Massachusetts CNA Exam 2026: The Complete MA NACE Guide
To work as a certified nursing assistant in any Massachusetts skilled nursing facility, your name must appear on the Massachusetts Nurse Aide Registry (NAR) maintained by the Department of Public Health (DPH). To get listed, you have to pass the Nurse Aide Competency Evaluation (NACE) — a 60-question knowledge test plus a hands-on clinical skills demonstration.
This guide covers everything DPH regulates in 2026: the 75-hour training floor, the 76% passing score, the D&S Diversified Technologies (Headmaster) TMU online registration system that replaced the Red Cross testing contract, four-language testing (English, Spanish, Chinese, Haitian Creole), background checks, the new Health Profession Licensing System renewal flow that launched in December 2023, and the critical steps Massachusetts evaluators mark automatic-fail. Every number here has been cross-checked against the Mass.gov Nurse Aide Registry Program page, the D&S Headmaster Massachusetts candidate handbook, and the DPH vendor-change FAQ, current through April 2026.
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What the Massachusetts Nurse Aide Does (and Who Regulates You)
Massachusetts nurse aides provide direct, hands-on care under the supervision of a licensed nurse: bathing, toileting, vital signs, feeding, ambulation, and observing and reporting changes in resident condition. The role is governed by 105 CMR 156.000 (the DPH regulation that defines nurse aide training and competency) — not the Massachusetts Board of Registration in Nursing. The Board licenses LPNs and RNs. DPH owns the Nurse Aide Registry, and DPH contracts test administration to D&S Diversified Technologies LLP — HEADMASTER.
Federal law (OBRA 1987) requires anyone who works more than four months as a nursing assistant in a Medicare- or Medicaid-certified nursing facility to be on the state registry. Massachusetts's NAR satisfies that requirement and is verified by every long-term care employer before hire.
Settings that require NAR listing:
- Skilled nursing facilities (nursing homes)
- Rest homes participating in Medicare/Medicaid
- Most assisted living residences verify NAR status even when not federally required
Hospitals, home health agencies, hospice programs, and Personal Care Attendant (PCA) programs can employ unlicensed assistive personnel who are not on the NAR, but the overwhelming majority of advertised Massachusetts CNA jobs require active registry status.
Massachusetts CNA Exam Format at a Glance
| Component | Details |
|---|---|
| Knowledge test | 60 multiple-choice questions |
| Knowledge time | 60 minutes |
| Knowledge passing score | 76% — 46 of 60 correct |
| Languages | English, Spanish, Chinese, Haitian Creole (audio/oral available) |
| Skills test | 3 or 4 randomly assigned tasks (including one mandatory task with embedded handwashing) |
| Skills time | 40 minutes total for all tasks |
| Skills passing | 80% on each task, and no missed critical (starred) steps on any task |
| Knowledge fee | $30 written / $40 audio |
| Skills fee | $70 |
| Combined fee | $100 written + skills ($110 audio + skills) |
| Knowledge attempts | 4 within 24 months of training completion |
| Skills attempts | 3 within 24 months of training completion |
| Testing vendor (2026) | D&S Diversified Technologies — HEADMASTER (TestMaster Universe / TMU portal) |
| Registry | nars.dph.mass.gov |
| Renewal portal | healthprofessionlicensing.mass.gov |
Important vendor update: For years, Massachusetts NACE testing was run by the American Red Cross Testing Office in Dedham. DPH has since transitioned to a single statewide testing vendor — D&S Diversified Technologies (Headmaster) — which now administers both the knowledge test and the skills test through the online TestMaster Universe (TMU) portal. The Red Cross still offers nurse aide training, but it is no longer a Massachusetts NACE testing vendor in 2026. If you see older guides quoting a $93 Red Cross fee, they are out of date — the current Headmaster fee structure is $30 + $70 = $100 ($110 with audio).
Massachusetts Training Requirement: 75 Hours Minimum
Massachusetts requires a minimum of 75 hours of instruction from a DPH-approved Nurse Aide Training Program (NATP), split between classroom theory and supervised clinical practice with real residents in a long-term care setting. That is the federal OBRA floor — but many Massachusetts programs exceed it, with 100-hour formats being common at community colleges and hospital-based schools.
