Kentucky Certificate of Need Laws
Kentucky
Most Restrictive
Year Enacted
1972
Services Regulated
18
National Rank
43 of 51
Top Systems
- Norton Healthcare
- Baptist Health
- CHI Saint Joseph
Market Concentration
3,720
Reform Status
Kentucky (No Reform)
Key Case
Case Concluded. CON Upheld.. The case received unfavorable decisions at both the district court and the Sixth Circuit Court of Ap
Kentucky's CON laws have been in place since 1972. They regulate 18 different services, devices, and procedures. Three hospital systems control 100% of the Louisville inpatient market. Competition is not just difficult here. It is illegal.
2 Services Behind the Gate
- ✓Hospitals
- ✓Home Health Agencies
Six Months to Say No
The process is bifurcated into two tracks. The Formal Review is the most common and complex path. The applicant bears the burden of proving the proposed service is necessary, and a decision is typically rendered six months after the application date. This process resembles a trial, where incumbent systems can intervene to block a new competitor's entry.
Hospital mergers have been found to increase the average hospital price by 6-18% nationwide. Kentucky's experience aligns with this trend, as the state's CON laws protect incumbent systems from new entrants that could offer more competitive pricing.
3 Systems. One Market.
Three systems control 100% of the inpatient hospital market in Louisville. Norton Healthcare's 55% share gives it a commanding position.
Sentara's $4.79B empire and the 17 services you cannot offer without government permission.
Case Concluded. CON Upheld.
Case Concluded. CON Upheld.
The case received unfavorable decisions at both the district court and the Sixth Circuit Court of Appeals (February 2022). The U.S. Supreme Court declined to hear the case in November 2022.
Tiwari v. Meier: Full Case Analysis
Kentucky (No Reform)
$2 billion health care conglomerate
Kentucky (No Reform)
States That Reformed
Data sourced from Cicero Institute, National Academy for State Health Policy (NASHP), Kentuckiana Health Collaborative, Centers for Medicare & Medicaid Services (CMS), Institute for Justice, Federal Trade Commission, and Department of Justice.
Last updated: April 2026