Washington Certificate of Need Laws
Washington
Most Restrictive
Year Enacted
—
Services Regulated
—
National Rank
43 of 51
Top Systems
- WA Dept. of Health
Market Concentration
HHI Average
Reform Status
No Meaningful Reform
Key Case
No major case law on record.
The nation's most restrictive CON law.
8 Services. One Board. Zero Competition.
- ✓Hospitals
- ✓Ambulatory Surgery Centers (ASCs)
- ✓Nursing Homes / Long-Term Care
- ✓Home Health Agencies
- ✓Hospice
- ✓Rehabilitation Facilities
- ✓Cardiac / Open Heart Surgery
- ✓Neonatal Care
The Permission Process
The process is lengthy and expensive, giving incumbent systems ample opportunity to block new competitors.
Washington has not repealed its CON law. Instead, the state continues to actively amend and update rules and fees, signaling a commitment to maintaining the regulatory barrier. The program remains one of the most comprehensive and restrictive in the United States.
The Washington Healthcare Cartel
Insurer Dominance
- Our complete breakdown of Certificate of Need laws across the United States.
Five systems control 40% of Washington's hospitals, with local monopolies even more pronounced.
$81.4 billion in drug discounts. $66.4 billion in gross margin. Zero disclosure requirements.
Blocked, Denied, Upheld
A proposal for a new three-room ambulatory surgical facility in Richland was denied by the Department of Health. The state determined the project was not consistent with its criteria for need, financial feasibility, and cost containment, classic CON gatekeeping that protects existing hospitals from a new, specialized competitor.
No Meaningful Reform
No Meaningful Reform
Data sourced from state agencies, Cicero Institute, and public records.
Last updated: April 2026