If you typed "home health aide certification" or "hha certification" into a search box, you probably got a page that says "requirements vary by state" and then sells you a course. This article is the version I wish existed: the federal rule, quoted; the states that add to it, named; and what the job pays, state by state, from government data.
I'm an occupational therapist, and I've worked in home health. The aide on a case was often the person who saw my patient most. I've also watched good people get turned away from an agency because a certificate from one program, or one state, wasn't the one the agency could accept. So this is for three readers: someone thinking about becoming a home health aide, a CNA wondering whether home health is open to them, and an aide moving to a new state. If you're a family member trying to understand what the aide on your parent's case does, our guide to who does what on a home health care team is the better place to start.
A note on labels, because they matter here. A rule is a federal regulation, and I'll cite the paragraph. A state rule is that state's code or its health department's own page, and I'll say which. PHI is a nonprofit that tracks aide training laws, and when a number is their tally rather than something I read in a state's code, I'll say so. Anything labeled my experience or my suggestion is just that. One more: in the federal rule, "HHA" means the home health agency, not the aide. In job ads it means the aide. I'll write "home health aide" for the person throughout.
The Short Answer
- The federal floor is 75 hours. Classroom plus supervised practical training, at least 16 classroom hours before at least 16 practical hours, then a competency evaluation by a registered nurse. That is 42 CFR §484.80(b) and (c).
- A CNA already qualifies. A nurse aide who finished a state-approved program and is in good standing on the state registry is a qualified home health aide under §484.80(a)(1)(iii). Some states still make you take their own certificate.
- There is no federal certificate, exam or registry for home health aides. The rule puts the duty on the agency to use only qualified aides. States decide whether to issue a certificate, and 17 of them plus DC ask for more than 75 hours, by PHI's count.
- Personal care aides have no federal floor at all. States set it, or don't.
- Pay: a national median of $17.21 an hour for home health and personal care aides (BLS, May 2025). The middle Medicare-certified agency spent $36 per aide visit on aide pay in 2024.
Three Credentials, One Table
People use "home health aide," "CNA" and "personal care aide" as if they were one job. They are three credentials with three rulebooks.
| Home health aide | Certified nursing assistant (CNA) | Personal care aide (PCA) | |
|---|---|---|---|
| Who writes the floor | Medicare's home health rule, 42 CFR §484.80 | Medicare and Medicaid's nursing home rules, 42 CFR §§483.152 to 483.156 | No federal training standard; the state, if anyone |
| Minimum training | 75 hours, at least 16 classroom before at least 16 supervised practical | 75 clock hours, at least 16 supervised practical, 16 hours of specified subjects before touching a resident | Whatever the state says. PHI counts 26 states and DC that set hours, and 7 that set nothing |
| The test | Competency evaluation by a registered nurse; five skill areas must be watched on a patient or pseudo-patient | Written or oral exam plus a skills demonstration, run by the state or its approved tester; at least three tries | State-specific, often none |
| A registry | No federal one. Some states keep one | Yes, the state nurse aide registry, with findings of abuse or neglect listed | Some states |
| Where the credential matters | Medicare-certified home health agencies (hospice has its own, parallel rule) | Nursing homes, and home health through the CNA door | Private-pay home care, Medicaid personal care, consumer-directed programs |
| Keeping it | 12 hours of in-service a year; lapses after 24 months without paid aide work | Registry entry removed after 24 months without nursing-related work | State-specific |
The rest of this article takes those one at a time, then the states, then the pay.
The Federal Floor for Home Health Aides
Every Medicare-certified home health agency lives under 42 CFR Part 484, the Conditions of Participation. §484.80 is the aide section. Its opening line puts the duty where it sits: "All home health aide services must be provided by individuals who meet the personnel requirements specified in paragraph (a) of this section." The agency is the one on the hook, which is why an agency will ask for your paperwork before you see a patient.
Four doors in
§484.80(a)(1) says a qualified home health aide is a person who has successfully completed one of four things:
(i) A training and competency evaluation program as specified in paragraphs (b) and (c) respectively of this section; or (ii) A competency evaluation program that meets the requirements of paragraph (c) of this section; or (iii) A nurse aide training and competency evaluation program approved by the state as meeting the requirements of § 483.151 through § 483.154 of this chapter, and is currently listed in good standing on the state nurse aide registry; or (iv) The requirements of a state licensure program that meets the provisions of paragraphs (b) and (c) of this section.
