CNA State Exam: How the Skills Test Differs by State

A CNA candidate who trains in Missouri and later moves to New York for work usually assumes the certification exam works roughly the same way everywhere. It does not. There is no single, federally administered CNA test. Federal law sets a floor and each state fills in the rest with its own vendor contract, its own skills pool, and in some cases its own exam entirely.

That floor comes from the Omnibus Budget Reconciliation Act of 1987, which created the Nurse Aide Training and Competency Evaluation Program (NATCEP). Under the implementing regulation at 42 CFR 483.152, a state-approved training program must run at least 75 clock hours, including at least 16 hours of supervised practical training, and the competency evaluation must include both a written or oral component and a skills-demonstration component. Everything above that floor, including who writes the questions, how many skills get tested, and what passing looks like, is left to the state.

The organizations that actually run the exam

CertQuestUSA's practice bank covers 23 states with real CNA competency exams. Researching each state's own health department or testing-vendor documentation turns up four distinct administering models, not one:

Credentia is the company most candidates associate with the name NNAAP (National Nurse Aide Assessment Program). Pearson VUE previously handled NNAAP registration and scheduling in many states; that relationship has changed, and Credentia now runs the program directly through its own CNA365 platform. Based on Credentia's own list of states it serves, it currently administers the exam in California, Colorado, Georgia, Maryland, North Carolina, Pennsylvania, South Carolina, Tennessee, Virginia, and Washington, in addition to states outside CertQuestUSA's current 23, such as Alabama, Alaska, Iowa, Kentucky, Nevada, Rhode Island, and Utah, plus Washington D.C. and several U.S. territories.

Headmaster, LLP, operating jointly with D&S Diversified Technologies, runs its own TestMaster Universe (TMU) platform state by state. Among CertQuestUSA's covered states, the department-of-health-published candidate handbooks confirm Headmaster/D&S as the administering vendor in Arizona, Massachusetts, Michigan, Minnesota, Missouri, Ohio, and Wisconsin. Minnesota is a useful example of how little these contracts stay fixed: the state ran its exam through Pearson VUE until testing moved to Headmaster on February 1, 2022.

Prometric administers the exam in Florida, New York, and Texas among CertQuestUSA's covered states (it also runs Connecticut and Kentucky, which fall outside this article's 23-state set). Prometric's state-specific candidate information bulletins, published directly on prometric.com, spell out each state's written-question count and skills structure separately.

Illinois is its own category. The Illinois Nurse Assistant Competency Exam (INACE) is not run by any of the three national vendors above. It is administered by Southern Illinois University Carbondale on behalf of the Illinois Department of Public Health, through the state's own nurseaidetesting.com portal.

The skills evaluation is not the same test everywhere

The written knowledge test gets most of the study-guide attention, but the part that actually varies most structurally is the hands-on skills evaluation, because each vendor draws from a different-sized skills pool and requires a different number of demonstrations.

Credentia's own California candidate handbook is explicit: candidates are given a randomly selected set of five nurse aide skills, get 30 minutes to complete all five, and must perform all five correctly (not just a passing average) to clear the skills evaluation. Credentia's written test in that same handbook runs 70 multiple-choice questions in English, with an oral version available at 60 multiple-choice plus 10 reading-comprehension questions for candidates who qualify.

Prometric's Texas Candidate Information Bulletin describes a different shape entirely: a 60-question written knowledge test with a 90-minute time limit, paired with a skills exam drawn from 22 possible skill topics, of which three are randomly selected for the candidate to perform. Hand hygiene and professional behavior are scored as part of every skill attempted, which functionally means a candidate is graded on more than the three named tasks.

Headmaster's Arizona candidate handbook specifies a 75-question written knowledge exam with a 76% passing score, and a skills exam requiring 3 to 4 randomly assigned tasks, where the candidate must complete all key steps of each task correctly and at least 80% of the remaining steps. Because Headmaster runs the same TMU testing platform across Arizona, Massachusetts, Michigan, Minnesota, Missouri, Ohio, and Wisconsin, the general two-part structure is consistent across those states, but this article verified exact written-question counts and passing thresholds only for Arizona; a candidate testing through Headmaster in another state should confirm the specific number against that state's own published candidate handbook rather than assume Arizona's figures apply verbatim, since vendor platforms can still carry state-specific contract terms.

Illinois breaks from all three national vendors. The INACE program, run by Southern Illinois University Carbondale for the Illinois Department of Public Health, pairs an 85-question written test (90 minutes, 75% required to pass) with a five-skill demonstration drawn from the state's own skills pool. Both parts must be passed within 24 months of completing an approved training program to be listed on the Illinois Health Care Worker Registry.

