Which states still require a Certificate of Need — and what that governs.
Thirty-three states and the District of Columbia require regulators to approve new hospital beds, equipment, or services before they can be built. Three are mid-repeal. Fifteen have none. The map below shows where; the table beneath each state shows what.
40
States with facility data on file
33
States require Certificate of Need
3
States mid-repeal — NC, SC, TN
6,958
Hospitals compiled nationwide
CON required
Partial — repeal in progress
No CON law
Click any state on the map above to see its Certificate of Need status and the facilities on file for it.
1. Color encodes legal status, not facility volume — a deliberate choice. Hospital counts track population size closely enough that a population-weighted map would mostly just redraw the census.
2. "Partial" states (NC, SC, TN) have repealed CON for some facility types but not others, on staggered timelines through 2030. Treating them as a third category avoids forcing a binary that doesn't exist in the statutes.
3. Bars beneath each state's hospital and bed counts are scaled to the full range across all 40 states with facility data on file — 14–1,621 hospitals, 61–48,245 beds — so a short bar means "small relative to New York," not "small."
4. "Top by facility count" lists the three most-frequent named operators in the source data per state. It is a count of source rows, not a verified list of the largest systems by revenue or bed share, and it is blank for the 37 states where the operator field was not populated.
5. A blank field in a facility record (legal entity, health system, licensed beds) means the source data did not include it — it is omitted below rather than shown empty.