West Virginia Certificate of Need Laws
West Virginia
Most Restrictive
Year Enacted
1977
Services Regulated
23+
National Rank
43 of 51
Top Systems
- WVU Medicine
- CAMC Health System
Reform Status
West Virginia (No Reform)
Key Case
No major case law on record.
West Virginia's CON laws, enacted in 1977, regulate 23+ healthcare services and facilities. Two systems, WVU Medicine and CAMC/Vandalia Health, dominate the state. In February 2025, a CON repeal bill failed by a single vote in the House Health Committee, despite being a top priority for the Republican governor. The hospital lobby won.
4 Services Held Hostage
- ✓Hospitals
- ✓Home Health Agencies
- ✓Hospice
- ✓Major Medical Equipment
The Permission Process
Data sourced from West Virginia Health Care Authority, IRS Form 990 filings (ProPublica Nonprofit Explorer), Cardinal Institute for West Virginia, Leapfrog Group, Mountain State Times, West Virginia Watch, Federal Trade Commission, and Department of Justice.
The West Virginia Healthcare Cartel
CON is required for construction, development, or acquisition of any health care facility, capital expenditures exceeding $5.8 million, substantial changes to bed capacity, addition of new health services, and expansion of hospice or home health service areas. The threshold is broad enough to capture nearly any meaningful investment in healthcare delivery.
WVU Medicine lost $30.5 million in 2023 but paid its CEO $3.96 million. CAMC earned $34.9 million in profit but paid its CEO only $1.07 million. When financial loss is rewarded with higher pay, market forces are not at play.
West Virginia (No Reform)
HB 2013: The CON Repeal That Died by One Vote
13-12 to kill the bill
A Republican-supermajority government that preaches free-market principles while actively voting to uphold a state-sanctioned cartel. The hospital lobby is more powerful than the governor.
West Virginia (No Reform)
States That Reformed
Data sourced from West Virginia Health Care Authority, IRS Form 990 filings (ProPublica Nonprofit Explorer), Cardinal Institute for West Virginia, Leapfrog Group, Mountain State Times, West Virginia Watch, Federal Trade Commission, and Department of Justice.
Last updated: April 2026