Typical Massachusetts program structure:
- 75–100 total hours
- 50–75 hours classroom/lab
- 21–25 hours supervised clinical at an approved long-term care facility
- 3–7 weeks full-time, or 8–12 weeks part-time
- Fully online programs are not permitted in Massachusetts — clinical must be in person
Where to find approved programs:
- DPH-approved NATP list via Mass.gov Nurse Aide Registry Program page
- Community colleges: Bunker Hill, Bristol, Berkshire, Cape Cod, Middlesex, North Shore, Roxbury, Springfield Tech, Quinsigamond
- Hospital-based programs at Mass General Brigham, Beth Israel Lahey, UMass Memorial, Baystate Health
- American Red Cross Training Services (still runs MA training — just not testing)
Typical program costs:
| Program type | Typical cost |
|---|---|
| Free (JVS Boston, IINE Lowell, MassHire, employer OBRA scholarship) | $0 |
| Community college | $800–$1,400 |
| Private/accelerated | $1,400–$2,250 |
Free pathways you should know about:
- JVS Boston — tuition-free CNA training for income-qualifying Greater Boston residents
- IINE Lowell — free training for immigrants and refugees
- MassHire Career Centers — WIOA-funded grants for unemployed/underemployed MA residents
- OBRA 1987 reimbursement — any nursing facility that hires you within 12 months of completion must reimburse your training costs
- Nursing facility-sponsored programs — train for free in exchange for a short work commitment
Background check (CORI/SORI): Massachusetts requires both a Criminal Offender Record Information (CORI) check and Sex Offender Registry Information (SORI) check. Your training program or employer typically initiates and pays for this. Certain disqualifying offenses — abuse, neglect, misappropriation, or specific violent felonies — will prevent registry listing regardless of exam score.
Minimum age: 16 to sit for the exam in most cases; 18 is typically required for employment in a nursing facility.
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Knowledge Test Content Breakdown
The 60-question NACE knowledge test draws from content aligned to the federal OBRA curriculum and the Massachusetts DPH nurse aide curriculum framework. Approximate weighting:
1. Physical Care Skills (~38%)
- Activities of daily living (bathing, dressing, grooming, toileting, feeding)
- Basic nursing skills: vital signs (BP, pulse, respirations, temperature, pain)
- Height, weight, intake and output (I&O)
- Specimen collection (urine, stool — not blood)
- Restorative services: range of motion, ambulation, prosthetic and assistive device care
- Skin integrity and pressure injury prevention
2. Psychosocial Care Skills (~11%)
- Emotional and mental health needs
- Dementia and Alzheimer's care (validation, redirection, reminiscence)
- Cultural, spiritual, and sexual needs of residents
- End-of-life and hospice care
- Depression, anxiety, and behavioral care
3. Role of the Nurse Aide (~51%)
- Communication: resident, family, and interdisciplinary team
- Client/resident rights under OBRA and Massachusetts regulation
- Legal and ethical behavior: abuse, neglect, misappropriation of property, mandatory reporting under M.G.L. c. 111, § 72F–72L
- Member of the health-care team (delegation, scope of practice, shift reporting)
- Safety and infection control: hand hygiene, PPE, standard precautions, fire safety (RACE and PASS)
What Massachusetts CNAs CANNOT Do
Scope-of-practice questions appear on every version of the knowledge test. Massachusetts nurse aides cannot:
- Administer medications (including over-the-counter)
- Perform sterile procedures or sterile dressing changes
- Insert or irrigate urinary catheters
- Insert, remove, or care for feeding tubes beyond basic hygiene around an established site
- Accept orders directly from a physician — orders flow through the licensed nurse
- Perform any task outside the DPH-approved skills list
The Massachusetts Skills Test: 3–4 Tasks in 40 Minutes
Unlike states that assign five skills, Massachusetts uses the D&S Headmaster format: you are assigned one mandatory task (which has handwashing embedded inside it) plus 2 or 3 additional randomly assigned tasks, for a total of 3 or 4 tasks. You have 40 minutes to complete all of them. You must score 80% on each task and hit every critical (starred) step.
You will test in full clinical attire (scrubs, closed-toe shoes, hair pulled back, no long nails, no jewelry beyond a plain band). Skills are demonstrated on live actors; catheter care and perineal care are demonstrated on a manikin.
