1.2 Training, Eligibility, and Attempts
Key Takeaways
- Missouri's approved CNA basic course is 175 hours: 75 instructional hours, 100 supervised on-the-job training hours, and a final examination.
- Most Missouri CNA students must be at least 18 and employable; 16-year-old students are limited to specific secondary-school health occupation pathways.
- Newly trained candidates must complete testing within one year of the training start date, not one year from whenever they feel ready.
- Standard candidates have three attempts; challenge candidates get one approved attempt and must complete the course if they fail.
The Missouri Training Route
Missouri is not a 75-hour-only CNA state. Section 198.082, RSMo, and 19 CSR 30-84.010 require a state-approved nursing assistant training program with at least 75 classroom or instructional hours and 100 supervised on-the-job training hours. The regulation defines the basic course as those two components plus the final examination. DHSS's CNA page summarizes the same path: 75 classroom hours, 100 on-the-job training hours, and a two-part final examination that includes written or oral knowledge testing and a practicum.
The purpose of the training rule is practical bedside readiness. The program is meant to prepare an individual for employment as a CNA by teaching resident-care skills that qualify the person to perform uncomplicated nursing procedures and assist licensed practical nurses (LPNs) or registered nurses (RNs) in direct resident care. That wording is important. Missouri is not training CNAs to assess independently, diagnose, or improvise a care plan; it is training aides to perform delegated care safely under licensed-nurse supervision.
Course Components to Remember
| Component | Missouri requirement | Exam implication |
|---|---|---|
| Instructional training | 75 hours in required curriculum areas | Know rights, infection control, safety, communication, basic care, restorative care, cognitive care, and reporting |
| Supervised on-the-job training | 100 hours in an approved setting under LPN or RN supervision | Skills are learned with residents or approved lab-style practice, not only from reading a checklist |
| Final examination | Knowledge plus practicum or skills | Passing class hours alone does not create registry status |
| Before direct resident contact | Medicare or Medicaid facility students must complete initial required instruction in communication, infection control, safety, independence, and rights | A student may not safely start resident contact before required orientation content |
| Student task limits | A student may not perform services for which they have not been trained and found proficient | Comfort or prior experience is not enough if the instructor has not checked proficiency |
A trainee who says, "I watched this transfer last week, so I can do it alone today" should ask the instructor, clinical supervisor, or licensed nurse first. Missouri links resident contact to training, proficiency, and supervision.
Eligibility, Reciprocity, and Challenge Paths
Most Missouri CNA class entrants must be at least 18 years old and employable. Employable means the person is not on the department's Employee Disqualification List and does not have disqualifying criminal history unless a good cause waiver has been granted. A 16-year-old fits only a narrower secondary-school health occupation or cooperative work pathway with direct clinical supervision.
A facility hire who is not yet certified is another common Missouri scenario. Section 198.082 requires enrollment in the first available approved program scheduled to start within 90 days of employment, with completion within four months. The DHSS FAQ states the practical rule: certification within 120 days, or four months, of the facility start date.
Main Pathways
| Pathway | Who uses it | Missouri-specific caution |
|---|---|---|
| Standard course | New candidates completing the 175-hour approved program | Testing must be completed within one year of the training start date |
| Reciprocity | A CNA active and in good standing on another state's registry | Missouri reviews documentation before adding the aide to MOCNAR; moving does not automatically transfer certification |
| Challenge | Certain nursing students, UAP-qualified candidates, inactive Missouri CNAs, or other DHSS-approved backgrounds | Challenge approval is for one attempt; failing either component means taking the full course |
| Inactive Missouri CNA | A CNA with a two-year break in qualifying employment | May need to challenge the exam if unable to document work |
| Expired Missouri CNA | A CNA with a five-year break in qualifying employment | DHSS FAQ warns the person may be required to retake the course |
Do not blur reciprocity and challenge. Reciprocity is for an active, good-standing out-of-state CNA asking Missouri to add them to MOCNAR. Challenge is permission to take Missouri's final examination without completing the entire basic course.
Timing, Fees, and Attempt Rules
The current handbook says a newly trained nurse aide candidate must pass both the knowledge and skills exams within one year of the training start date. That clock is not one year after graduation or one year after the first failed test. If the year passes, another Missouri DHSS-approved program is required before scheduling.
Standard candidates have three attempts to pass the knowledge and skill portions. The handbook states that a person who fails the final examination, except a challenge candidate, has the opportunity to retake it twice within 90 calendar days of the initial examination. If the individual fails the final examination a third time, the entire basic course must be retaken before another examination can be given. When only one portion is failed, the candidate pays for and schedules the failed portion before retesting.
The DHSS FAQ currently lists the Missouri CNA exam at $135 total, split into $32 for knowledge and $103 for skills. The audio knowledge option adds $10.
Attempt Scenario Traps
- A standard candidate fails skills once and knowledge passes. The next step is to retake and pay for the failed skills portion, not repeat both parts automatically.
- A candidate waits thirteen months from the training start date before trying to schedule. The safer answer is that the candidate needs another approved training program before testing.
- A nursing-program student receives challenge approval and fails knowledge. Challenge approval does not create three standard attempts; the full CNA course is required after the failed challenge attempt.
- A 17-year-old who is not in the secondary-school pathway asks to enroll like an adult candidate. Missouri's regulation does not treat that as the ordinary adult enrollment path.
Know when training started, confirm your instructor entered completion in TMU, make sure your legal name matches your ID, and schedule early enough for a failed portion to be retaken.
A newly trained Missouri CNA candidate started class on February 1, 2026, finished later in the spring, and has not tested by February 10, 2027. What is the key eligibility issue?
Which candidate is using the reciprocity path rather than the challenge path?
A standard Missouri candidate fails the skills portion for the third time. What happens before another CNA final examination can be given?