New Jersey splits the exam across two separate vendors

New Jersey is the clearest example of how far state contracting can diverge from a clean single-vendor model. The skills evaluation portion is administered by Headmaster/D&S, the same organization running the exam in Arizona, Massachusetts, Michigan, Minnesota, Missouri, Ohio, and Wisconsin. But the written and oral knowledge exam in New Jersey is administered separately, by PSI Services. A candidate studying only from a generic Headmaster-format guide, or only from a generic PSI-format guide, is preparing for half the actual exam.

Indiana is the honest gap in this comparison

Indiana does not fit any of the three national-vendor categories above. According to the Indiana Department of Health's own nurse aide program page, the CNA competency exam is administered directly by Ivy Tech Community College on the department's behalf, not by Credentia, Headmaster, or Prometric. Secondary sources disagree on the exact written-question count, with figures ranging from 60 to 100 questions depending on the source, and this article is not going to average those numbers into a false precision. Indiana candidates should get the current written-question count, time limit, and passing score directly from Ivy Tech's CNA testing page or by calling Ivy Tech's program office, not from a third-party guide, including this one.

Why the differences matter for how a candidate should actually study

The practical consequence of this fragmentation is that a state-agnostic CNA study guide is guessing at the skills count, the written-question count, or both. A candidate preparing for Texas needs to know they will perform three skills out of a 22-topic pool with hand hygiene scored on every attempt; a candidate preparing for California needs to know they will perform all five randomly assigned skills correctly in a 30-minute block with no partial credit for four out of five. Those are different test-taking strategies, not just different trivia.

Renewal cycles, number of retest attempts allowed, and reciprocity rules follow the same pattern: they are set by each state's nurse aide registry under its own administrative code, not standardized by NATCEP or by the testing vendor. A vendor administers the exam under contract; it does not set state policy on how many times a candidate can retest or how long a certification stays active before requiring renewal. Any guide that states a single national number for retest attempts or renewal length is either wrong or quietly only describing one state.

The state-by-state vendor table above is CertQuestUSA's attempt to be the first published, sourced comparison of testing organization and skills-evaluation structure across the states it covers, built from each vendor's or state health department's own published documentation rather than from aggregator sites that still list Pearson VUE as the NNAAP administrator years after that relationship changed.

Why so many guides still get the vendor wrong

Pearson VUE's name is still attached to NNAAP across a large share of CNA prep content published before 2024, because for years Pearson VUE handled registration and scheduling for the NNAAP program in many states. That relationship has changed, and Credentia now runs NNAAP directly through its own CNA365 platform. Minnesota shows the same pattern from a different angle: the state ran its exam through Pearson VUE until testing moved to Headmaster on February 1, 2022, a change some third-party guides still have not caught up to years later. A candidate who registers based on an outdated vendor name risks showing up at the wrong portal or studying a format the state no longer uses.

This is also why CertQuestUSA verified every vendor listed in the table above directly against that vendor's own current state page or the state health department's own nurse aide program page, rather than against secondary aggregator sites that copy each other's tables without re-checking them. Contracts change; Minnesota's 2022 switch and Credentia's takeover of NNAAP registration are proof that a table published once and never revisited goes stale.

How to confirm your own state before test day

Because vendor contracts and skills pools change, and because this article could only independently verify exact written-question counts and passing thresholds for a subset of states even after direct primary-source research, a candidate's safest move before enrolling in any prep course is to pull their own state's current official candidate handbook. For Credentia states, that means the state-specific handbook published at that state's kb-[state].credentia.com knowledge base. For Headmaster/D&S states, it means the state-specific candidate handbook published at hdmaster.com. For Prometric states, it means the state-specific Candidate Information Bulletin published directly at prometric.com. For Illinois, it means the official INACE materials at nurseaidetesting.com. Skipping that step and studying from a generic, unbranded 'CNA practice test' that does not specify which state's skills pool and question count it is modeling is the single most common way candidates over- or under-prepare for the wrong version of the exam.

The broader point stands regardless of which of the 23 states a candidate is testing in: the CNA credential is real, the underlying nursing skills tested are largely consistent in substance across states, but the administrative shape of the test itself, who runs it, how many skills get demonstrated, how long the written section takes, is a state-by-state decision that changes on its own schedule and deserves the same direct verification a candidate would give to any other licensing requirement.