North Carolina’s certificate-of-need law has become one of the most contested healthcare policy fights in the state, playing out simultaneously in the legislature, the courts and the state budget. Here’s where things stand.
- The law covers a lot of ground. North Carolina’s CON program requires state approval before a provider can build new health facilities, substantially expand services, add beds, or purchase certain major medical equipment. North Carolina is one of roughly three dozen states that still have a CON program on the books.
- A full repeal has been stuck in the House for over a year. State Senate Bill 370 and companion House Bill 455 would wipe out CON requirements statewide. Senate Bill 370 passed the Senate 31-17 in April 2025 and has remained stuck in the House Rules Committee since.
- An interim carve-out already lets some ASCs skip CON. Since Nov. 1, 2023, ASCs located in counties with populations over 125,000 no longer require CON approval, a change that has already spurred new facility development in high-demand regions like the Research Triangle and Charlotte.
- This summer’s budget added a narrower, targeted repeal. State Senate Bill 257, the 2026 Appropriations Act, includes a provision repealing CON review for inpatient rehabilitation services, facilities and beds starting Oct. 1, 2026. Gov. Josh Stein signed the $34 billion budget in July.
- A six-year court battle just hit a setback for repeal advocates. New Bern ophthalmologist Jay Singleton has been challenging CON’s constitutionality since 2020. A bipartisan three-judge trial court panel upheld the law’s constitutionality in December 2025, rejecting his challenge. Justices denied Singleton’s request to bypass the Court of Appeals in June 2026, meaning the case must work through the intermediate appellate court before it can head back to the Supreme Court.
- A new investigation puts a number on the CON gridlock: More than 1,100 beds stuck in appeals. Carolina Public Press’ “Battling for Beds” series found that since 2020, DHHS has approved more than 1,100 acute care beds that remain undeveloped because competitors challenged the approvals — with 12 of 14 approved projects appealed in 2025 and 6 of 8 in 2026 so far
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