Read door (ii) again. The federal rule allows an agency to use someone who passed the competency evaluation without the 75 hours of training. Read door (iii) too: a CNA in good standing on the state registry is in. In my experience, agencies rarely take door (ii) for a new aide, because their state or their own policy asks for the training, but the rule is what it is.
The lapse rule
§484.80(a)(2) is the one that catches people who stepped away:
A home health aide or nurse aide is not considered to have completed a program, as specified in paragraph (a)(1) of this section, if, since the individual's most recent completion of the program(s), there has been a continuous period of 24 consecutive months during which none of the services furnished by the individual as described in § 409.40 of this chapter were for compensation. If there has been a 24-month lapse in furnishing services for compensation, the individual must complete another program, as specified in paragraph (a)(1) of this section, before providing services.
Two years without paid aide work and the program you finished no longer counts. Volunteer work doesn't stop the clock, because the rule says "for compensation."
The 75 hours
§484.80(b)(1) and (2):
Home health aide training must include classroom and supervised practical training in a practicum laboratory or other setting in which the trainee demonstrates knowledge while providing services to an individual under the direct supervision of a registered nurse, or a licensed practical nurse who is under the supervision of a registered nurse. Classroom and supervised practical training must total at least 75 hours.
A minimum of 16 hours of classroom training must precede a minimum of 16 hours of supervised practical training as part of the 75 hours.
Notice what the rule does not say. It does not split the other 43 hours between classroom and practical. It does not say the practical hours must be in a patient's home; a "practicum laboratory or other setting" will do. States fill in those blanks, which is one reason their numbers differ.
What the course has to cover
§484.80(b)(3) lists the subject areas a program must address. Here they are, in the rule's order:
- Communication skills, including reading, writing and verbally reporting clinical information to patients, representatives, caregivers and agency staff.
- Observation, reporting and documentation of patient status and the care furnished.
- Reading and recording temperature, pulse and respiration.
- Basic infection prevention and control.
- Basic elements of body functioning, and changes that must be reported to the aide's supervisor.
- Maintaining a clean, safe and healthy environment.
- Recognizing emergencies and knowing how to start emergency procedures.
- The physical, emotional and developmental needs of the people the agency serves, including respect for the patient, their privacy and their property.
- Safe personal hygiene and grooming: bed bath; sponge, tub and shower bath; shampooing in sink, tub and bed; nail and skin care; oral hygiene; toileting and elimination.
- Safe transfer techniques and ambulation.
- Normal range of motion and positioning.
- Adequate nutrition and fluid intake.
- Recognizing and reporting changes in skin condition.
- Any other task the agency may choose to have an aide perform, as permitted under state law.
Paragraph (b)(3)(xv) adds that the agency is responsible for training aides, as needed, in skills not on that list.
The test
§484.80(c) opens with the sentence that matters: "An individual may furnish home health services on behalf of an HHA only after that individual has successfully completed a competency evaluation program as described in this section." (HHA there means the agency.) Then (c)(1):
The competency evaluation must address each of the subjects listed in paragraph (b)(3) of this section. Subject areas specified under paragraphs (b)(3)(i), (iii), (ix), (x), and (xi) of this section must be evaluated by observing an aide's performance of the task with a patient or pseudo-patient. The remaining subject areas may be evaluated through written examination, oral examination, or after observation of a home health aide with a patient, or with a pseudo-patient as part of a simulation.
So five areas have to be watched, not written: communication, vital signs, personal hygiene and grooming, transfers and ambulation, and range of motion and positioning. The evaluation "must be performed by a registered nurse in consultation with other skilled professionals, as appropriate" (§484.80(c)(3)). It "may be offered by any organization," with the exception in paragraph (f), which bars agencies that were sanctioned in the previous two years from running their own programs (§484.80(c)(2) and (f)).
