Private equity’s growing footprint in healthcare — and a string of high-profile bankruptcies, closures and cost complaints tied to investor-owned providers — has pushed state legislatures to write their own rules for reviewing healthcare deals.
Most of these laws require advance notice to an attorney general or health agency before a transaction closes; a smaller number go further, restricting who can own a practice or control a management services organization outright.
At least 13 states have enacted statutes governing private equity involvement in healthcare transactions. Seven have passed or substantially rewritten their laws within roughly the past 18 months, several taking effect only in 2026 or 2027 and explicitly naming private equity companies, hedge funds and MSOs as regulated parties. The other six laid the groundwork earlier, in some cases as far back as 2019, and remain the backbone of state-level deal review even as legislatures return to strengthen them.
The newest, most active laws
1. Illinois. Lawmakers passed House Bill 5000 on May 28, adding a formal definition of “private equity company” to the Illinois Antitrust Act’s 30-day pre-closing notice requirement and closing a gap that let deals structured through holding companies avoid state review. The bill also repeals a Jan. 1, 2027, sunset date, making the notice regime permanent. It was sent to Gov. JB Pritzker’s desk June 26 and is expected to be signed into law.
2. Indiana. House Bill 1666, effective in parts on July 1, 2025, and Jan. 1, 2026, refined the state’s existing health care entity transaction law, which already required 90 days’ notice to the attorney general for mergers between health care entities — a term broad enough to include private equity partnerships — with combined assets of $10 million or more. The 2025 update exempts certain practitioner-owned practices and gives the attorney general added authority to investigate market concentration.
3. Maine. Signed into law in 2026, Maine’s Health Care Consolidation Oversight Act takes effect Jan. 1, 2027, and requires 180 days’ pre-closing notice to and approval from the Department of Health and Human Services before a private equity company, hedge fund or MSO can acquire majority ownership or operational control of a health care entity — the longest lead time among the 13 states. The department can approve, approve with conditions or refer a deal for a comprehensive review that can add more than eight months to the timeline; violations carry civil penalties of up to $10,000 per day.
4. Massachusetts. The Health Policy Commission’s decade-old material change notice law, Chapter 6D, Section 13, got real teeth in January 2025, when Gov. Maura Healey signed a rewrite that, as of April 8, 2025, lets the commission demand capital structure, ownership and audited financial information from “significant equity investors” involved in a deal — the law’s first explicit reach into private equity.
5. New Mexico. House Bill 586, effective July 1, 2025, created the Health Care Consolidation Oversight Act, replacing a temporary 2024 law. It requires hospitals and certain provider organizations proposing a merger, acquisition or change in majority ownership or control to submit a transaction notice to the Health Care Authority before closing; the deal can be denied if regulators find it works against the public interest, raises costs or reduces access. New Mexico has one of the highest concentrations of private equity-owned hospitals in the country.
6. Rhode Island. A new Pre-Merger Notification Rule for Medical-Practice Groups, effective Jan. 28, 2026, requires 60 days’ notice to the attorney general before a medical-practice group merges, is acquired or changes control as a result of a “significant equity investor” — a term the rule defines to include private equity companies and any investor holding more than 10% of a practice or MSO. Penalties run up to $200 per day before closing and up to $100,000 after.
7. Washington. House Bill 2548, signed March 25, 2026, and effective June 11, 2026, broadens the state’s health care market participants law, which has required 60 days’ notice to the attorney general for hospital and provider-organization mergers since 2020. State regulators cited rising private equity ownership and its link to higher provider fees and hospital prices in pressing for the expansion, which adds new disclosure, timing and public-transparency requirements.
Established review frameworks
8. California. Signed in 2022 and fully in effect since April 2024, the Health Care Quality and Affordability Act requires health care entities to give the Office of Health Care Affordability at least 90 days’ notice of a “material change transaction.” OHCA cannot block a deal, but it can refer one to the attorney general for further antitrust review and can extend its review well beyond the initial notice period.
9. Connecticut. Under Section 19a-486i of the state’s health care institutions statute, parties to a transaction resulting in a material change to a group practice’s business or corporate structure must give the attorney general 30 days’ notice before closing, plus a separate notice to the Office of Health Strategy within 30 days after. The provision dates to 2014 but has been the subject of repeated attempts to expand it to reach private equity more directly.
10. Minnesota. Enacted in 2023, Minnesota Statute 145D.01 requires health care entities with average annual revenue of at least $80 million to notify the attorney general and the commissioner of health 30 to 60 days before closing a transaction, depending on size. Minnesota’s attorney general has among the strongest enforcement tools of any notice-based state law: authority to sue to enjoin or unwind a transaction found contrary to the public interest.
11. Nevada. The oldest of the 13 frameworks, NRS 598A.390 has required 30 days’ advance notice to the attorney general for reportable healthcare and health carrier transactions since October 2021. Parties who willfully violate the notice requirement face civil penalties of up to $1,000 per day.
12. New York. Article 45-A of the Public Health Law, in effect since August 2023, requires “health care entities” — including physician practices and MSOs — to give the Department of Health at least 30 days’ notice of a material transaction, which the department forwards to the attorney general. The law grew directly out of state concern over investor-backed physician practices; failure to disclose can bring civil penalties of up to $2,000 per day.
13. Oregon. In effect since 2022, ORS Chapter 415 requires health care entities to notify the Oregon Health Authority of material change transactions subject to review. Oregon has since gone further on a separate track: Senate Bill 951, a first-of-its-kind 2025 law strengthening the state’s corporate practice of medicine doctrine, restricts private equity-backed MSOs from holding ownership stakes in the medical practices they manage, with new arrangements required to comply starting Jan. 1, 2026.
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