============================================================================== CERTIFICATE OF NEED INTELLIGENCE BRIEF: ALABAMA The Rojas Report | conlaws.rojasreport.com/states/alabama/ ============================================================================== State: Alabama (AL) Score: 80/100 Tier: Highly Restrictive Rank: 33 of 51 jurisdictions ------------------------------------------------------------------------------ KEY METRICS ------------------------------------------------------------------------------ 7 Services regulated by CON 1979 Year CON enacted 10,000 Decatur Market HHI 84% Top Insurer Market Share ------------------------------------------------------------------------------ SUMMARY ------------------------------------------------------------------------------ Alabama CON score 80/100 (highly restrictive). 7 services regulated since 1979. One system controls a monopoly in Decatur (HHI 10,000), while one insurer has 84% of the state market. ------------------------------------------------------------------------------ SCOPE OF REGULATION ------------------------------------------------------------------------------ * Services Requiring CON Approval ------------------------------------------------------------------------------ APPLICATION PROCESS ------------------------------------------------------------------------------ The statutory timeline for a decision is 90 days, but the actual process often extends from 6 to 12 months. Any party that can demonstrate a 'viable interest' can contest an application, a loophole frequently exploited by established competitors to block new market entrants. In April 2024, South Baldwin Regional Medical Center sought to build a new freestanding emergency department in Loxley to serve a rapidly growing community. The application was contested by incumbent providers in the area. ------------------------------------------------------------------------------ MARKET CONCENTRATION ------------------------------------------------------------------------------ Alabama's CON laws, enacted in 1979, regulate 7 different healthcare services. The state's healthcare landscape is marked by extreme market concentration, with Decatur experiencing a literal monopoly (HHI 10,000) and a single insurer controlling 84% of the commercial market. Top Hospital System Market Share (Estimated) ------------------------------------------------------------------------------ REFORM STATUS ------------------------------------------------------------------------------ Alabama's CON laws, enacted in 1979, regulate 7 different healthcare services. The state's healthcare landscape is marked by extreme market concentration, with Decatur experiencing a literal monopoly (HHI 10,000) and a single insurer controlling 84% of the commercial market. Current Status: No Meaningful Reform ------------------------------------------------------------------------------ CASE LAW / DENIALS ------------------------------------------------------------------------------ Case: South Baldwin RMC Freestanding Emergency Department Denied In April 2024, South Baldwin Regional Medical Center sought to build a new freestanding emergency department in Loxley to serve a rapidly growing community. The application was contested by incumbent providers in the area. ============================================================================== Source: The Rojas Report | conlaws.rojasreport.com/states/alabama/ Data: Cicero Institute, NASHP, FTC, DOJ, CMS, state health departments Generated: April 2026 ==============================================================================