If you fail a task, §484.80(c)(4) says what happens:
A home health aide is not considered competent in any task for which he or she is evaluated as unsatisfactory. An aide must not perform that task without direct supervision by a registered nurse until after he or she has received training in the task for which he or she was evaluated as "unsatisfactory," and has successfully completed a subsequent evaluation. A home health aide is not considered to have successfully passed a competency evaluation if the aide has an "unsatisfactory" rating in more than one of the required areas.
One unsatisfactory area means retraining and re-evaluation in that task. Two means you did not pass.
Who teaches, and what it costs you
Instructors: "Classroom and supervised practical training must be performed by a registered nurse who possesses a minimum of 2 years nursing experience, at least 1 year of which must be in home health care, or by other individuals under the general supervision of the registered nurse" (§484.80(e)).
Cost: the home health aide rule says nothing about who pays for training. The nursing home rule does, and it's worth knowing the difference. Under 42 CFR §483.152(c)(1), "No nurse aide who is employed by, or who has received an offer of employment from, a facility on the date on which the aide begins a nurse aide training and competency evaluation program may be charged for any portion of the program (including any fees for textbooks or other required course materials)." That protection is for nurse aides and nursing facilities. §484.80 has no equivalent, so a home health aide program can charge you, and New York's training FAQ, for one, says programs may charge for materials you keep. In my experience, agencies that run their own program often train new hires free in exchange for a work commitment. Ask.
After you're in
Two more paragraphs follow you through the job. §484.80(d): "A home health aide must receive at least 12 hours of in-service training during each 12-month period. In-service training may occur while an aide is furnishing care to a patient." And the supervision rules in §484.80(h): when the patient also gets nursing or therapy, a registered nurse or therapist must do a supervisory assessment of the aide's services at least every 14 days, you don't have to be present, and once a year someone has to watch you work on site. We go through those in the supervisory visit rules.
What §484.80 never creates is a federal certificate, a national exam or a federal registry for home health aides. Your proof is the training program's certificate and the competency evaluation record, and the agency's file (§484.80(b)(4) and (c)(5) require the agency to keep documentation that the standards were met). Keep your own copies.
The CNA Route
The nurse aide rules were written for nursing homes, but door (iii) above makes them a route into home health, so here is the floor. Under 42 CFR §483.152(a), a state-approved nurse aide training and competency evaluation program must, at a minimum:
(1) Consist of no less than 75 clock hours of training; (2) Include at least the subjects specified in paragraph (b) of this section; (3) Include at least 16 hours of supervised practical training.
§483.152(b)(1) adds a rule the home health aide version doesn't have: at least 16 hours in communication, infection control, safety and emergency procedures including the Heimlich maneuver, promoting residents' independence, and respecting residents' rights, all "prior to any direct contact with a resident."
The CNA test is a real exam, not just an agency nurse's checklist. Under §483.154(b), it has a written or oral part (your choice) drawn from a pool of questions, and a skills demonstration of "randomly selected items drawn from a pool consisting of the tasks generally performed by nurse aides." To pass, "an individual must pass both the written or oral examination and the skills demonstration" (§483.154(e)(1)). If you don't, you must be told which areas you missed and "that he or she has at least three opportunities to take the evaluation"; a state may cap attempts, "but the maximum may be no less than three" (§483.154(f)). A passing result goes on the state nurse aide registry within 30 days (§483.154(e)(2)).
The registry has its own lapse rule. §483.156(c)(2): "The registry must remove entries for individuals who have performed no nursing or nursing-related services for a period of 24 consecutive months, unless the individual's registry entry includes documented findings of abuse, neglect, or misappropriation of property." Since the home health door requires you to be "currently listed in good standing," a CNA who falls off the registry loses the home health door with it.
If you hold a CNA and want to work in home health, two things to check. First, whether your state issues a separate home health aide certificate and expects you to get it. California does, with a 40-hour bridge for CNAs (next section). Second, whether the agency's own policy asks for home-specific training on top of your CNA. The federal rule doesn't require it; plenty of agencies do.
Personal Care Aides: No Federal Floor
Personal care aides work in Medicaid personal care programs, private-pay home care, and consumer-directed programs where the client is the employer. Medicaid's definition of the service, 42 CFR §440.167(a)(2), asks only that it be "Provided by an individual who is qualified to provide such services and who is not a member of the individual's family." Qualified how? The rule doesn't say. The state does.
