Eliminate Certificate of Need Laws

Do you care for an ailing parent or loved one?  Are you frustrated that you cannot find a convenient healthcare provider that can meet your unique needs?

COVID-19 highlighted weaknesses in our medical care system, that extend beyond the demands of mitigating the disease.  States must do everything in their power to increase the supply of healthcare.


But many states have laws on the books that intentionally limit the supply of medical care, and for no good reason.

These laws are called “Certificates of Need,” and 37 states have varying versions of them.


Patients who live in CON jurisdictions suffer from higher costs, decreased quality of services, and fewer options for treatment.  

Per capita, these patients have access to fewer hospitals, hospital beds, surgery centers, and hospice facilities.


Here’s how they work.  If your local hospital wants to increase its number of hospital beds, a CON law may require it to ask the state if it’s allowed to add those beds. It works like a permission slip. But a nearby existing medical provider can tell the state, “you should deny their request,” in order to protect themselves from competition; and the state will deny the hospital’s request to expand, thereby denying your community more care.

Some other examples:

  • Consider Michelle Gross, whose daughter was born with a rare chromosomal translocation and needs at-home care while Michelle is working to support her family. But the one home healthcare agency in her community was unprofessional and difficult to work with–but was her only option.
  • Or Dipendra Tiwari, a native Nepali speaker, who wanted to start a home health care agency in Louisville, Kentucky, that would cater to the Nepali refugee population, offering services in their own language. Kentucky would not allow him to start his business.
  • Or the clients of Dignity Home Care in Omaha, Nebraska, whose caregivers cannot drive their patients to the pharmacy. That’s considered nonemergency medical transportation and it needs a special type of permission to operate.

All three of these are in states that require a Certificate of Need to start or expand a healthcare service.  Not only is getting permission to open or expand time consuming and very expensive, but at the end of the day, existing medical providers can completely shut you out.  This creates artificial, unnecessary, and dangerous limits on medical care.

Michelle, Dipendra, and the patients of Dignity Home Care are all victims of CON—as well as millions of more Americans.

It is possible that if you are unable to access adequate healthcare for yourself or a loved one, you are being affected by CONs.  The Institute for Justice is working hard to get rid of these harmful and unnecessary laws.

We wan to help you figure out if CON laws are making your difficult situation even worse.  Tell us your story.

Please share your story with us.

We will not share it without your permission. An IJ team member may reach out to you if we have questions or can help in your state.