Hawaii Certificate of Need Laws
Hawaii
Restrictive
Year Enacted
—
Services Regulated
—
National Rank
27 of 51
Top Systems
- Queen's Health System$1.7B
- Hawaii Pacific Health
Reform Status
Restrictive with no active reform bill.
Key Case
Blocked Competition:
An analysis of the state's healthcare regulations and their effects on market competition and patient care.
3 Services Behind the Gate
- ✓Nursing Homes / Long-Term Care
- ✓Home Health Agencies
- ✓Rehabilitation Facilities
The Permission Process
The path to approval is lengthy and provides ample opportunity for established players to block new competition.
The state's regulatory framework creates a protectionist moat around incumbent systems.
Queen's Health System: $1.7B
Insurer Dominance
- Largest Insurer:
- Largest Insurer
- HMSA (BCBS)
- Read our comprehensive overview of Certificate of Need laws across the United States.
Most communities have only one hospital system.
$81.4B in discounted drugs. Zero disclosure requirements.
Blocked Competition:
Blocked Competition:
Reform Status: Restrictive
Annual Revenue: ~$1.7 Billion
Despite criticism from free-market advocates, Hawaii's CON law has not been repealed and remains one of the strictest in the nation.
Data sourced from Hawaii Revised Statutes, SHPDA public records, and health system financial reports. Analysis by The Rojas Report.
Last updated: April 2026