PHI, which tracks these laws, puts it this way: training for personal care aides "is not governed by any federal standards, unlike training for home health aides and nursing assistants." By its tally of 2024 and 2025 state policy, 26 states and the District of Columbia require a minimum number of training hours for personal care aides, 31 states and DC have one consistent requirement for all Medicaid-funded, agency-employed aides, and 7 states do not regulate their training at all. The hours it lists range from a handful (8 in Pennsylvania's consumer-directed program) to 125 in DC. Those are PHI's numbers, and the page is the place to look up your state.
If you're choosing between the two credentials, my suggestion is to get the home health aide training even if a personal care job doesn't require it. It opens the Medicare-certified agencies, which is where the per-visit pay in the table below comes from, and nothing stops you from taking a personal care job with it.
The States That Ask for More Than 75 Hours
PHI's state-by-state table of home health aide training requirements reads 33 states as sitting at the federal 75 hours with 16 clinical, and 17 states plus DC as requiring more. It also notes that the National Academy of Medicine has suggested the floor "should be raised to at least 120 hours," which, by PHI's count, only six states and DC meet. Here is PHI's list of the 18 above the floor. For four of them, marked, I read the state's own rule or health department page, and I'll tell you what I found underneath.
| State | Total hours (PHI) | Clinical hours (PHI) | Read in the state's own rule? |
|---|---|---|---|
| Alaska | 140 | 80 | |
| California | 120 | 20 | Yes, see below |
| District of Columbia | 125 | 40 | |
| Hawaii | 100 | 70 | |
| Idaho | 120 | 40 | |
| Illinois | 120 | 40 | |
| Kansas | 110 | 45 | |
| Maine | 180 | 70 | |
| Maryland | 100 | 40 | |
| Montana | 91 | 25 | |
| New Hampshire | 100 | 60 | |
| New Jersey | 76 | 16 | Yes, see below |
| Rhode Island | 100 | 20 | |
| Utah | 100 | 24 | |
| Vermont | 80 | 30 | |
| Washington | 85 | 50 | Yes, and the state's page says 75 plus an exam, see below |
| Wisconsin | 120 | 32 | |
| Wyoming | 91 | 16 |
I also read New York, which PHI lists at the federal 75, because its certificate works differently from most.
California: 120 hours, a state certificate, and a CNA bridge
California's regulation, 22 CCR §74747, sets the program: "The basic training program for certification shall be a minimum of 120 hours," with "a minimum of 20 hours of clinical experience of which 15 hours are in personal services," and "no more than 75 hours of classroom lecture." The California Department of Public Health certifies home health aides under Health and Safety Code §§1725 to 1742. Its page says an applicant must be at least 16, complete a CDPH-approved 120-hour program "which includes an examination to test the applicant's knowledge and skills related to basic patient care services," and obtain a criminal record clearance. A CNA with an active certificate takes a 40-hour CDPH-approved program instead. The certificate renews every two years with 24 hours of in-service or continuing education, at least 12 in each year.
New Jersey: 76 hours and the Board of Nursing
New Jersey calls the credential Certified Homemaker-Home Health Aide, and the Board of Nursing, not the health department, issues it. N.J.A.C. 13:37-14.4(c): "A CHHA training program shall consist of at least 76 hours. The program shall include 60 hours of classroom instruction and 16 hours of clinical instruction" in a skills laboratory or patient care setting. Programs are run by home care agencies or approved educational institutions with the Board's written approval.
New York: 75 hours, a registry-issued certificate, and a competency-only door for aides trained elsewhere
New York's Department of Health FAQ for training programs spells out the 75: "59 hours classroom and 16 hours of supervised practical training," as a 40-hour home care curriculum and a 35-hour health-related task curriculum. Programs get 60 days from the day a trainee enters to finish. For aides trained after September 25, 2009, the certificate is generated by the state's Home Care Registry, with a registry number printed on it. The FAQ also says an aide's certification lapses two years after the date the person last worked at a New York home health agency, which is the federal 24-month rule in state clothes, and that the employing agency must provide 12 hours of in-service a year.
