Care-worker training requirements by state
Federal rules set training floors for home health aides, nurse aides, and hospice aides. For personal care aides, direct support professionals who serve people with developmental disabilities, and staff who give medications, each state writes its own rules. The rules differ on hours, testing, who approves the course, and whether an employer can write it. This page maps those rules in 13 states from the regulations and agency guidance.
Washington requires 75 hours and a state exam before a home care aide is certified; California requires 5 hours for a registered home care aide. In Colorado, Illinois, Minnesota, Pennsylvania, and Texas, a licensed home care agency writes its own aide training without state pre-approval. New York requires its own curriculum for every aide program.
Why these rules matter now
The training rules on this page govern the occupation projected to add one in seven new U.S. jobs over the next decade, as the population that needs care grows fastest.
The oldest group grows 35 times faster than the working-age pool
Projected change in U.S. population by age, 2025 to 2035
85 and older: 7.05 million to 11.18 million. 18 to 64: 203.8 million to 207.1 million.
Fewer aides per person aged 85 and older, even with projected job growth
Home health and personal care aide jobs per 1,000 people aged 85 and older
A 25 percent drop, although aide jobs grow by 847,300, one in seven of all projected new U.S. jobs.
8.2 million people need help with bathing, dressing, or other self-care
People with a self-care difficulty, by age, 2024
15.8 million adults have difficulty doing errands alone, such as visiting a doctor or shopping.
Nearly nine in ten aide openings replace a worker who left
Average annual openings for home health and personal care aides, 2025 to 2035
Each opening is a new worker to train under the rules on this page before the first shift.
What federal rules require
Medicare and Medicaid set training and competency floors for three aide roles. A Medicare home health agency may train its own aides: training “may be offered by any organization except by an HHA that, within the previous 2 years,” had listed sanctions, and in-service training “may be offered by any organization” (42 CFR 484.80(d), (f)). A nursing facility may run its own nurse aide program unless it was sanctioned in the prior two years (42 CFR 483.151(b)(2)).
| Worker | Initial training | Ongoing | Competency | Rule |
|---|---|---|---|---|
| Home health aide (Medicare agency) | 75 hours: at least 16 classroom hours before 16 supervised practical hours | 12 hours every 12 months | A registered nurse observes listed skills on a patient or a stand-in | 42 CFR 484.80(b)-(d) |
| Nurse aide (nursing facility) | 75 clock hours: 16 supervised practical, 16 before any resident contact | 12 hours a year, including dementia and abuse prevention | State exam: written or oral, plus a skills demonstration | 42 CFR 483.152, 483.154, 483.95(g) |
| Hospice aide | Same 75-hour structure as home health aides | 12 hours a year | Competency evaluation; registered nurse supervisory visit every 14 days | 42 CFR 418.76 |
| Child care provider paid with federal subsidy | Within 3 months: 11 health and safety topics plus child development | Set by the state | Fingerprint background check, repeated every 5 years | 45 CFR 98.41, 98.43, 98.44 |
| Personal care aide, direct support professional, medication aide | No federal hour minimum | No federal minimum | Set by the state | State rules (table below) |
What each state requires
One row per state rule and worker type. “Who writes the content” records whether the state requires its own curriculum, approves content a provider writes, or leaves the content to the provider. Skills checks stay in person in nearly every state, even where classroom hours may be taken online.
Who can supply the training
How many people one home may serve
Small care settings run in a private home are capped by state law. Each is a small employer that answers to a state training rule.
| State | Setting | Limit | Rule | Source check |
|---|---|---|---|---|
| Washington | Adult family home | 6 residents; 8 with state approval | RCW 70.128.010, .066 | Official text |
| Oregon | Adult foster home | 5 residents; 1 caregiver per 5 | OAR 411-049-0105 | Official text |
| Florida | Adult family-care home | 5 residents | F.S. 429.65 | Official text |
| Minnesota | Adult foster care | 4; 5 if all residents are 55 or older | Minn. Stat. 245A.11, subd. 2a | Official text |
| Arizona | Adult foster care home | 1 to 4 residents | A.R.S. 36-401 | Official text |
| Michigan | Adult foster care family home | 3 to 6 residents | MCL 400.703 | Official text |
| Colorado | Host home (developmental disabilities) | 3 persons | HB26-1147; CDPHE | Official text |
| Ohio | Type B family child care home | 1 to 7 children, at most 3 under age 2 | OAC 5180:2-13-01, -18 | Official text |
| Ohio | Type A family child care home | 8 to 14 children; 7 per staff member | OAC 5180:2-13-01, -18 | Official text |
| Massachusetts | Family child care home | 6 children under 16, including the provider’s own | G.L. c.15D s.1A | Official text |
| Massachusetts | Large family child care home | Up to 10 children | 606 CMR 7.00 | Older official copy |
| Illinois | Day care home | 8 children with 1 caregiver | 23 Ill. Adm. Code 2007 | Official text |
| North Carolina | Family child care home | More than 2, fewer than 11 children | G.S. 110-86 | Official text |
Care programs and Workforce Pell
Workforce Pell pays for programs of 150 to 599 clock hours over 8 to 14 weeks (34 CFR 690.92). The federal floor for nurse aides and home health aides is 75 hours. On state Eligible Training Provider Lists, about half of the nursing assistant listings that report their length and two-thirds of such home health aide listings run under 150 hours.
