Connecticut Certificate of Need Laws
Connecticut
Highly Restrictive
Year Enacted
—
Services Regulated
—
National Rank
37 of 51
Top Systems
- Hospital Expansions
Market Concentration
Avg. HHI Score
Reform Status
No Meaningful Reform
Key Case
No major case law on record.
An Assessment of a Restrictive Certificate of Need Regime
6 Services Held Hostage
- ✓Hospitals
- ✓Ambulatory Surgery Centers (ASCs)
- ✓Nursing Homes / Long-Term Care
- ✓Imaging (MRI, CT, PET)
- ✓Cardiac / Open Heart Surgery
- ✓Major Medical Equipment
The Permission Process
Connecticut's CON law is comprehensive, covering a wide array of healthcare services and facilities. Any significant capital expenditure, service addition, or equipment acquisition requires state approval.
The process is managed by the Office of Health Strategy (OHS) for most facilities and the Department of Social Services (DSS) for long-term care. It involves fees, lengthy reviews, and public hearings where competitors can intervene.
In a clear example of CON laws restricting access to care, Norwalk Hospital was denied a certificate to offer elective angioplasty (PCI) services. The state's rationale was the hospital's lack of an on-site cardiac surgery backup, a requirement that protects incumbent hospitals with full-service cardiac programs. This decision forced patients in the Norwalk area to travel farther for a common, life-saving procedure, prioritizing market stability over patient convenience and access.
The Connecticut Healthcare Cartel
Insurer Dominance
- Insurer Landscape
- The insurance market is similarly concentrated, with Anthem (BCBS) and UnitedHealthcare holding the lion's share of the commercial market, further limiting consumer choice.
- An overview of how Certificate of Need laws create government-enforced monopolies in healthcare across the United States.
Connecticut's hospital market is a duopoly. Two behemoth systems, Yale New Haven Health and Hartford HealthCare, control approximately 60% of the state's hospital revenue, creating a highly concentrated and anti-competitive landscape.
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No Meaningful Reform
No Meaningful Reform
Data sourced from state agencies, Cicero Institute, and public records.
Last updated: April 2026