State regulators have approved an additional 267 hospital beds for hospitals in Wake County, far below the 644 that were requested. They also rejected a request to build a new hospital.
The proposals were made in September.
WakeMed’s main campus in Raleigh received approval from the North Carolina Department of Health and Human Services (NCDHHS) to add 164 acute care beds, which is expected to cost just under $430 million, to be completed in October 2032.
The hospital system, however, was denied a request for an additional 25 acute care beds at its WakeMed North Hospital at a cost of $28 million, with completion in October 2029; and 78 acute care beds at a new hospital being built in Garner, at a cost of $272.5 million, with a completion date of October 2028.
Duke Health System was approved for an additional 52 beds at its Duke Raleigh Hospital at a cost of $29 million, about half of the 101 beds it was seeking.
NCDHHS also denied Duke’s request to add 120 beds to its future West Cary hospital, scheduled to open in 2027, which was estimated at about $ 1.2 billion.
UNC Health Rex received approval for 51 additional beds at its Raleigh hospital, fewer than the 106 it requested. Capital expenditure for the beds is $98.4 million, with a project completion date of November 2030.
NCDHHS also denied the hospital system’s request to build a new 50-bed acute care hospital in Wake Forest at a cost of $485.5 million, with a completion date of July 2031. This was the second time the request has been denied.
Winston-Salem-based Novant Health was also denied entry into the Triangle for the second year in a row.
NCDHHS denied the Novant’s scaled-back application from the previous year to build a new 26-bed acute care hospital in Knightdale by January 2030 with a price tag of almost $255 million.
In 2024, they proposed a new 36-bed acute care hospital with one operating room, but that proposal was also denied. The project was expected to cost $286.9 million and be completed in October 2029.
The North Carolina Department of Health and Human Services Division of Health Service Regulation made the determination based on the Certificate of Need law (CON), which prohibits health care providers from acquiring certain medical equipment or developing new health services, facilities, and health service facility beds without the prior approval of NCDHHS. According to the agency, the law restricts unnecessary increases in health care costs and limits unnecessary health services and facilities based on geographic, demographic, and economic considerations.
Free-market economists have argued over the years that CON laws hurt, not help, people who truly need to be served, especially with the state’s rapidly growing population.
“This latest denial of hundreds of additional hospital beds in Wake County demonstrates the absurdity of North Carolina’s Certificate of Need (CON) laws,” Brian Balfour, senior vice president of research at the John Locke Foundation, told Carolina Journal. “Wake is a rapidly growing county, and the medical care providers are far more in tune with the health care needs of the community than a committee of state regulators. Moreover, it is the hospitals that are willing to financially invest in expanding their facilities, so they have a vested interest in not wasting resources. Patients are having to wait unnecessarily long in ER waiting rooms and having difficulty accessing care — and the CON law is a major reason why.”
In November, North Carolina State Treasurer Brad Briner filed a friend-of-the-court brief supporting a New Bern eye surgeon who challenges North Carolina’s CON law as unconstitutional.
The treasurer’s office oversees the State Health Plan. It serves 750,000 active and retired government workers. The plan “is one of the largest purchasers of health care in North Carolina, and its costs are a significant portion of the State’s budget,” Briner’s lawyers wrote. Costs reached $4.5 billion in the last budget year.
As “keeper of the public purse,” Briner focuses on the CON law’s impact for costs and access.
In 1986, the federal government repealed the CON mandate, and many states immediately began retiring their CON programs.
According to the Pacific Legal Foundation, residents in states with Certificate of Need laws receive lower-quality care, have access to fewer facilities, pay more for care, and wait longer for care.
Hospitals may have a better chance if they reapply, as the 2026 State Medical Facilities Plan indicates a need for 233 acute care beds in Wake County. The deadline to apply is in August.
That plan also shows a need for 63 beds in Johnston County, 37, in Orange County, and 236 beds in Durham County. Deadlines for the counties to apply are Feb. 16 for Johnston, August for Orange, and April for Durham.