The Four Mandatory Tasks (One Is Assigned to You)
Every Massachusetts candidate gets exactly one of these four tasks as their mandatory opener — handwashing is embedded inside each:
- Assist resident with bedpan; measure and record urinary output; handwashing
- Provide catheter care (female, on manikin); handwashing
- Don gown and gloves; empty urinary drainage bag and measure/record output; remove and dispose of PPE; handwashing
- Provide perineal care (female, on manikin); handwashing
Additional Randomly Assigned Tasks (2–3 Selected)
| Category | Sample tasks |
|---|---|
| Vital signs | Counting and recording radial pulse; counting and recording respirations; measuring and recording electronic blood pressure |
| Personal care | Partial bed bath; mouth care on a conscious resident; denture care; fingernail care; foot care; dressing a resident with a weak (affected) arm |
| Mobility & positioning | Transfer from bed to wheelchair using a transfer/gait belt; ambulation with a transfer belt; positioning a resident on one side; passive range of motion for shoulder; passive range of motion for knee and ankle |
| Nutrition & elimination | Feeding a dependent resident; applying one knee-high anti-embolism (TED) stocking |
| Other | Making an occupied bed; measuring and recording weight of an ambulatory resident |
Critical (Starred) Steps That Fail the Task
Drop any of these and the task is marked failed regardless of the rest:
- Hand hygiene at the start and end of every task (friction on all surfaces; at least 20 seconds)
- Identify the resident by name and a second identifier (ID band or photo)
- Explain the procedure before touching the resident
- Provide privacy — close the door, pull the curtain
- Lock wheels on bed and wheelchair before any transfer
- Use a transfer/gait belt for standing-pivot transfers and ambulation
- Position the call light within reach before leaving the resident
- Lower the bed to the lowest position before leaving
- Female perineal care: clean front to back, one stroke per area, then turn the cloth
- Measure urinary output at eye level on a flat surface using the graduate
- Check water temperature (inside wrist or thermometer) before any bath
- Support the weak (affected) side when dressing or transferring a resident with one-sided weakness
D&S Headmaster evaluators mark these critical elements with a star on the skill scoring sheet. Memorize them — they are the single biggest difference between pass and retake.
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6-Week Study Timeline (After Your NATP)
| Week | Knowledge focus | Skills focus | Hours |
|---|---|---|---|
| Week 1 | Resident rights, role of the nurse aide, communication | Handwashing (embedded) + donning/doffing gown and gloves | 8–10 |
| Week 2 | Infection control, safety, body mechanics, fire safety | Occupied bed, transfer with gait belt | 10–12 |
| Week 3 | Personal care, ADLs, skin integrity | Partial bed bath, perineal care (manikin), mouth care | 10–12 |
| Week 4 | Vital signs, I&O, nutrition, feeding | Radial pulse, respirations, electronic BP, feeding dependent resident | 10–12 |
| Week 5 | Psychosocial care, dementia, end-of-life, cultural needs | Passive ROM (shoulder, knee/ankle), positioning on side, ambulation | 8–10 |
| Week 6 | Full-length practice tests + weak areas | Timed 40-minute mock run with a partner calling critical steps | 10–15 |
Total recommended review: 55–75 hours after your 75-hour NATP. Massachusetts candidates who pass both portions on the first attempt typically log 60+ hours of post-class review and at least 3 full-length timed mock skills runs.
8 Massachusetts-Specific Pitfalls That Cost Candidates Their Pass
- Using an outdated Red Cross registration packet. The American Red Cross Testing Office in Dedham no longer administers Massachusetts NACE. All registration now goes through the D&S Headmaster TMU portal at hdmaster.com. Fees, forms, and scheduling flow through TMU — a Dedham money order will be returned.
- Confusing DPH and the Board of Registration in Nursing. All NAR matters — training approval, testing, registry listing, renewal, abuse complaints — go to DPH at (617) 753-8144 or nars@mass.gov. The Board of Registration in Nursing handles LPN and RN licensure and will redirect you.
- Letting your 24-month testing window expire. Once you complete your NATP, the clock starts. Miss the window and you must retake the entire 75-hour program.
