I've said this before, your CNA exam is administered by your state's Board of Nursing or designated testing agency. The written exam content is similar across states (based on the NNAAP® blueprint), but the registration process, testing vendor, clinical skills requirements, and reciprocity rules vary significantly. This guide covers the four most populous states — together representing over 40% of all CNAs in the U.S.
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California (CA)
- Testing Vendor: D&S Diversified Technologies / Headmaster (d&sdt-headmaster.com)
- Exam Name: California Nurse Aide Competency Exam
- Training Required: 60 hours classroom + 100 hours clinical (160 total)
- Written Exam: 70 multiple-choice questions, 2 hours
- Skills Test: 3–5 skills demonstrated, 25–40 minutes
- Passing Score: 70% written, 100% per skill (critical elements must be perfect)
California-Specific Details
Knowledge Exam Fee (Effective March 1, 2026): $40 (standard), $45 (audio version)
Skills Test Fee: $100
Total Exam Cost: $140 (combined)
Skills Handbook: Available at hdmaster.com under California Nurse Aide → Candidate Handbook. The California skills list follows the Credentia NNAAP® framework with 23 skills arranged alphabetically (Hand Hygiene listed first as a reminder).
California-Specific Written Exam Focus:
- Mobility and positioning — California emphasizes falls prevention and safe patient handling
- Dementia and Alzheimer's care — significant portion of California's long-term care population
- Infection control protocols — strict adherence required post-COVID updates
- Resident rights under California law — additional state-specific protections beyond federal
Clinical Skills Critical Elements (CA):
- Hand hygiene is required before and after EVERY skill — missing this = automatic fail
- Privacy must be provided (curtain, screen, or door) for all personal care skills
- Bed must be in low position with wheels locked before leaving patient
- Signaling device must be within patient's reach after every skill
California CNA Registry: Maintained by the California Department of Public Health (CDPH). Renewal every 2 years; must work at least 8 hours in a paid nursing-related role during each 24-month period.
Reciprocity: California accepts CNAs from other states if the training meets California's 160-hour requirement and the candidate passes the California competency exam.
Where to Apply: TULIP system (cdph.ca.gov) or through D&S Headmaster website.
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New York (NY)
- Testing Vendor: Prometric (prometric.com/exams/nurseaide-ny)
- Exam Name: New York State Nurse Aide Exam
- Training Required: 100 hours minimum (including 30 hours clinical)
- Written Exam: 60 multiple-choice questions, 90 minutes
- Skills Test: 3–5 skills demonstrated, 25–40 minutes
- Passing Score: 70% written, 100% per skill
New York-Specific Details
Exam Fees: Knowledge Exam $40, Skills Test $68 (as of 2026)
Total Exam Cost: $108
New York-Specific Written Exam Focus:
- NYSDOH (New York State Department of Health) regulations — know the state's specific resident rights and abuse reporting laws
- Infection control and PPE protocols — New York has strict facility-level protocols
- Cultural competence — New York's diverse population requires specific cultural sensitivity training
- Documentation standards — NY facilities use specific charting formats
Clinical Skills (NY):
- Prometric administers the NNAAP® skills evaluation in NY
- Most tested skills in NY: Hand hygiene, radial pulse, blood pressure, perineal care, transfer with belt
- Critical: New York requires documentation of 100 training hours through a state-approved program before you can even register for the exam
New York CNA Registry: Maintained by the New York State Department of Health. Renewal every 2 years with proof of 8 hours paid work in the 24-month period.
1199SEIU Union: Many New York CNAs are represented by 1199SEIU; union members may have access to free training programs and exam fee reimbursement.
Reciprocity: New York has a formal reciprocity process — CNAs certified in other states can apply for NY certification by endorsement if their training meets NY's 100-hour requirement.
Where to Apply: prometric.com → Nurse Aide → New York
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Texas (TX)
- Testing Vendor: Prometric (Prometric handles TX NATCEP exams)
- Exam Name: Texas Nurse Aide Competency Evaluation
- Training Required: 60 hours classroom + 40 hours clinical (100 total)
- Written Exam: 70 multiple-choice questions, 2 hours
- Skills Test: 3–5 skills demonstrated, 25–40 minutes
- Passing Score: 70% written, 100% per skill
Texas-Specific Details
Exam Fees: Written $35, Skills $45 (as of 2026)
Total Exam Cost: $80
Texas-Specific Written Exam Focus:
- Texas Health and Safety Code Chapter 250 — know the state's nurse aide laws
- Employee Misconduct Registry (EMR) — Texas maintains a separate misconduct registry; CNAs listed cannot work in facilities
- Long-term care regulations — Texas has specific rules for nursing facilities under HHSC (Health and Human Services Commission)
- Spanish-language support — Texas offers the written exam in Spanish through Prometric
Clinical Skills (TX):
- TULIP System: All applications go through Texas Unified Licensure Information Portal (TULIP)
- Critical steps emphasized in TX: Hand hygiene, privacy, bed positioning, signaling device within reach
- HHSC Computer-Based Training (CBT): Texas offers a 60-hour online classroom option + 40 hours clinical for those who can't attend in-person training
Texas CNA Registry: Maintained by Texas Health and Human Services (hhs.texas.gov). Renewal every 2 years with 8 hours paid work in the 24-month period.
