Certified Nursing Assistant Salary by State (2026): CNA Pay Compared Across All 50 States

Certified nursing assistant salary by state varies significantly across the U.S. — the spread between top and bottom states reflects state minimum-wage laws, state Medicaid SNF reimbursement rates, state CMS minimum-staffing rules, union representation, and the regional density of nursing homes and acute-care hospital PCT roles. The national median for Certified Nursing Assistants sits at $45,007, but state-by-state pay across the 52 states tracked here ranges widely — from $24,335 in Puerto Rico to $53,711 in Washington. That spread reflects state-level cost of living plus several structural factors that move CNA pay independently of the broader healthcare wage environment.

This page compares the average certified nursing assistant salary by state across 1686+ metropolitan and non-metropolitan areas — drawing on the Bureau of Labor Statistics Occupational Employment and Wage Statistics (OEWS) survey for SOC 31-1131. If you're a working CNA evaluating relocation, a new aide completing state-approved training, or an SNF or hospital recruiter benchmarking pay across states, the state-level comparison below is the central reference point.

How CNA Salary by State Is Measured

The BLS reports state-level CNA salary through three numbers:

• Annual median (50th percentile) — used to rank state-level pay in the table below.
• Annual mean (average) — typically runs 2–5% above median for CNAs because the pay distribution is more compressed than for higher-skilled roles.
• Percentile distribution (P10 / P25 / P75 / P90) — P10 reflects newly certified CNAs at assisted living facilities; P90 reflects senior patient care technicians (PCTs) at unionized hospitals, certified medication aides (CMA/CMT), CNA II credentialed aides, and home-health/private-duty CNAs in busy metros.

The state-comparison table below applies BEA Regional Price Parity (RPP) adjustment so both nominal pay and real purchasing power are visible.

1. State-Level CNA Title Distinction

The certified nursing assistant credential goes by different state-specific titles, but all reference the same federal OBRA-87 training standard administered through state nurse aide registries:

• CNA — Certified Nursing Assistant (most states)
• STNA — State Tested Nursing Assistant (Ohio)
• NA-C — Nursing Assistant — Certified (Washington)
• CNA II — advanced-scope CNA credential in North Carolina, Virginia, Oregon, and others (additional procedures: catheter care, sterile dressing changes, tracheostomy suctioning)
• PCT / PCA — Patient Care Technician / Patient Care Assistant (hospital titles, typically a CNA with additional unit-specific training)

For state-by-state comparison, treat CNA / STNA / NA-C / PCT as comparable. The federal OBRA-87 standard requires minimum 75 hours of training plus a state competency exam (most commonly the NNAAP — National Nurse Aide Assessment Program — administered by Pearson VUE).

2. State Cost of Living and Minimum-Wage Laws

State minimum-wage laws are the largest non-CMS-funded driver of state-level CNA pay because CNA hourly wages cluster near state minimum-wage floors at the entry level. States with high minimum wage anchor higher state-level CNA pay:

• High-minimum-wage states — California, Washington, Connecticut, New Jersey, New York (especially NYC), Massachusetts, Oregon, Colorado, and others maintain state minimum wages of $15–$18+/hour. These states reliably lead state-level CNA pay rankings.
• Federal-minimum-wage states — states without state minimum wage above the federal $7.25 floor (mostly Southern states) anchor the bottom of state CNA pay rankings.
• Cost-of-living adjustment — high-minimum-wage states are also high-cost states. After BEA RPP adjustment, the real-purchasing-power gap is narrower than nominal rankings suggest, though high-COL states still lead in real-dollar pay.

3. State Medicaid SNF Reimbursement and CMS Minimum-Staffing Rules

The single largest CNA-specific pay driver beyond minimum wage is state Medicaid nursing-home reimbursement, because CNA hourly wages at SNFs scale directly with Medicaid per-resident-day reimbursement:

• Strong-Medicaid SNF reimbursement states — California, New York, Massachusetts, Connecticut, New Jersey, Maryland, Pennsylvania, Minnesota maintain higher Medicaid SNF reimbursement, supporting higher CNA pay floors.
• CMS minimum-staffing rules — the 2024 CMS federal minimum-staffing rule for nursing homes (still being phased in and contested in court) plus state-level minimum-staffing rules in California, Florida, and several other states drive competition for CNA talent.
• State CMS-approved nurse aide registries — every state maintains a CMS-approved nurse aide registry. Some states (NY, MA, NJ, CT) have stricter registry rules and continuing-education requirements that raise the floor for CNA employability.
• Union representation at SNFs and hospitals — California (SEIU-UHW, NUHW), New York (1199SEIU, NYSNA), Massachusetts (1199SEIU, MNA), Illinois (SEIU HCII), New Jersey (1199SEIU), Pennsylvania (SEIU HCPA) have strong CNA union representation. Union CNAs reliably earn $2–$6/hour above non-union peers and have stronger pension and benefits.