The useful part for anyone moving in: the FAQ lists who may take the competency evaluation only, "in lieu of the standardized training." The list includes "An individual with documented home health aide or nurse aide training and competency evaluation from an out-of-state training program," a nursing assistant with a year of full-time hospital experience in the past five years, and a home health aide who has been out of the work for 24 consecutive months. So New York's answer to an out-of-state certificate is the test, not the 75 hours again.
Washington: a state credential for long-term care workers, and a moving deadline
Washington is a different animal. It certifies home care aides under RCW chapter 18.88B, a state credential for "long-term care workers." That term is defined in RCW 74.39A.009 to include "direct care workers employed by home care agencies" and "any other direct care worker providing home or community-based services to the elderly or persons with functional disabilities," and to exclude people employed by nursing homes, hospitals, facilities certified under 42 CFR Part 483, hospice agencies and adult day centers. Medicare-certified home health agencies are not on the exclusion list. So an aide at one in Washington should assume both apply, the state credential and the §484.80 qualification, and ask the agency which it checks. The Department of Health's page says "Long-term care workers must complete 75 hours of training" through a program approved by the Department of Social and Health Services, pass "the home care aide certification examination" (the page links to Prometric), and clear a fingerprint background check. RCW 18.88B.021(1) says a long-term care worker "must be certified as a home care aide as provided in this chapter within 200 calendar days after the date of hire." The current rule, WAC 246-980-030, stretches that: a worker loses eligibility to work without a credential if not certified "within 365 calendar days from their date of hire, or 425 calendar days if granted a provisional certificate," with those timelines in effect from August 25, 2025 through December 31, 2027. PHI's 85 may include hours the state counts elsewhere, such as the continuing education it requires; I couldn't tell from its page.
What to take from the four
Reading four states out of eighteen taught me that the hour count is the least of it. What differs more is who issues the certificate (a training program, a registry, a board of nursing, a health department), whether the test sits inside the hours or on top of them, whether there's a renewal cycle, and whether the credential is for Medicare home health at all. When you call your state, those are the questions to ask.
What It Pays, State by State
Two numbers, from two government sources, and they measure different things.
Hourly wage. The Bureau of Labor Statistics' occupation 31-1120, home health and personal care aides, had a national median of $17.21 an hour, or $35,800 a year, in May 2025, with 4,677,100 jobs in 2025 and projected growth of 18 percent from 2025 to 2035. One caution: that occupation folds personal care aides in with home health aides, across every employer type, and the personal care side pulls the median down. A certified aide at a Medicare agency usually sits above it.
Agency spending per visit. Medicare-certified home health agencies report what they spent on aide pay and how many aide visits they made, in their annual cost reports. Divide one by the other and you get what the middle agency spent per aide visit. For 2024 the national middle was $36, with the middle half of agencies between $25 and $51, across 3,424 agencies with a usable number. That is agency spending, not an offer; it includes the agency's payroll cost for the visit, not just your check. Our pay per visit by state article explains how the number is built and shows it for every discipline, and the LPN article shows how per-visit pay compares with hourly.