| Occupation | ETPL listings | Median hours | Under 150 hours | In the Workforce Pell window | Median tuition and supplies | Completed of exiters | Employed Q2 of exiters |
|---|---|---|---|---|---|---|---|
| Nursing assistants | 2,057 | 152 | 49% | 268 (18%) | $1,339 | 84% | 53% |
| Home health and personal care aides | 358 | 80 | 66% | 17 (7%) | $948 | 86% | 47% |
| Childcare workers | 226 | 656 | 12% | 2 (1%) | $3,605 | 57% | 35% |
Listings whose first occupation code is 31-1131, 31-1120 to 31-1122, or 39-9011. Hours are listed hours per week times listed weeks. Outcomes are summed across listings that report them, for each listing’s reporting period before Workforce Pell began.
The earnings test
Under 34 CFR 690.95, a program’s value-added earnings are its completers’ median earnings, adjusted for state prices, minus 150 percent of the poverty line for one person; tuition and fees may not exceed that amount. Nearly every care certificate program clears zero, but with the smallest margin of any field except cosmetology.
| Field | Programs | Median first-year earnings | Median value-added | Above zero | At least $3,000 | Rank, lowest first |
|---|---|---|---|---|---|---|
| Practical nursing and nursing assistants (51.39) | 153 | $26,557 | $5,476 | 98.0% | 82% | 2nd of 36 |
| Human development and family studies, incl. child care (19.07) | 77 | $27,950 | $6,547 | 97.4% | 91% | 3rd of 36 |
| All other fields | 2,537 | $39,556 | $18,633 | 99.5% | 98% |
Post-Secondary Employment Outcomes (Census, release R2026Q2, 2023 dollars): certificates under one year, graduates of 2016 to 2020, 29 states. Earnings divided by the 2023 BEA state price parity, minus $21,870 (150 percent of the 2023 one-person poverty guideline; higher in Alaska and Hawaii). Rank among 36 fields with 20 or more programs; cosmetology is lowest. PSEO covers all graduates in a 4-digit field; the rule measures Pell completers in a 6-digit field, and the nursing field includes some practical nursing certificates.
How to read this map
- Sources
- Each row names the regulation, statute, or agency guidance it comes from. Federal rules were read in the Electronic Code of Federal Regulations as of November 4, 2026. State rules were read on official state sites where they allow it.
- Source check
- “Official text” means the state’s own register, code, or statute site. “Copy of official text” means a reprint such as Cornell’s Legal Information Institute, used where the state site refused automated reading; those rows were compared with official copies where any could be reached. “Older official copy” means an official version that may predate later amendments. “Agency guidance” means a program manual or agency page rather than the rule itself.
- Not confirmed
- A cell reads “Not confirmed” where the rule was found but the specific point (hours, online delivery, who writes content) could not be confirmed at a source. Worker types a state regulates but that could not be confirmed at all are left out: Colorado direct support rules, Massachusetts homemaker hours, and New York’s adult family home capacity among them.
- Demand figures
- Jobs and openings: BLS Employment Projections 2025-35, Table 1.2 (home health and personal care aides, 31-1120; all occupations). Population: Census Bureau 2023 National Population Projections, middle series. Aide jobs per 1,000 people aged 85 and older divides projected aide employment by the projected 85 and older population. Self-care and independent living difficulty: American Community Survey 2024 1-year, table S1810, civilian noninstitutionalized population. Waiting lists: KFF Medicaid HCBS Waiver Program Survey, FY2026. Turnover: National Core Indicators State of the Workforce 2024 (27 states) and the CMS Payroll-Based Journal staff turnover measure, October 2026. Child care homes: National Center on Early Childhood Quality Assurance.
- Coverage
- 13 states: the nine that combine the largest aide workforces, binding training rules, Medicaid home care spending, and Workforce Pell activity, plus California, Texas, Florida, and Colorado. Other states are not yet mapped.
- Versioning
- Version 1, November 6, 2026. Rules change: Connecticut adds 8 paid training hours plus 8 a year from January 1, 2027; Massachusetts home care regulations are pending; Indiana cut nurse aide training to 75 hours in 2025. Data files are dated and are not overwritten.
- Short ETPL programs against the Workforce Pell standards: completion and employment for every program in the length window.
- State Implementation Record: every state’s Workforce Pell status and named programs.