Isaac Prentice
May 13, 2026
If you are planning to become a home health aide, the requirements in your specific state will shape your training path more than anything else. Hours, exams, clinical evaluations, registry rules: all of it varies depending on where you live and where you plan to work.
Federal guidelines from the Centers for Medicare and Medicaid Services (CMS) require a minimum of 75 training hours for home health aides working for Medicare or Medicaid-certified agencies. Individual states may set higher minimums. Most states also require a competency evaluation that includes a written test and a supervised clinical skills component. For a complete walkthrough of the certification process from enrollment to registry listing, read our complete guide to becoming a home health aide in 2026.
Any home health agency that accepts Medicare or Medicaid reimbursement must employ HHAs who have completed at least:
These standards are established under the Omnibus Budget Reconciliation Act (OBRA) and enforced by CMS. States may — and frequently do — set requirements that exceed this federal floor. Always verify your specific state’s current rules directly with your state health department before enrolling in any program.
NCOOA’s home health aide online course is built around the CMS 75-hour curriculum standard and covers all 12 federally required competency areas, making it a strong foundation regardless of which state you plan to work in.
| State | Min. training hours | Clinical hours | Notes |
| California | 120 hours | Included | One of the highest requirements |
| Colorado | 80 hours | 16 hours | Skills evaluation required |
| Connecticut | 75 hours | 16 hours | Renewal required every 2 years |
| Florida | 40 hours | 16 hours | State registry required |
| Georgia | 40 hours | 16 hours | Employer may require more |
| Illinois | 40 hours | 16 hours | Many employers require 75+ |
| Maryland | 100 hours | 16 hours | State competency evaluation |
| Massachusetts | 75 hours | 16 hours | Renewal with CEUs required |
| New York | 75 hours | 16 hours | Competency evaluation required |
| Ohio | 75 hours | 16 hours | Skills evaluation required |
| Pennsylvania | 60 hours | 16 hours | CPR often included |
| Texas | 60 hours | 16 hours | Background check required |
Note that employer requirements often exceed state minimums — particularly in Illinois and Georgia, where many agencies require 75 or more hours regardless of the state floor. Always confirm requirements with both your state registry and your target employer before enrolling.
For context on how HHA hour requirements compare to other caregiver credentials, see our full comparison: CNA vs HHA vs PCA — what’s the difference?
The CMS home health conditions of participation specify that every HHA competency evaluation must cover these 12 areas:
Every one of these competency areas is covered in NCOOA’s HHA certification curriculum. For a broader look at the skills that employers value most in patient care roles, read our guide on top skills for patient care workers.
The HHA competency evaluation has two components in most states.
Written knowledge test
A multiple-choice or written exam covering the 12 federally required competency areas. Most states administer this through an approved testing organization or employer-based evaluation process.
Clinical skills evaluation
A supervised hands-on demonstration of safe patient care skills, observed by a registered nurse or licensed therapist. Common evaluated skills include vital sign measurement, safe transfer techniques, personal hygiene assistance, and infection control procedures.
Both components must be passed before you can be listed on your state’s HHA registry and begin working with patients independently. For a detailed explanation of how online training satisfies these requirements, read our guide: is online HHA training accepted?
Most states maintain an HHA registry — a publicly searchable database of certified home health aides in good standing. Employers are required to verify registry status before assigning aides to patient cases.
Maintaining an active registry listing is essential to continued employment. A lapsed or inactive registry status can result in immediate suspension from patient contact until the issue is resolved. For everything you need to know about keeping your certification current, read our guide on HHA certification renewal.
Employers and agencies can verify candidate credentials through NCOOA’s certification verification page.
In addition to training hour and competency requirements, HHAs working in home settings are subject to workplace safety standards governed by OSHA’s bloodborne pathogens and healthcare worker guidelines. These include proper PPE use, safe needle handling where applicable, and infection control protocols — all of which are covered in approved HHA training programs.
For a practical breakdown of what equipment HHAs need and who is responsible for providing it, read our guide on HHA equipment and supplies.
For many caregivers, HHA certification is the beginning of a longer career journey. The skills and patient experience you build as an HHA transfer directly into higher credentials — from CNA to LPN to RN.
According to the Bureau of Labor Statistics, HHA employment is projected to grow 22 percent through 2032, one of the fastest growth rates of any occupation in the country. Understanding your state’s certification requirements is the first step — and getting started quickly puts you ahead of that demand curve.
For the full picture of where an HHA career can lead, read our guide: HHA career path — how to advance from home health aide to RN and beyond. And for current earning potential across experience levels and states, see our home health aide salary guide.
HHAs do not hold a state license in the same sense as a nurse or physician. However, most states require completion of an approved training program, a competency evaluation, and registration on a state HHA registry. For more on what the role involves and how it differs from licensed roles, read our guide: what is a home health aide?
HHA certification is generally not portable between states. If you relocate, you may need to complete additional training or pass a new competency evaluation in your new state. Some states have reciprocity provisions — verify with your new state’s health department before assuming your existing certification is valid. Read our guide on is online HHA training accepted? for more context on how states treat out-of-state credentials.
From enrollment to registry listing, most students complete HHA certification in 4 to 8 weeks depending on their state’s hour requirements and their study pace. For a full timeline breakdown, read our guide: how long does HHA certification take?
Yes, for the knowledge and theory components. The supervised clinical skills evaluation typically requires an in-person component. NCOOA’s home health aide online course covers the full theory curriculum online, with the clinical evaluation arranged separately through an approved provider.
Earnings vary by state, employer, and experience level. For a full breakdown, read our home health aide salary guide and our broader overview of how much caregivers make in 2026. For additional questions about enrollment and course access, visit the NCOOA FAQ page.
NCOOA’s online HHA program is built around the CMS 75-hour curriculum standard, covering all 12 federally required competency areas.
