Missouri CNA Practice Test — Free NNAAP Prep

Missouri employs roughly 30,000 certified nursing assistants — a workforce slightly larger than its population share would suggest, because the state has one of the highest per-capita counts of skilled nursing facilities in the country. Missouri operates more than 500 licensed nursing homes plus a large assisted living and residential care sector, and chronic shortages have been documented in nearly every region. The Missouri Department of Health and Senior Services has flagged direct-care workforce capacity as one of the state's top long-term care policy issues.

Demand is concentrated in the two major metros — St. Louis and Kansas City — but the Springfield/Branson area, mid-Missouri (Columbia/Jefferson City), and the Bootheel face equally tight or tighter shortages. Rural Missouri facilities consistently offer sign-on bonuses, shift differentials, and tuition assistance that metro hospital systems often don't match. The state's significant veterans' population also supports a strong VA and state veterans-home CNA hiring pipeline.

The average CNA wage in Missouri is approximately $15.50/hour. Missouri taxes earned income on a graduated scale topping out under 5%, and cost of living statewide is well below the national median — Springfield, Columbia, Jefferson City, and most of the Ozarks remain among the most affordable healthcare-job markets in the country. A Missouri CNA wage typically buys substantially more housing than the same wage in Illinois, Colorado, or any coastal market.

Missouri requires 75 hours of state-approved Certified Nurse Assistant training — the federal minimum — though most Missouri programs run longer because the state mandates additional skills-lab and clinical hours on top of the classroom theory. Programs are offered through community colleges, career centers, vocational schools, and many Missouri nursing facilities that train candidates in exchange for an employment commitment. Many Missouri high schools also operate accredited CNA programs that allow students to graduate already certified.

The exam is administered by HDmaster (D&S Diversified Technologies) under contract with the Missouri Department of Health and Senior Services — Missouri is not a Prometric state. The written portion covers the standard nurse aide content domains, and the manual skills portion requires demonstrating randomly selected hands-on skills in front of an HDmaster-approved evaluator. Once you pass, your name is added to the Missouri CNA Registry.

You have up to 3 attempts to pass both portions of the exam. If you fail all three, Missouri requires you to complete a new approved training program before retesting. Register through the HDmaster Missouri nurse aide testing portal once your training program submits your eligibility.

The largest CNA employers in Missouri include BJC HealthCare and SSM Health in St. Louis, Saint Luke's Health System and Children's Mercy in Kansas City, CoxHealth and Mercy Springfield in southwest Missouri, University of Missouri Health Care in Columbia, and the Veterans Affairs medical centers in St. Louis, Kansas City, and Columbia. BJC and Mercy together run one of the largest hospital footprints in the central US and offer structured CNA-to-LPN and CNA-to-RN pipeline benefits, though most prefer 6–12 months of facility experience before hiring new CNAs into acute care.

Long-term care operators are the most common entry point for new Missouri CNAs. Americare (Missouri-headquartered), Bethesda Health Group, Lutheran Senior Services, Delmar Gardens, NHC HealthCare, and dozens of independent SNFs hire new graduates aggressively. Many will pay for your training program in exchange for a 6- to 12-month employment commitment.

Home health is a strong and growing employer in Missouri, particularly across the Ozarks and rural northern Missouri where facility beds are scarce. BAYADA, Phoenix Home Care & Hospice (Missouri-founded), Addus HomeCare, Integrity Home Care, and Interim HealthCare recruit CNAs statewide. Home health in Missouri typically requires a reliable vehicle, but offers scheduling flexibility and per-visit pay that often beats facility hourly rates.