Are you concerned about efficiently yet safely staffing your certified nursing assistant (CNA) personnel? Our state-by-state guide to CNA-to-patient staffing ratios can help you determine the minimum staffing rule for your nursing home.
We know that simply staffing more isn’t always possible or sustainable, yet too few nursing assistants can cause safety and regulatory problems for your facility.
Learn what the minimum nurse staffing requirements are in your state.
What is the legal CNA-to-patient ratio?
The legal CNA-to-patient ratio requirements for your facility are contingent on location—specifically, on the state.
Not all states place staffing ratio requirements on certified nursing assistants.
Alternatively, we sometimes see regulations imposed on the minimum number of hours per resident per day (HPRD). This term refers to the number of care hours each resident receives daily from nursing personnel or other direct care staff.
What are the federal staffing requirements for nursing homes?
There are currently no federally imposed staffing requirements for nursing homes in the United States. As of July 4, 2025, the One Big Beautiful Bill Act placed a moratorium on the HPRD and 24/7 RN requirements which prohibits the implementation, administration, or enforcement of these standards until October 1, 2034.
In 2024, the Centers for Medicare and Medicaid Services (CMS) issued a mandate for staffing minimums in long-term care (LTC) facilities. The mandate placed requirements on facility assessments, HPRD, and the presence of a registered nurse (RN) on site 24/7. However, these requirements are no longer enforceable under the new legislation.
A few states have regulations in place that are equivalent to or exceed the HPRD requirements of the 2024 federal mandate. However, very few states have rules in place that allocate a specific amount of HPRD to be performed by a CNA.
CNA-to-patient ratios by state
Find what the CNA staffing requirements for nursing home facilities in each state are below.
*Please note that CNA staffing requirements for other types of facilities may be different. Information was sourced in April 2025. For reader convenience, source links are supplied.
Alabama
Alabama’s Administrative Code does not provide a specific ratio for CNAs; it only indicates that sufficient staff in nursing facilities is required at all times.
Source: Alabama Administrative Code 420-5-10.11 Nursing Services.
Alaska
Alaska’s Administrative Code does not provide a specific ratio for CNAs; it only indicates that sufficient staffing is required to meet resident needs.
Source: Alaska Administrative Code 7 AAC 12.275 Nursing and Medical Services, 7 AAC 12.630 Governing Body.
Arizona
Arizona’s Administrative Code does not provide a specific ratio for CNAs, although it does indicate that sufficient nursing personnel is required to meet resident needs.
Source: Arizona Administrative Code R9-10-412. Nursing Services.
Arkansas
Arkansas regulations do not specify a required CNA staffing ratio. However, current legislation enforces a mandatory average of 3.36 HPRD.
Additionally, the Arkansas Office of Long Term Care (OLTC) offers an online portal and tool called the “Minimum Staffing Calculator” to facilitate easier reporting and calculation of staffing requirements for nursing facilities.
Source: Code of Arkansas Rules 20 CAR § 400-1404. Average direct care hours per resident—Certified nursing facilities.
California
California’s Health and Safety Code does not provide a specific ratio for CNAs. Nevertheless, it does state that all skilled nursing facility residents must receive 3.5 HPRD, of which 2.4 HPRD must be provided by a CNA.
Source: California Health and Safety Code HSC § 1276.65.
Colorado
Colorado regulations do not provide a specific ratio for CNA staffing. However, they indicate that sufficient staff is required to offer “prompt assistance.”
Source: Code of Colorado Regulations 6 CCR 1011-1 Chapter 05. Section 9.3 Nursing Services.
Connecticut
The Connecticut Public Health Code stipulates the following CNA staffing rules.
In a “Rest Home”
Under licensed nurse supervision, there must be at least one CNA on duty on each resident floor at all times.
Additionally, between 7 a.m. and 9 p.m., nursing and CNA personnel must provide .70 HPRD, and between 9 p.m. and 7 a.m., nursing and CNA personnel must provide .17 HPRD.
In a “Chronic and Convalescent Nursing Home”
During the hours of 7 a.m. and 9 p.m., patients must receive 1.4 HPRD from nursing and CNA personnel. From 9 p.m. to 7 a.m., patients must receive .5 HPRD from nursing and CNA personnel.
Source: Connecticut Public Health Code Title 19, Sec. 19-13-D8t. (m) Nursing Staff.
Delaware
According to the Delaware Code, required CNA staffing ratios are as follows:
- Day: One CNA to seven residents
- Evening: One CNA to 10 residents
- Night: One CNA to 15 residents
Furthermore, the Code indicates that adequate staffing must be in place to meet all residents’ needs and 3.67 HPRD.
