==============================================================================
  CERTIFICATE OF NEED INTELLIGENCE BRIEF: HAWAII
  The Rojas Report | conlaws.rojasreport.com/states/hawaii/
==============================================================================

  State:    Hawaii (HI)
  Score:    65/100
  Tier:     Restrictive
  Rank:     27 of 51 jurisdictions

------------------------------------------------------------------------------
  SUMMARY
------------------------------------------------------------------------------

  In-depth analysis of Hawaii's Certificate of Need (CON) laws, examining
their impact on healthcare competition, market concentration, and patient
access.

------------------------------------------------------------------------------
  SCOPE OF REGULATION
------------------------------------------------------------------------------
  * Regulated Services
  * Skilled nursing facilities / Intermediate care facilities
  * Outpatient clinics and ambulatory care facilities
  * Home health agencies

------------------------------------------------------------------------------
  APPLICATION PROCESS
------------------------------------------------------------------------------

  The path to approval is lengthy and provides ample opportunity for
established players to block new competition.

  The state's regulatory framework creates a protectionist moat around
incumbent providers.

------------------------------------------------------------------------------
  MARKET CONCENTRATION
------------------------------------------------------------------------------

  Most communities have only one hospital system.

  $81.4B in discounted drugs. Zero disclosure requirements.

------------------------------------------------------------------------------
  REFORM STATUS
------------------------------------------------------------------------------

  Annual Revenue: ~$1.7 Billion

  Despite criticism from free-market advocates, Hawaii's CON law has not been
repealed and remains one of the strictest in the nation.

==============================================================================
  Source: The Rojas Report | conlaws.rojasreport.com/states/hawaii/
  Data: Cicero Institute, NASHP, FTC, DOJ, CMS, state health departments
  Generated: April 2026
==============================================================================