============================================================================== CERTIFICATE OF NEED INTELLIGENCE BRIEF: ILLINOIS The Rojas Report | conlaws.rojasreport.com/states/illinois/ ============================================================================== State: Illinois (IL) Score: 65/100 Tier: Restrictive Rank: 27 of 51 jurisdictions ------------------------------------------------------------------------------ KEY METRICS ------------------------------------------------------------------------------ 6+ Services regulated by CON 1974 Year CON enacted 97% BCBS HMO market share 2029 Sunset date (if not renewed) ------------------------------------------------------------------------------ SUMMARY ------------------------------------------------------------------------------ Illinois CON score 65/100 (restrictive). 6+ services regulated since 1974. One insurer controls 97% of the HMO market. CON law sunsets in 2029. ------------------------------------------------------------------------------ SCOPE OF REGULATION ------------------------------------------------------------------------------ * Services Requiring CON Approval ------------------------------------------------------------------------------ APPLICATION PROCESS ------------------------------------------------------------------------------ Illinois calls it the Health Facilities Planning Act. It should be called the Incumbent Protection Racket Act. One insurer controls 97% of the HMO market. The state's CON law is the moat that protects this castle, ensuring no new competition can threaten the cozy arrangement between dominant insurers and hospital systems. The HFSRB reviews all applications for new healthcare facilities and major capital expenditures. The process allows incumbent providers to protest, effectively giving existing players a veto over new competition. Application fees can reach $150,000. ------------------------------------------------------------------------------ MARKET CONCENTRATION ------------------------------------------------------------------------------ The HFSRB reviews all applications for new healthcare facilities and major capital expenditures. The process allows incumbent providers to protest, effectively giving existing players a veto over new competition. Application fees can reach $150,000. The case illustrates how the CON process can be weaponized — not just to protect incumbents from competition, but potentially to punish those who challenge the system itself. ------------------------------------------------------------------------------ CASE LAW / DENIALS ------------------------------------------------------------------------------ Edward Hospital — Plainfield Facility Denial The Health Facilities and Services Review Board denied the application. The hospital's CEO alleged the denial was retaliatory after she exposed a kickback scheme within the review process. Despite the allegations, the board formally rejected the CON, leaving the community without the facility it needed. The case illustrates how the CON process can be weaponized — not just to protect incumbents from competition, but potentially to punish those who challenge the system itself. ============================================================================== Source: The Rojas Report | conlaws.rojasreport.com/states/illinois/ Data: Cicero Institute, NASHP, FTC, DOJ, CMS, state health departments Generated: April 2026 ==============================================================================