Personal Care Aide Training Standards Across the United States: 2025 Update

Together, personal care aides and home health aides make up the largest occupational group in the U.S. workforce.  However, personal care aides – unlike home health aides who are required to have at least 75 hours of entry-level training –are not subject to any federal minimum training requirements. As a result, personal care aides often receive inconsistent preparation for their roles, with standards contingent on where they live and work—undermining job quality and career mobility, while also impacting the care they provide to consumers.

More than a decade ago, PHI collaborated with the University of California, San Francisco’s (UCSF) Health Workforce Research Center (HWRC) to publish the first-ever analysis of personal care aide training standards across the United States, which we updated in 2019. This year, with funding from the Health Resources and Services Administration, PHI and UCSF have published another full update of training standards for personal care aides across all 50 states and Washington, D.C.

Through systematic online searches and desk research, we identified training requirements for agency-employed personal care aides in Medicaid state plans, home and community-based services waiver programs, and home care licensing rules. We analyzed these requirements across three domains: consistency, rigor, and portability.

• Consistency refers to the uniformity or variation of training requirements for agency-employed personal care aides across each state’s Medicaid programs
• Rigor examines the individual components of each set of training requirements, including training hours, specified competency, competency evaluation or exams, the presence of a state-sponsored training curriculum, training instructor qualifications, and continuing education hours
• Portability assesses whether training and credentials can be transferred between roles, settings, and employers through recognized credentials and/or a centralized training system.

We found that a majority of states (31 states and D.C.) now have consistent training standards across Medicaid programs, while seven states still have no training requirements at all. By comparison, only 19 states had consistent training requirements in 2014, and 11 states had no training requirements at all. However, progress over the past 11 years in training standards has been uneven, as some states enhanced their training requirements, while others reduced them.

Considering rigor, we found that 42 states and D.C. specified competencies in their training requirements, but only 34 states and D.C. require a competency assessment of some kind to test knowledge gained from training. Twenty-six states and D.C. require a minimum number of training hours, and just 12 states and D.C. have a state-sponsored training curriculum.

When it comes to portability, fewer than half of all states (19 states and D.C.) provide a recognized credential for personal care aides who complete training requirements, and fewer still (13 states and D.C.) have a centralized training registry for at least one personal care aide role in the state.

These findings underline the significant variation in training requirements for personal care aides across states, leading to uneven levels of preparedness for these workers and hindering their ability to move between employers, roles, and settings. More broadly, uneven and inadequate training requirements undermine professional recognition for this essential workforce. Such disparities stress the imperative for national, competency-based training standards that support professional growth through portable credentials and clear career pathways. Establishing universal core competencies will be a critical step in strengthening the direct care workforce and the quality, efficiency, and continuity of care provided.

Read the updated personal care aide training standards report here. For a summary of each state’s training requirements, visit PHI’s website.