============================================================================== CERTIFICATE OF NEED INTELLIGENCE BRIEF: NORTH CAROLINA The Rojas Report | conlaws.rojasreport.com/states/north-carolina/ ============================================================================== State: North Carolina (NC) Score: 100/100 Tier: Most Restrictive Rank: 43 of 51 jurisdictions ------------------------------------------------------------------------------ KEY METRICS ------------------------------------------------------------------------------ 13+ Categories regulated by CON 1977 Year CON enacted ~85% Charlotte Market Share (2 Systems) 62% BCBS NC Market Share ------------------------------------------------------------------------------ SUMMARY ------------------------------------------------------------------------------ North Carolina CON score 85/100 (highly restrictive). 18 services regulated since 1977. Two systems control nearly 100% of Charlotte's inpatient market. ------------------------------------------------------------------------------ SCOPE OF REGULATION ------------------------------------------------------------------------------ * Services Requiring CON Approval * UNC Hospitals PET Scanner Application ------------------------------------------------------------------------------ APPLICATION PROCESS ------------------------------------------------------------------------------ The review process is lengthy and allows incumbent providers to file a 'contested case' against a new applicant. This legal challenge mechanism significantly raises the cost and time required to bring new services to a community, protecting established players from competition. — Dr. Gajendra Singh, whose application for a new hospital was blocked ------------------------------------------------------------------------------ MARKET CONCENTRATION ------------------------------------------------------------------------------ North Carolina's CON law is a textbook case of regulatory capture. In Charlotte, two hospital systems, Atrium and Novant, control nearly 100% of the market. The state uses its power to pick winners and losers, stifling competition and leaving patients with fewer choices and higher costs. Combined hospital market share of Atrium & Novant in Charlotte ------------------------------------------------------------------------------ REFORM STATUS ------------------------------------------------------------------------------ National Reform Efforts An overview of the legislative battles to repeal or reform CON laws. ------------------------------------------------------------------------------ CASE LAW / DENIALS ------------------------------------------------------------------------------ North Carolina's CON law is a textbook case of regulatory capture. In Charlotte, two hospital systems, Atrium and Novant, control nearly 100% of the market. The state uses its power to pick winners and losers, stifling competition and leaving patients with fewer choices and higher costs. The review process is lengthy and allows incumbent providers to file a 'contested case' against a new applicant. This legal challenge mechanism significantly raises the cost and time required to bring new services to a community, protecting established players from competition. — Dr. Gajendra Singh, whose application for a new hospital was blocked ============================================================================== Source: The Rojas Report | conlaws.rojasreport.com/states/north-carolina/ Data: Cicero Institute, NASHP, FTC, DOJ, CMS, state health departments Generated: April 2026 ==============================================================================