Florida
Florida partially repealed its CON laws in 2019, eliminating them for general hospitals. However, CON requirements remain for nursing homes, hospices, and intermediate care facilities, protecting incumbent providers in the post-acute care sector.
What CON Covers in Florida
Florida's CON program is administered by the Agency for Health Care Administration (AHCA). While hospitals were deregulated, incumbent providers can still block new competitors in the nursing home and hospice markets.
| Category | Services Requiring CON Approval |
|---|---|
| Facilities | Nursing homes (community skilled nursing facilities), hospice programs (including freestanding inpatient hospices), and intermediate care facilities for the developmentally disabled (ICF/DD) |
| Exemptions | General hospitals, specialty hospitals, ambulatory surgical centers, and most other healthcare facilities are exempt as of 2019/2021 reforms. |
The Application Process
The process for remaining CON services is rigorous. Any 'substantially affected person,' including existing providers, can request an administrative hearing to object to a new competitor's application, creating significant barriers to entry.
| Review Detail | Value |
|---|---|
| Reviewing Agency | Agency for Health Care Administration (AHCA) |
| Application Fee | $10,000 base + 1.5% of expenditure (capped at $50,000) |
| Review Timeline (Actual) | 3-5 months |
| Can Competitors Intervene? | Yes. Incumbents can block new entrants. |
Who Benefits
While hospital markets are now more competitive, Florida's remaining CON laws protect large incumbent systems in the lucrative post-acute care sector, particularly in major metro areas.
As a dominant system, AdventHealth benefits from limited competition in its remaining CON-protected service lines.
Source: Company Reports, 2023
AdventHealth and Orlando Health dominate the Central Florida market, including post-acute care.
Source: State Filings
Florida Blue (BCBS) holds a significant share of the commercial insurance market, reducing consumer choice.
Source: KFF, 2022
Courts have upheld local hospice monopolies, ruling that ending them is not a valid reason to approve a CON.
Source: Case Law, 2018
Orlando Area Hospital Market Share (Illustrative)
AdventHealth and Orlando Health are the two dominant players in Central Florida. While hospital CON is gone, their scale gives them immense leverage in the remaining regulated services like hospice and nursing homes.
By repealing most of its CON law, Florida took a significant step toward a more competitive hospital market. However, by leaving protections for nursing homes and hospices, the state continues to shield some of the most profitable sectors from competition.
— The Rojas Report Analysis
The Human Cost
Florida's remaining CON laws continue to create barriers, as seen in a 2018 case where the state explicitly defended a local hospice monopoly.
Sarasota County Hospice Denial
Decided 2018 · Sarasota County, Florida · State Court
In 2018, a court upheld the Agency for Health Care Administration's (AHCA) denial of a CON for a new hospice provider in Sarasota County. At the time, the county was served by a single monopoly hospice provider.
The applicant argued that introducing competition would benefit the community. However, the court ruled that the applicant failed to demonstrate sufficient 'unmet demand' under the state's formula. The court explicitly stated that ending a monopoly was not, by itself, a sufficient reason to approve a new competitor.
This case highlights the core flaw of CON laws: they prioritize the financial stability of existing providers over the benefits of market competition. The state actively defended the incumbent's monopoly, forcing residents to rely on a single provider for end-of-life care.
The purpose of the certificate of need law is not to protect existing providers from competition, but that is its practical effect.
— Florida Court of Appeals, paraphrased
Reform Status
Florida passed major reforms in 2019 and 2021, but left key protections for post-acute care in place. This created a two-tiered system: a competitive hospital market and a protected post-acute market.
Florida (Partial Reform)
- CON for hospitals repealed in 2019
- CON for specialty hospitals repealed in 2021
- CON remains for nursing homes & hospices
- Score: 5/100 (Mostly Free)
- Allows competition in acute care
- Protects incumbents in post-acute care
States With Full Repeal
- 12 states have no CON program
- Includes California, Texas, Pennsylvania
- Studies show increased access and lower costs post-repeal
- ASCs per capita increased 44-47% after repeal
- Hospital charges 5.5% lower five years after repeal
- No significant increase in overall healthcare spending
The Rojas Report Take
Florida politicians love to talk about freedom and free markets, but their CON laws for post-acute care tell a different story. While they wisely deregulated hospitals, they left the protection racket in place for nursing homes and hospices, ensuring local monopolies can print money without fear of competition. It’s a gift to the incumbents, paid for by seniors and their families.
Look no further than Sarasota County, where the state explicitly defended a government-run hospice monopoly. A court decided that even though one provider had the entire market locked up, a new competitor couldn’t enter because they failed to prove 'unmet need.' This is how the game is rigged. It’s not about need; it’s about protecting the turf of established players. With giants like AdventHealth pulling in over $17 billion and Florida Blue controlling over a third of the insurance market, the system is working exactly as designed: for them, not for you.
Florida's reform was a job half-done. True healthcare freedom means ending all CON laws and letting competition, not government protection, drive value for patients.
Related Content
The National CON Investigation
The full origin story of Certificate of Need laws and our 50-state rankings on market restrictiveness.
State ProfileKentucky: A State Held Hostage
With a perfect 100/100 score, Kentucky has the most restrictive CON laws in the nation. See how it impacts care.
Alabama CON Profile
Certificate of Need investigation for Alabama.
Data sourced from Cicero Institute, National Academy for State Health Policy (NASHP), Agency for Health Care Administration (AHCA), KFF, and company financial reports.