Delaware Certificate of Need Laws
Delaware
Moderate
Year Enacted
1978
Services Regulated
6+
National Rank
23 of 51
Top Systems
- ChristianaCare$2.5B
- Bayhealth
Reform Status
Delaware (No Reform)
Key Case
No major case law on record.
Delaware's CON program, established in 1978, is narrower than many states but still regulates hospitals, nursing facilities, and select healthcare services. The state's small geography and concentrated market give ChristianaCare an outsized position in the healthcare landscape.
2 Services Behind the Gate
- ✓Hospitals
- ✓Nursing Homes / Long-Term Care
The Permission Process
Applications are reviewed by the Delaware Health Resources Board. The process includes a public hearing where interested parties, including competitors, can testify for or against the application.
ChristianaCare: $2.5B
Delaware is the second-smallest state by area and has only three counties. This natural geographic concentration means that even a moderate CON program has an outsized effect on competition. When one or two systems dominate the entire state, the regulatory barrier to entry does not need to be as high to be effective.
The state's proximity to Philadelphia means that some Delaware residents seek care across state lines, which partially mitigates the domestic concentration. But for the majority of Delawareans, particularly those in Kent and Sussex counties, the local market is the only practical option.
Delaware (No Reform)
Delaware (No Reform)
States That Reformed
Data sourced from Delaware Health Resources Board, National Academy for State Health Policy (NASHP), Cicero Institute, Federal Trade Commission, and Department of Justice.
Last updated: April 2026