Reciprocity: Texas accepts CNAs from other states via reciprocity if the original training meets Texas's 100-hour requirement. Apply through TULIP.
Unique Texas Rule: If you fail the exam 3 times, you must complete an additional 100-hour state-approved training program before retesting.
Where to Apply: hhs.texas.gov → Nurse Aide Registry → TULIP
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Florida (FL)
- Testing Vendor: Prometric
- Exam Name: Florida Nursing Assistant Competency Exam
- Training Required: None required for "challenge the test" option (but 120 hours recommended)
- Written Exam: 60 multiple-choice questions, 90 minutes
- Skills Test: 3–5 skills demonstrated, 25–40 minutes
- Passing Score: 70% written, 100% per skill
Florida-Specific Details
Exam Fees: Written $35, Skills $45 (as of 2026)
Total Exam Cost: $80
Florida-Specific Written Exam Focus:
- Florida Administrative Code Chapter 64B9 — nursing assistant scope of practice under Florida Board of Nursing
- Hurricane/disaster preparedness — unique to Florida; know emergency evacuation procedures for long-term care facilities
- Elder abuse reporting — Florida has strict mandatory reporting laws with specific hotline (1-800-962-2873)
- Background screening (Level II) — Florida requires ORI# EDOH0380Z fingerprinting through approved vendors
Clinical Skills (FL):
- Challenge the test: Florida allows candidates to take the exam without completing a training program if they are 18+ and pass the competency exam — this is unique among major states
- If you completed training within 6 months: You only need to take the written portion (skills are waived)
- Most tested skills in FL: Hand hygiene, vital signs, feeding, perineal care, dressing with weak side
Florida CNA Registry: Maintained by Florida Board of Nursing (floridasnursing.gov). Renewal every 2 years with 8 hours paid work in the 24-month period.
Background Screening Requirement: House Bill 975 (2024) requires electronic fingerprinting (Level II background screening) through an approved vendor. Your application cannot be approved without it.
Reciprocity: Florida accepts out-of-state CNAs by endorsement. Submit application through floridasnursing.gov with proof of current certification and background screening.
Unique Florida Rule: If you fail the exam 3 times, you must complete an approved training program before retesting — unlike the "challenge" option for first-time takers.
Where to Apply: floridasnursing.gov → Certified Nursing Assistant → Apply by Examination
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State Comparison at a Glance
| Testing Vendor | D&S Headmaster | Prometric | Prometric | Prometric |
| Training Hours | 160 (60 class + 100 clin) | 100 min (30 clin) | 100 (60 class + 40 clin) | 0 (challenge allowed) |
| Written Exam | 70 Qs, 2 hrs | 60 Qs, 90 min | 70 Qs, 2 hrs | 60 Qs, 90 min |
| Skills Test | 3–5 skills | 3–5 skills | 3–5 skills | 3–5 skills |
| Exam Fee | $140 total | $108 total | $80 total | $80 total |
| Renewal | Every 2 yrs | Every 2 yrs | Every 2 yrs | Every 2 yrs |
| Work Req for Renewal | 8 hrs/24 mos | 8 hrs/24 mos | 8 hrs/24 mos | 8 hrs/24 mos |
| Unique Feature | Highest hour req | 1199SEIU union | TULIP system | "Challenge" allowed |
| 3-Fail Rule | Retrain required | Retrain required | Retrain required | Retrain required |
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Key Takeaways
- California has the highest training hour requirement (160) and highest exam fee ($140).
- New York requires exactly 100 training hours and uses Prometric; union support available via 1199SEIU.
- Texas uses the TULIP system for all applications; fails 3 times = mandatory retraining.
- Florida uniquely allows "challenging the test" with no training required (must be 18+).
- All four states use 70% passing for written and 100% accuracy per skill for clinical.
- All four states require 8 hours of paid work in 24 months to renew certification.
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Conclusion
Most CNA study guides treat the exam as one-size-fits-all. It's not. California's 160-hour training requirement, Florida's "challenge the test" option, Texas's TULIP system, and New York's union pathways are all major differences that affect how you prepare and register. Use this guide to focus on the rules, vendor, and emphasis areas specific to your state — and you'll walk into exam day knowing exactly what to expect.