4. State Demand-Supply Dynamics for CNAs

State-level CNA pay reflects the demand-supply balance:

• State SNF concentration — Florida, Pennsylvania, Texas, Ohio, Indiana, Tennessee, Michigan have high SNF concentration relative to population. Senior SNF chains (Genesis HealthCare, Brookdale Senior Living, Life Care Centers of America, Encompass Health, ProMedica, Ensign Group, HCR ManorCare, Trilogy Health, ProMedica Senior Care) compete for CNA talent.
• State hospital PCT demand — major metros with dense academic medical center concentration (Boston, NYC, Philadelphia, Baltimore, Houston, Los Angeles, Chicago, Atlanta, Seattle) drive PCT pay above SNF baseline.
• State assisted-living growth — Florida, Arizona, Nevada, Texas, North Carolina, Tennessee, South Carolina have rapidly growing assisted-living markets supporting CNA hiring.
• State home-care market (Medicaid HCBS waivers) — states with strong Medicaid HCBS waiver programs (California, New York, Pennsylvania, Texas, Oregon, Massachusetts) support home-health-aide demand and per-visit pay above SNF baseline.
• State HPSA concentration — rural Mountain West, Deep South, and Appalachian states with high health professional shortage area concentration routinely offer sign-on bonuses for CNAs.

5. State CNA II and Specialty Endorsement Distribution

Several states offer advanced CNA credentials that materially affect state pay distributions:

• CNA II (advanced-scope CNA) — North Carolina, Virginia, Oregon, and others issue CNA II credentials authorizing catheter care, sterile dressing changes, tracheostomy suctioning. These states show higher state-level CNA medians because of broader scope.
• Certified Medication Aide (CMA/CMT — state-specific, distinct from AAMA medical assistant) — 30+ states recognize a Certified Medication Aide credential allowing trained CNAs to administer routine medications under nurse supervision. Common at SNFs in Texas, North Carolina, Kansas, Oklahoma, and Pennsylvania.
• Telemetry / EKG technician training — adds PCT-level scope at hospitals; cluster in major-metro hospital systems.
• Dementia and memory-care certification — state-specific training programs supporting specialty memory-care unit pay.

How to Compare CNA Salary by State Effectively

When comparing the average certified nursing assistant salary by state, work through this checklist:

• Treat CNA / STNA / NA-C as comparable — same federal OBRA-87 standard, different state title.
• Compare nominal and real (cost-adjusted) pay together — a state with the highest nominal median can have lower real purchasing power if its cost of living is higher.
• Check state income tax — CNAs in Texas, Florida, Tennessee, Nevada, Washington, Wyoming, South Dakota, Alaska, and New Hampshire keep more of every dollar.
• Verify state minimum-wage floor — state minimum wage is the single largest driver of entry-level CNA pay.
• Factor in state Medicaid SNF reimbursement — high-reimbursement states (CA, NY, MA, CT, NJ, MD) anchor higher SNF CNA pay.
• Consider state CNA II credential availability — if you plan to credential into CNA II, target states (NC, VA, OR) that recognize the credential.
• Factor in setting mix — hospital PCT roles in unionized academic medical center states (CA, NY, MA, IL) pay substantially above SNF baseline.

2026 State-Level CNA Salary Outlook

CNA pay has grown at a compound annual rate of 6.50% nationally over the past five years — faster than for many higher-skilled occupations because the post-pandemic SNF and hospital staffing crisis forced aggressive pay increases. States with rapid Medicaid SNF reimbursement increases (California, New York, Massachusetts), states with state-mandated minimum-staffing rules (California's AB 1629, similar Florida and Massachusetts rules), and states with rapid assisted-living market expansion (Florida, Arizona, Nevada, Texas, North Carolina) are seeing the fastest state-level CNA pay growth through 2026. The BLS projects Certified Nursing Assistants employment growth at 4% through 2033 with roughly 213,000 CNA openings each year on average — keeping upward pressure on state-level wages, especially in SNF-heavy and hospital-PCT-strong states.

Browse the state-by-state comparison table below to see the $45,007-baseline state ranking, top 10 and bottom 10 states by projected median, regional groupings (Northeast / Midwest / South / West), and direct links to per-state pages for deeper city-level breakdown.