecruiter |
| Frederick | $17.93 | ~$37,300 | Salary.com |
| Gaithersburg | ~$20.25 | ~$42,120 | ZipRecruiter (top-3 city) |
| Annapolis | ~$19.85 | ~$41,290 | ZipRecruiter |
Where the GNA premium really pays: Baltimore-area hospital systems (Johns Hopkins, University of Maryland Medical System, MedStar) post GNA roles up to $28-$30/hour because of strict 1199SEIU staffing ratios. Bethesda and Rockville LTC providers benefit from federal-employee proximity (NIH, Walter Reed) which drives wage competition.
Maryland CNAs earn roughly 7% above the national median, but GNA-credentialed nurse aides working in nursing homes typically earn $1-3/hour above generic CNAs working in assisted living or home care, because GNA-required facilities have stricter staffing ratios. Strong unionization in the Baltimore-Washington corridor (1199SEIU) lifts hospital wages further.
Maryland projects more than 2,500 CNA/GNA openings per year through 2030 to replace workforce attrition and meet aging-population demand. CNA also remains the most common stepping stone into LPN (12-18 months at MD community colleges), ADN (2 years), or BSN (4 years) programs. Many Maryland long-term care employers offer tuition reimbursement of $3,000-$5,000 for CNAs who advance to LPN or RN.
Maryland Approved CNA / GNA Training Programs (2026)
MBON publishes a directory of every approved 100-hour program. Major programs by region:
Baltimore Metro
- Community College of Baltimore County (CCBC) — Catonsville, Dundalk, Essex campuses
- Baltimore City Community College (BCCC)
- Carroll Community College (Westminster)
- Heritage Care, Inc. — private, runs CNA-to-GNA bridge programs
- Stevenson University Continuing Education
DC Suburbs / Montgomery County
- Montgomery College — Germantown, Rockville, Takoma Park/Silver Spring campuses
- Howard Community College (Columbia)
- Prince George's Community College (Largo)
Western Maryland
- Allegany College of Maryland (Cumberland)
- Frederick Community College
- Hagerstown Community College
Eastern Shore / Southern Maryland
- Wor-Wic Community College (Salisbury)
- Chesapeake College (Wye Mills)
- College of Southern Maryland (La Plata, Leonardtown, Prince Frederick)
- Cecil College (North East)
Employer-Sponsored Programs
Genesis HealthCare, FutureCare, Lorien Health Services, Brightview Senior Living, and Erickson Senior Living run free in-house MBON-approved NATCEPs that refund tuition once you complete a 6-12 month employment commitment.
Military, Spouse, and Nursing-Student Waivers
Maryland recognizes pathways that let qualifying candidates skip the 100-hour MBON-approved program:
Active-Duty Service Members and Veterans
With Joint Base Andrews, Fort Meade, NSA Bethesda, USNA Annapolis, and the Pentagon all in or near Maryland, the state has a high concentration of military medical personnel. Army 68W, Navy HM, and Air Force 4N0X1 ratings can submit DD-214, JST, or active-duty orders. If the JST documents 75+ hours of equivalent training, MBON typically authorizes the candidate to sit for the NNAAP directly.
Military Spouses
Maryland's expedited spouse-licensure provision under Health Occupations Article §1-403 accelerates licensing for spouses of active-duty members assigned to a Maryland base. Spouses holding an active CNA credential in another state can request expedited reciprocity through the Route A-4 endorsement application — MBON targets 30 days.
Nursing Students
If you completed a Fundamentals of Nursing course at an accredited LPN, ADN, or BSN program in Maryland, you can challenge the NNAAP by submitting transcripts and a letter from the Director of Nursing.
Foreign-Educated Nurses
Foreign-educated nurses pre-approved for NCLEX (the standard route into US nursing licensure) automatically qualify under Route A-1. Nurses without NCLEX pre-approval must obtain credential evaluation through CGFNS or an equivalent.
Career Ladder: From CNA / GNA to LPN to RN in Maryland
| Path | Months | Typical MD tuition | Typical wage post-completion |
|---|---|---|---|
| GNA → Medication Technician (CMT) | 60-hour bridge | $400-$900 | $19-$24/hour |
| GNA → LPN (CCBC, Montgomery, BCCC) | 12-18 months | $9,000-$16,000 | $28-$34/hour |
| LPN → RN (ADN) bridge | 12-18 months | $11,000-$19,000 | $36-$44/hour |
| RN (ADN) → BSN online (UMB, Towson, Frostburg) | 12-24 months | $14,000-$24,000 | $40-$52/hour |
Many Maryland long-term care employers reimburse $3,000-$7,500 per year of LPN or RN tuition for CNAs/GNAs who commit to 24+ months of post-graduation employment. Maryland Higher Education Commission's Workforce Shortage Student Assistance Grant also subsidizes tuition for nursing students from CNA backgrounds.
Pass the Maryland CNA / GNA Exam — Free, Today
Our Maryland-aligned course covers every NNAAP subject area, all 25 NNAAP skills, plus reading-comprehension drills, and includes:
- 500+ practice questions matched to the Credentia Maryland Handbook blueprint
- Step-by-step skill checklists with critical steps highlighted
- AI-powered explanations for any wrong answer
- Timed mock exams that match the 70-question format
- Updated April 2026 for current MBON and Credentia rules
No credit card. No paywall. Just pass.
Official Maryland CNA / GNA Resources
- Maryland Board of Nursing — CNA Information
- Maryland Department of Health — Nursing Assistant Certification
- Credentia Maryland Test-Taker Page
- Maryland NNAAP Candidate Handbook (Credentia PDF)
- Credentia Maryland Knowledge Base
- Maryland Nursing Assistant Application (Credentia PDF)
- MBON: 410-585-1900 | Credentia: 888-204-6249
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