Both sets of numbers, every state:
| State | Median hourly wage, home health and personal care aides (BLS, May 2025) | Agency spending per aide visit, middle agency (middle half of agencies, number of agencies), 2024 |
|---|---|---|
| Alabama | $13.39 | $25 ($21–$31, 47) |
| Alaska | $19.11 | fewer than 5 agencies |
| Arizona | $17.51 | $35 ($26–$66, 60) |
| Arkansas | $13.30 | $29 ($24–$51, 34) |
| California | $16.50 | $40 ($33–$52, 868) |
| Colorado | $18.53 | $30 ($25–$46, 46) |
| Connecticut | $18.75 | $38 ($30–$67, 41) |
| Delaware | $16.50 | $87 ($46–$147, 7) |
| District of Columbia | $20.53 | $37 ($26–$64, 6) |
| Florida | $16.25 | $23 ($20–$36, 215) |
| Georgia | $14.07 | $36 ($26–$46, 45) |
| Hawaii | $18.32 | $50 ($50–$51, 5) |
| Idaho | $16.72 | $25 ($20–$43, 19) |
| Illinois | $18.30 | $40 ($30–$51, 174) |
| Indiana | $16.86 | $36 ($25–$53, 62) |
| Iowa | $17.34 | $34 ($26–$45, 45) |
| Kansas | $15.03 | $34 ($21–$52, 28) |
| Kentucky | $17.52 | $34 ($24–$55, 26) |
| Louisiana | $10.83 | $22 ($17–$31, 77) |
| Maine | $18.55 | $64 ($57–$90, 7) |
| Maryland | $18.29 | $41 ($33–$51, 31) |
| Massachusetts | $19.67 | $44 ($33–$69, 57) |
| Michigan | $16.83 | $40 ($32–$67, 87) |
| Minnesota | $18.45 | $42 ($31–$60, 28) |
| Mississippi | $11.47 | $26 ($22–$35, 26) |
| Missouri | $15.90 | $36 ($25–$51, 29) |
| Montana | $17.61 | $52 ($31–$104, 6) |
| Nebraska | $17.38 | $57 ($36–$151, 19) |
| Nevada | $16.19 | $35 ($30–$40, 100) |
| New Hampshire | $18.64 | $47 ($42–$59, 16) |
| New Jersey | $17.83 | $43 ($37–$52, 28) |
| New Mexico | $13.71 | $28 ($22–$61, 25) |
| New York | $19.05 | $76 ($49–$116, 55) |
| North Carolina | $15.02 | $37 ($27–$50, 94) |
| North Dakota | $18.96 | $106 ($50–$137, 6) |
| Ohio | $16.57 | $36 ($25–$51, 88) |
| Oklahoma | $13.32 | $24 ($20–$36, 97) |
| Oregon | $21.35 | $51 ($40–$88, 18) |
| Pennsylvania | $14.14 | $39 ($31–$62, 83) |
| Rhode Island | $21.00 | $28 ($24–$46, 11) |
| South Carolina | $14.48 | $31 ($25–$43, 24) |
| South Dakota | $18.15 | $44 ($30–$93, 10) |
| Tennessee | $15.45 | $26 ($22–$35, 37) |
| Texas | $11.65 | $27 ($21–$41, 416) |
| Utah | $17.25 | $30 ($24–$43, 50) |
| Vermont | $20.00 | $47 ($39–$53, 8) |
| Virginia | $14.57 | $41 ($28–$70, 56) |
| Washington | $22.95 | $50 ($36–$73, 36) |
| West Virginia | $13.47 | $31 ($25–$46, 18) |
| Wisconsin | $17.47 | $51 ($38–$77, 24) |
| Wyoming | $15.96 | $35 ($33–$52, 10) |
How to read it. The hourly column is a wage survey across every kind of employer. The per-visit column is what Medicare-certified agencies spent, and it swings with how long a visit runs and how far apart patients are. Where the agency count is small, in the single digits, treat the per-visit figure as a handful of agencies, not a market. Alaska is blank because fewer than five agencies had a usable number.
Two patterns are plain in the data. The lowest hourly medians are in Louisiana, Mississippi and Texas, and those three are also near the bottom on what agencies spend per aide visit. And the states that require the most training hours are not reliably the states that pay the most: Maine, at 180 hours, has a high per-visit figure from only 7 agencies, while Washington, which pays the highest hourly median, asks for 75 hours and a test. Training rules and labor markets are set by different people.
If you want the number for your own county, the clinician pay calculator covers aides alongside the other eight disciplines. It shows your county when at least five agencies serving it have a usable number, and your state when they don't.
How to Get Certified: My Suggested Order
This is my suggestion, not a rule.
- Start with your state, not a school. Search your state health department's site, or the board of nursing in states like New Jersey, for its list of approved home health aide training programs. If a program isn't on the state's list, ask it, in writing, which rule its certificate satisfies.
- Ask three questions before you pay. How many hours, and how many of them with a patient or in a lab? Who performs the competency evaluation, and is that person a registered nurse? Does the state issue a certificate or registry entry when I finish, or only the program?
- If you're a CNA, ask about the bridge. In some states your registry listing is enough under §484.80(a)(1)(iii). In others, California for one, there's a shorter state program. Either way, keep your registry listing active.