Source: Delaware Code Title 16 Health and Safety § 1162. Nursing Staffing (e).
District of Columbia
The Washington, D.C., Municipal Regulations stipulate a minimum of two nursing employees per unit per shift, in addition to licensed nurse staff requirements.
The minimum daily average for HPRD is 3.5.
Source: D.C. Municipal Regulations Title 22 B3211.2d Nursing Personnel.
Florida
According to the Florida Statutes, a minimum ratio of one CNA per 20 residents is required. Residents must receive a minimum of two HPRD from a CNA. Additionally, Sufficient staffing is required to meet residents’ needs and meet a weekly average of 3.6 HPRD.
Source: Florida Statutes 400.23.
Georgia
Georgia Rules and Regulations do not provide a staffing ratio specific to CNAs. However, they indicate that at least one of every seven nursing staff members (excluding dining assistants) must be a licensed nurse, and residents must receive at least two HPRD.
Source: Georgia Rules and Regulations Rule 111-8-56-.04. Nursing Services.
Hawaii
Hawaii’s Administrative Rules do not indicate a specific CNA staffing ratio. Nevertheless, they indicate that sufficient nursing personnel is required to meet resident needs.
Source: Hawaii Administrative Rules Title 11 Chapter 94.2-39 Nursing Services.
Idaho
Idaho’s Administrative Rules do not specify a staffing ratio requirement for CNAs in skilled nursing facilities.
Source: Idaho Administrative Rules 16.03.02 Skilled Nursing Facilities.
Illinois
The Illinois Administrative Code for Long Term Care Facilities does not provide a specific staffing ratio requirement for CNAs. However, it provides an in-depth explanation of the formula facilities should use to calculate the level of staffing required.
Source: Illinois Administrative Code Title 77 Chapter 1. Section 300.1230 Direct Care Staffing.
Indiana
The Indiana Administrative Code does not specify a CNA staffing ratio requirement, although it indicates that sufficient staff is required to provide nursing and related services to each resident.
Source: Indiana Administrative Code 410 16.2-3.1-17 Nursing Services.
Iowa
The Iowa Code does not provide a specific CNA staffing ratio requirement. Nevertheless, it indicates that a facility must provide sufficient nursing staff.
Source: Iowa Administrative Code 441. Chapter 81.13(11) Nursing Services.
Kansas
Kansas Administrative Regulations do not specify a CNA staffing ratio requirement, although they indicate that the staffing ratio of nursing personnel to residents can be no fewer than one to 30 residents, “or for each fraction of that number of residents.”
Per state regulations, each resident must receive a weekly average of two HPRD and a daily average of no lower than 1.85 HPRD.
Source: Kansas Administrative Regulations Article 39-154. Nursing Services.
Kentucky
Kentucky Administrative Regulations do not provide a specific CNA staffing ratio requirement, stating that adequate staffing is required to meet patient needs.
Source: Kentucky Administrative Regulations Section 902 KAR 20:048 - Operation and Services; Nursing Homes.
Louisiana
Louisiana Administrative Code does not specify a CNA staffing ratio requirement, although it indicates that sufficient staff are required to provide nursing and related services to each resident. Each resident must receive a minimum of 2.35 HPRD.
Source: Louisiana Administrative Code Title 48-Part I-(Book 2)-Chapter 98. §9823. Nursing Service Personnel.
Maine
The Code of Maine Rules indicates that the direct care staff-to-patient ratio for facilities shall not fall below the following:
- Day shift: One to five
- Evening shift: One to 10
- Night shift: One to 15
The Code indicates that CNAs are considered direct care staff alongside RNs, LPNs, and personal support specialists.
Source: Code of Maine Rules 10.144-Chapter 110-Section 9-Resident Care Staffing A.4. Minimum Staffing Ratios.
Maryland
The Maryland Code Regulations do not specify a CNA staffing ratio requirement. However, they indicate that the ratio of “nursing service personnel” to patients/residents may not fall below one to 15. Additionally, sufficient supervisory and support personnel are required to provide a minimum of three HPRD for every resident.
Source: Maryland Code Regulations 10.07.02.19 Nursing Services - Staffing.
Massachusetts
According to the Code of Massachusetts Regulations, residents in Level I, Level II, and Level III facilities must receive a minimum of 3.58 HPRD, .508 of which must be provided by an RN.
Additionally, Level III facilities must have at least one CNA on duty during night shifts.
Source: 105 Code of Massachusetts Regulations 150.000: Standards for Long-Term Care Facilities Section 150.007 Nursing Services.