- Skipping CORI/SORI before the exam. Employers cannot legally hire you until both background checks clear — even if you pass NACE. Initiate CORI/SORI the same week you start training.
- Wearing the wrong attire on skills day. No open-toed shoes. No street clothes. Long hair must be tied back. Artificial nails and nail polish are prohibited. Test sites turn candidates away and you forfeit the fee.
- Forgetting Massachusetts offers testing in four languages. Knowledge test and skills-test instructions are available in English, Spanish, Chinese (simplified and traditional), and Haitian Creole — the last added December 2, 2024. Choose your language in the TMU registration; switching on test day is not allowed.
- Misreading scope-of-practice questions. Massachusetts CNAs cannot administer medications, perform sterile dressing changes, or insert catheters. Multiple-choice questions test these limits in almost every scope item.
- Burning all 4 knowledge attempts (or all 3 skills attempts) inside 24 months. Exhausting attempts voids your eligibility and forces you to complete an entirely new 75-hour DPH-approved NATP before you can retest. Budget retakes — do not wing them.
How to Register for the Massachusetts NACE via TMU (Step-by-Step)
All Massachusetts NACE registration now flows through D&S Headmaster's TestMaster Universe (TMU) portal — there is no separate Red Cross route in 2026.
- Your DPH-approved training program confirms your completion in TMU (Headmaster cannot release the registration until your NATP posts your roster)
- Create a TMU candidate account at hdmaster.com → "Massachusetts CNA"
- Upload your NATP completion certificate, valid photo ID, and any ADA accommodation request
- Choose your language (English, Spanish, Chinese, Haitian Creole) and whether you need the audio version — cannot be changed on test day
- Pay online by credit/debit card: $30 knowledge ($40 audio) + $70 skills
- Select a test date and test site — regional sites include community colleges and hospital-based facilities across MA; remotely proctored knowledge exams are available in approved situations
- Request ADA accommodations at least 10–14 business days in advance with supporting documentation
- Candidate support: (888) 401-0462 (8 AM–8 PM ET Mon–Fri), email massachusetts@hdmaster.com
Results timing: Headmaster typically posts knowledge scores to your TMU account within 5–10 business days; skills results are posted by the test site on the same timeline.
Test-Day Checklist
Bring:
- Valid government-issued photo ID — name must exactly match your TMU registration
- Printed or digital TMU admission confirmation
- Watch with a second hand (for pulse and respirations) — analog only, no smartwatches
- Two pens (blue or black)
Wear:
- Full clinical scrubs (any color)
- Closed-toe, non-slip shoes
- Hair tied back; nails short and unpolished; no artificial nails; no jewelry beyond a plain wedding band and small stud earrings
Arrive:
- 20–30 minutes early
- Cell phone off, in your bag, in the designated cubby — any buzz during the skills exam is grounds for dismissal
Mindset:
- Talk through every step out loud — the evaluator scores what they see and hear
- If you realize mid-task that you skipped a critical step, ask the evaluator if you may redo it before starting the next task; some sites allow self-correction within the same skill
- Do not rush. Average 3–4 task completion comes in well under the 40-minute limit.
After You Pass: NAR Listing, Renewal, and Reciprocity
Getting on the Registry
D&S Headmaster transmits passing scores directly to DPH. Allow up to 30 business days for your name to appear on the public NAR at nars.dph.mass.gov. Employers cannot legally schedule you for unsupervised CNA shifts until your listing is active.
Renewal — Every 24 Months (No Fee, No CEUs)
Since December 4, 2023, Massachusetts CNA renewals run through the Health Profession Licensing System at healthprofessionlicensing.mass.gov. Massachusetts has one of the simpler renewal rules in the country: no fee, no continuing education, no renewal test. Just one requirement every 24 months:
- Work at least 8 consecutive hours of paid nurse-aide work in a qualifying setting during the 24-month period (orientation, training, and unpaid hours do not count)
- Submit renewal through the Health Profession Licensing System
- Upload employer documentation (pay stub, employer letter, or employer attestation) via the built-in document upload
Process your renewal in the 60 days before your expiration date. Allow up to 30 business days for DPH processing. There is no renewal fee.
Qualifying employers: nursing homes, rest homes, hospitals, home health agencies, hospices, assisted living residences, and certain state-licensed long-term care settings.
