Missouri Certificate of Need Laws
Missouri
Highly Restrictive
Year Enacted
—
Services Regulated
—
National Rank
33 of 51
Top Systems
- Major medical equipment (MRI
Reform Status
Partial Repeal Pending
Key Case
No major case law on record.
Certificate of Need Investigation
6 Services Held Hostage
- ✓Hospitals
- ✓Nursing Homes / Long-Term Care
- ✓Psychiatric Facilities
- ✓Imaging (MRI, CT, PET)
- ✓Rehabilitation Facilities
- ✓Major Medical Equipment
The Permission Process
Missouri's CON law covers a broad range of healthcare services, requiring providers to obtain state approval for significant capital expenditures. This includes:
Missouri Health Facilities Review Committee
In a clear example of bureaucratic hurdles, the Missouri Health Facilities Review Committee unanimously denied a CON for an 18-bed residential care facility. The denial was not based on need, but on a technicality: the applicant had moved the proposed site by 1.5 miles after filing the initial letter of intent. This case highlights how CON regulations can stifle development over procedural minutiae rather than community benefit.
While full repeal has failed multiple times, a significant reform bill (SB 1268) was introduced in 2026 and is currently pending in the Senate Families, Seniors and Health Committee. If passed, the bill would eliminate CON review for new hospitals and major medical equipment. CON requirements would remain for other services like long-term care. The fight for a fully open market continues.
The Missouri Healthcare Cartel
Insurer Dominance
- Top 3 Insurers
- Our comprehensive overview of Certificate of Need laws across the United States.
CON laws often lead to consolidated markets, benefiting established players. In Missouri, the healthcare landscape is dominated by a few large systems, particularly in the St. Louis metropolitan area.
$81.4B in discounted drugs. Zero disclosure requirements.
Partial Repeal Pending
Partial Repeal Pending
Data sourced from state agencies, Cicero Institute, and public records.
Last updated: April 2026