Michigan
The Michigan Compiled Laws do not provide a specific CNA staffing ratio requirement. However, they provide nursing care personnel-to-patient ratios as follows:
- Morning shift: One to eight
- Afternoon shift: One to 12
- Night shift: One to 15
Furthermore, nursing homes must provide sufficient staff to provide no less than 2.25 HPRD.
Source: Michigan Compiled Laws - Section 333.21720a
Minnesota
Minnesota Administrative Rules do not dictate a CNA staffing ratio requirement.
Residents in nursing homes not participating in the medical assistant program must receive a minimum of two HPRD.
Furthermore, residents in participating nursing homes must receive the greater of the following:
- Two hours per resident per 24 hours
- 0.95 hours per standardized resident day
Source: Minnesota Administrative Rules 4658.0510 Nursing Personnel.
Mississippi
The Mississippi Health Facilities Regulations do not specify a CNA staffing ratio requirement, but they indicate that sufficient staff are required so that all residents receive a minimum of 2.80 HPRD.
Source: Mississippi Health Facilities Regulations Rule 45.4.1 Nursing Facility.
Missouri
The Missouri Code of State Regulations does not specify a CNA staffing ratio requirement. However, it specifies that an adequate number and type of staff is required to provide proper care to each resident.
Source: Missouri Code of State Regulations Title 19 CSR 30-85.042.
Montana
The Montana Administrative Rules do not provide a CNA staffing ratio requirement, indicating only that staffing levels must be appropriate to comply with federal laws and regulations.
Source: Montana Administrative Rules 37.40.315.
Nebraska
Nebraska’s Health and Human Services Regulations do not specify a CNA staffing ratio requirement, although they indicate that sufficient qualified nursing personnel are required to meet residents’ needs.
Source: Nebraska Administrative Code Title 175. 12-006.04C7 Other Nursing Personnel.
Nevada
Nevada’s Administrative Code does not provide a CNA staffing ratio requirement, indicating only that sufficient qualified nursing personnel are required to meet residents’ needs.
Source: Nevada Administrative Code NAC 449.199. Staffing Requirements.
North Carolina
The North Carolina Administrative Code states that facilities with multiple stories should have a CNA on duty at all times on each patient floor.
Source: North Carolina Administrative Code Title 10A 13D .2303 Nurse Staffing Requirements.
North Dakota
The North Dakota Regulatory Code does not provide a specific ratio for CNA staffing. However, it indicates that sufficient qualified nursing staff are required to meet residents’ nursing care needs.
Source: North Dakota Regulatory Code 33-07-03.2-14 Nursing Services.
New Hampshire
The New Hampshire Code of Administrative Rules does not specify a CNA staffing ratio requirement.
Source: New Hampshire Code of Administrative Rules He-P 803.15 - Required Services.
New Jersey
The New Jersey Administrative Code does not provide CNA staffing ratio requirements. Residents require a minimum of 2.5 HPRD, 20 percent of which RNs or LPNs must provide.
Source: New Jersey Administrative Code Title 8, Chapter 39-25.2 Mandatory nurse staffing amounts and availability.
New Mexico
The New Mexico Administrative Code does not specify a CNA staffing ratio requirement.
The Code stipulates that a seven-day average of 2.5 HPRD is required per resident in skilled nursing facility settings, and a seven-day average of 2.3 HPRD per resident is required in intermediate care facilities.
It provides the following general “nursing department employee” staffing ratios:
For the 2.5 HPRD requirement
- Day shift: One to seven
- Evening shift: One to 10
- Night shift: One to 12
For the 2.3 HPRD requirement
- Day shift: One to eight
- Evening shift: One to 10
- Night shift: One to 13
Source: New Mexico Administrative Code 8.370.16.51 Nursing Staff.
New York
The New York Codes, Rules, and Regulations stipulate that each resident should receive 3.5 HPRD, and no less than 2.2 HPRD must be provided by a CNA, effective January 1, 2023.
Source: New York Codes, Rules and Regulations Section 415.13 Nursing Services and Minimum Nursing Staff Requirements.
Ohio
The Ohio Administrative Code does not specify a CNA staffing ratio. However, it indicates that each resident must receive a minimum of 2.5 HPRD.
Source: Ohio Administrative Code 3701 Nursing Homes -17-08 Personnel Requirements.
Oklahoma
Oklahoma Administrative Rules do not provide a specific CNA staffing ratio. Nevertheless, they indicate that facilities should be staffed to provide nursing and health services at all times.
Source: Oklahoma Administrative Rules 310:675-13-5. Nursing Services.
Oregon
The Oregon Administrative Rules provide the following minimum CNA-to-patient staffing ratios:
- Day shift: One to seven
- Evening shift: One to 9.5
- Night shift: One to 17
Furthermore, the Rules stipulate additional CNAs above the staffing standard may be required in the event that the Department authorizes the “bariatric rate.”