- Keep every page. The training certificate, the competency evaluation record with the evaluator's name and the date, and the subject checklist. The agency must keep documentation; so should you. An agency in a new state will ask for it.
- Count your 12 hours. In-service is yours to track as much as the agency's. If you leave an agency mid-year, ask for a record of the hours you completed.
- Watch the 24-month clock. Paid aide work keeps the program valid. If you're going to step away for a while, know that coming back after two years means a program again.
Frequently Asked Questions
How many hours of training does home health aide certification take?
The federal floor is 75 hours of classroom and supervised practical training, with at least 16 classroom hours before at least 16 hours of supervised practical training, followed by a competency evaluation performed by a registered nurse. That is 42 CFR 484.80(b) and (c), and it binds every Medicare-certified home health agency. PHI tallies 17 states and the District of Columbia as requiring more, from 76 hours in New Jersey to 180 in Maine. Your state's health department or board of nursing has the number that applies to you.
Is a home health aide the same as a CNA?
No, but the federal rule lets a CNA work as a home health aide. Under 42 CFR 484.80(a)(1)(iii), a person who completed a state-approved nurse aide training and competency evaluation program and is listed in good standing on the state nurse aide registry is a qualified home health aide. Both credentials sit on a 75-hour federal floor. The CNA program is written for nursing homes and the home health aide program for care at home, and some states, California for one, add a short bridge course for CNAs who want the home health aide certificate.
Do I need a certification to be a home health aide?
If you work for a Medicare-certified home health agency, yes. The agency may only use aides who have completed training and a competency evaluation, or one of the other routes in 42 CFR 484.80(a)(1). Personal care aides in private-pay or Medicaid home care are a different matter. There is no federal training standard for them, and PHI counts 7 states that do not regulate their training at all. Check your state.
How much does a home health aide make?
BLS puts the national median at $17.21 an hour, or $35,800 a year, for home health and personal care aides as of May 2025. State medians run from $10.83 in Louisiana to $22.95 in Washington. In 2024 Medicare cost reports, the middle home health agency spent $36 per aide visit on aide pay, with the middle half of agencies between $25 and $51. That is agency spending per visit, not a wage offer.
Does a home health aide certification transfer to another state?
Sometimes. The rule that follows you everywhere is the lapse rule: under 42 CFR 484.80(a)(2), 24 consecutive months without paid home health aide work means you must complete a program again before an agency can use you as an aide. Beyond that, each state decides what it accepts. New York's training FAQ lets an aide with documented out-of-state training and competency evaluation take the competency evaluation only, instead of the 75 hours again. California issues its own certificate after its own 120-hour program. Call the receiving state's health department or board of nursing before you move, and bring your training certificate and competency evaluation.
Sources
Federal rules (Cornell LII):
- 42 CFR §484.80, Condition of participation: Home health aide services
- 42 CFR §483.152, Requirements for approval of a nurse aide training and competency evaluation program
- 42 CFR §483.154, Nurse aide competency evaluation
- 42 CFR §483.156, Registry of nurse aides
- 42 CFR §440.167, Personal care services
State rules and pages:
- California: 22 CCR §74747, Home Health Aide Training (Cornell LII)
- California Department of Public Health, Home Health Aide certification page
- New Jersey: N.J.A.C. 13:37-14.4, Homemaker-home health aide training programs (Cornell LII)
- New York State Department of Health, Home Health Aide Training Program FAQ
- Washington State Department of Health, Home Care Aide certification requirements
- Washington: RCW 18.88B.021, Certification requirements
- Washington: WAC 246-980-030
Training-hour tallies (PHI's compilation, cited as theirs):
- PHI, Home Health Aide Training Requirements by State
- PHI, Personal Care Aide Training Requirements by State
Pay:
- BLS Occupational Outlook Handbook, Home Health and Personal Care Aides (May 2025 wages)
- BLS Occupational Employment and Wage Statistics, May 2025, occupation 31-1120 by state
- Home Health Agency cost report data, HHA20FY2024 (CMS HCRIS)
What do agencies near you spend per aide visit?
The clinician pay calculator shows the low, middle and high end for aides in your county, your state and the US, from 2024 Medicare cost reports. No name or email.