Certificate-of-need laws in North Carolina have been at the center of ongoing controversy within the state’s highly competitive healthcare ecosystem.
The state had originally planned to repeal its CON laws by the end of 2025, but a recent court ruling has paused those plans. Here is a timeline of North Carolina’s controversy surrounding CON between 2021 and 2025:
Dec. 15, 2025: The North Carolina Supreme Court declined to hear a challenge to Altamonte Springs, Fla.-based AdeventHealth’s planned hospital in Weaverville, N.C. With the court declining Asheville, N.C.-based Mission Health’s appeal, AdventHealth is set to proceed with the construction of a 67-bed hospital serving Buncombe, Graham, Madison and Yancey counties
Dec. 12, 2025: A North Carolina trial court upheld the constitutionality of the state’s certificate-of-need laws Dec. 12, 2025 rejecting the years-long legal challenge by Jay Singleton, MD, owner of Singleton Vision Center in New Bern, N.C. The judges ultimately rejected the argument that CON laws provide a monopoly and “exclusive emolument” to incumbent healthcare providers.
July 26, 2025: North Carolina’s high court granted Mission Health’s motion for a stay, pausing a decision that affirmed the state Department of Health and Human Services’ approval of AdventHealth’s project.
Feb. 21, 2025: An article by The Carolina Journal found that the state health department denied six projects in September 2024, blocking 11 surgical rooms and 176 acute care beds.
Oct. 18, 2024: The North Carolina Supreme Court issued an unsigned, unanimous four-page ruling that allowed Dr. Singleton to move forward with the case.
Nov. 1, 2023: As an interim measure, North Carolina implemented a law stating that ASCs in counties with populations over 125,000 were exempt from CON.
June 11, 2021: Dr. Singleton’s case is first dismissed in Wake County Superior Court.
