Nebraska Certificate of Need
Nebraska has significantly narrowed its CON program, but the remaining regulations for long-term care beds continue to shield incumbents and limit competition in a critical sector.
A lower score indicates a less restrictive and more competitive market.
Jim Pillen
1979
Heavily Reformed
CHI Health
UnitedHealth (24%)
Scope of Regulation
What CON Covers
Regulated Services
Nebraska's CON law is narrow, primarily acting as a moratorium on new beds in specific long-term care facilities.
Application Process
The process is managed by the DHHS with no competitor intervention rights.
| Reviewing Agency | NE Dept. of Health and Human Services (DHHS) |
| Application Fee | $1,000 |
| Statutory Review Time | 60 days |
| Incumbent Intervention | Not permitted |
Market Concentration
Who Benefits
Regional Dominance
Major metropolitan areas are highly concentrated, dominated by a few large systems.
Lincoln Market: Bryan Health holds a commanding 70% inpatient market share.
Omaha Market: Led by CHI Health, with Nebraska Medicine as the primary competitor.
Insurer Landscape
The insurance market is similarly concentrated, with three carriers controlling over 62% of the market.
Notable Disputes
The Human Cost
Beatrice Manor, Inc. v. Department of Health (1980)
A classic example of central planning failure. Beatrice Manor was denied a CON for additional nursing home beds in Gage County. The state's rationale was not a lack of quality or financial viability, but simply that the county already had 82 beds per 1,000 elderly residents, exceeding the state's arbitrary optimum of 68.6. This denial protected existing facilities from competition at the direct expense of patient choice and potential access to newer facilities.
Legislative Status
Reform Efforts
Heavily Reformed, But Not Repealed
Nebraska took a significant step in 1997 by repealing its broad CON framework. However, the state left a targeted, bed-focused regime in place for long-term and rehabilitation care. This "CON-lite" approach still creates barriers to entry and protects incumbents in a market segment crucial for an aging population.
The Rojas Report Take
Nebraska presents a frustrating case study in half-measures. The state deserves credit for dismantling the worst of its CON regime in 1997, an act that moved it far from the protectionist rackets seen in states like Maryland or D.C. Yet, by leaving a narrow CON law for long-term care and rehabilitation beds, policymakers left a critical gate locked, and the incumbents kept the key.
This isn't a theoretical problem. In Lincoln, one system—Bryan Health—controls a staggering 70% of the inpatient market. While CON may not be the only driver, a regulatory moat around new nursing and rehab beds certainly doesn't foster a competitive environment. It tells potential innovators and new providers that they aren't welcome, ensuring the established players can operate with minimal threat of disruption.
The state's own data shows the original law was used to deny care based on arbitrary ratios. While the scope is smaller now, the principle remains the same: central planners, not patients and providers, decide what healthcare services are "needed." Nebraska's CON law may be on a diet, but it's still feasting on the state's long-term care market.