If You Lapse
A 24-month gap with no qualifying paid work means expired status. To get back on the NAR, you must retest (both knowledge and skills). The 75-hour course is not required again, but you must pass NACE within the 24-month window from your new challenge date.
Interstate Reciprocity (Endorsement)
Moving to Massachusetts with an active out-of-state CNA certification?
| Your situation | Massachusetts path |
|---|---|
| On another state's registry in good standing, active within the last 24 months, and never previously certified in Massachusetts | Apply for reciprocity — no retest, no Massachusetts fee |
| Lapsed >24 months in old state, or no recent qualifying work hours | Apply as a challenge candidate — must pass Massachusetts NACE |
| Never trained as a CNA | Complete a 75-hour Massachusetts DPH-approved NATP first |
How to apply for reciprocity: Complete the Massachusetts Nurse Aide Registry Reciprocity Application (Form 9110) via your TMU account. For the following 10 states, DPH verifies your certification directly with your home-state registry — you complete only the Application Information and Current Registry Information sections:
California, Colorado, Georgia, Louisiana, Missouri, North Carolina, North Dakota, Tennessee, Virginia, Wisconsin.
For all other states, your home-state registry must complete the verification section. Processing takes 2–4 weeks and Massachusetts charges no reciprocity fee.
Leaving Massachusetts? Most states accept Massachusetts CNAs via reciprocity if you are in good standing. Contact the destination state's nurse aide registry directly; they verify through DPH.
Massachusetts CNA Salary and Job Outlook (2026)
Massachusetts CNAs earn well above the national median, driven by Boston-area healthcare wages, aggressive union contracts, and a statewide long-term care staffing shortage.
| Metric | Value |
|---|---|
| Statewide average wage | $18–$22/hour |
| Statewide annual average | $37,800–$45,500 |
| Boston metro median | $21.89/hour (ZipRecruiter, 2026) |
| Top 10% of Massachusetts CNAs | $26+/hour |
| Hospital CNAs (vs. nursing home) | +$2–$5/hour premium typical |
| Travel CNA assignments | $28–$35+/hour with stipends |
| National BLS average | $18.96/hour, $39,430/year |
Major Massachusetts employers: Mass General Brigham, Beth Israel Lahey Health, UMass Memorial Health, Baystate Health, Tufts Medicine, Boston Medical Center, Cape Cod Healthcare, Benchmark Senior Living, Life Care Centers, Hebrew SeniorLife, Genesis HealthCare.
Demand is high. Massachusetts's aging population and ongoing long-term care staffing shortage mean most graduates have a job offer before their NAR listing finalizes. BLS projects 4% growth for nursing assistants through 2033 nationally — Massachusetts tracks slightly higher, especially inside the Route 128 belt.
Career Ladder from CNA
| Next step | Typical timeline | Why Massachusetts CNAs choose it |
|---|---|---|
| Home Health Aide (HHA) add-on | 20–40 add-on hours | Expanded scope for home care and higher hourly pay |
| LPN | 12–18 months | Bridge programs widely available at MA community colleges |
| RN (ADN or BSN) | 2–4 years | Many Massachusetts employers offer tuition reimbursement for working CNAs |
| Surgical Tech / Phlebotomist / EMT | 4–12 months | Lateral moves into hospital-based care |
| Medication Aide (in states that allow it) | 75 add-on hours | Higher pay; Massachusetts does not currently certify med aides, but neighboring states (CT, RI, NH) do |
Pass the Massachusetts CNA Exam with Confidence
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Official Massachusetts CNA Resources
- MA DPH Nurse Aide Registry Program — Main page
- MA DPH Nurse Aide Registry Program Vendor Change FAQs
- MA DPH Information for Nurse Aide Training Programs
- Public Nurse Aide Registry Inquiry System
- Health Profession Licensing System (renewal)
- D&S Headmaster — Massachusetts Nurse Aide Home
- MA DPH Nurse Aide Registry contact: (617) 753-8144 / nars@mass.gov
- D&S Headmaster candidate support: (888) 401-0462 / massachusetts@hdmaster.com / PO Box 6609, Helena, MT 59604
- Massachusetts regulation: 105 CMR 156.000 (Nurse Aide Training and Competency Evaluation)
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