Source: Oregon Administrative Rules 411-086-0100 Nursing Services: Staffing.
Pennsylvania
The Pennsylvania Administrative Code provides requirements for CNA-to-resident staffing ratios—effective July 1, 2024—as follows:
- Day shift: One to 10
- Evening shift: One to 11
- Night shift: One to 15
Additionally, residents should receive a minimum of 3.2 HPRD.
Source: Pennsylvania Administrative Code Title 28 § 211.12. Nursing Services.
Rhode Island
Although the Rhode Island Code of Regulations does not specify a CNA staffing ratio, it stipulates that at least one nursing assistant must be included in creating the staffing pattern plan.
Furthermore, the Code states that a minimum of two personnel members certified in Basic Life Support must be on duty at all times, one of whom must be a licensed nurse.
Source: Rhode Island Code of Regulations Title 216, Chapter 40-10-1.16.6 Nursing Service and Minimum Staffing.
South Carolina
Although the South Carolina Code of State Regulations does not provide CNA staffing ratio requirements, it stipulates that an adequate number of direct care staff is required at all times.
Source: South Carolina Code of State Regulations 61-17.600.603 - Direct Care Staff.
South Dakota
The South Dakota Administrative Rules do not specify a CNA staffing ratio. However, they stipulate that the ratio of RNs or LPNs to nurse aides must be sufficient for appropriate supervision and that an adequate number of direct care staff is required at all times.
Source: South Dakota Administrative Rules 44:73:06:07 Nursing service staffing.
Tennessee
The Tennessee Rules and Regulations do not set a CNA staffing ratio requirement. However, they stipulate that each resident must receive a minimum of two HPRD, of which .4 must be provided by licensed nursing personnel.
Source: Tennessee Rules and Regulations Chapter 0720-18 Standards for Nursing Homes.
Texas
Although the Texas Administrative Code does not provide specific CNA staffing ratios, it indicates that a facility must have sufficient staff with the appropriate skills to provide nursing services for each resident.
Source: Texas Administrative Code Title 26 Code § 554.1001 - Nursing Services.
Utah
The Utah Administrative Code does not specify a CNA staffing ratio requirement. Nevertheless, it indicates that nursing staff must be present at all times to provide services to residents.
Source: Utah Administrative Code R432-150-5. Scope of Services.
Vermont
Although the Code of Vermont Rules does not provide a specific staffing ratio for licensed nursing assistants (LNAs), it indicates that LNAs must provide a minimum of two HPRD for each resident.
Furthermore, sufficient staff must be on duty at all times to provide resident services, and each resident must receive a minimum of three HPRD on a weekly average.
Source: Code of Vermont Rules 13-110-005-X 7.13. Nursing Services.
Virginia
The Virginia Administrative Code does not specify a CNA staffing ratio requirement, although it indicates that a facility must provide sufficient qualified nurses and certified nurse aides on all shifts.
Source: Virginia Administrative Code 12 VAC 5-371-210. Nurse staffing.
Washington
The Washington Administrative Code does not require a CNA staffing ratio. However, it indicates that sufficient staff must be on duty at all times to provide resident services.
Source: Washington Administrative Code WAC 388-97-1080 Nursing Services.
West Virginia
The West Virginia Code of State Rules stipulates that sufficient nursing personnel are required at all times to provide services, and each resident must receive no less than 2.25 HPRD.
Ratios specific to CNA staff are not provided. However, a table (64-13.A.) indicating minimum ratios for general “resident care personnel” to residents is provided at the end of the Rule.
Source: West Virginia Code of State Rules Title 64. Series 13. Nursing Home Licensure. 8.14 Nursing Services Staffing.
Wisconsin
The Wisconsin Administrative Code does not specify a CNA staffing ratio requirement, although it specifies that there must be sufficient nursing service personnel to care for the needs of each patient.
Source: Wisconsin Administrative Code § DHS 132.62 - Nursing Services.
Wyoming
Wyoming Rules and Regulations do not provide a CNA staffing ratio requirement.
They stipulate that each resident requiring skilled nursing care must receive 2.25 HPRD, and each resident not requiring skilled nursing care must receive 1.5 HPRD.
Source: Wyoming Rules and Regulations Chapter 11. Section 9. Nursing Services.
Meet CNA staffing regulations affordably and efficiently
When the patient census fluctuates, it can be difficult to manage safe CNA staffing ratios without the bulky overhead cost of hiring several new internal staff nursing assistants.
Contract CNAs only when you need them, one shift at a time, by posting per diem shifts on Nursa.
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