The certificate of need (CON) process requires healthcare providers hoping to expand or develop new healthcare facilities in the state to get approval by state officials. This approval is not, however, to ensure the health and safety of employees or patients. Instead, healthcare providers are tasked with demonstrating a “need” for the expansion or new healthcare facility in the area the providers hope to serve. The certificate of need process was initially suggested by the federal government, which incentivized states to adopt CON laws. Almost every state created a CON system. Just a few years later, the federal government studied the results of CON laws, which it had hoped would lead to a decrease in healthcare costs and realized the ineffectiveness of the programs. The federal government ended the incentivizing of CON laws and state after state repealed the system because of its inability to reduce costs and its anti-competitive nature. Today, Alabama maintains its CON regime though twelve states have fully repealed their laws and neighboring states of Tennessee, Florida, and Georgia have recently restricted the CON process. Mississippi also enacted targeted CON reforms in 2026, further reducing regulatory barriers and increasing flexibility for healthcare providers in the region. As a result, Alabama’s CON system places the state at a competitive disadvantage in expanding access to healthcare services.

CON reforms have been discussed in recent legislative sessions, but no comprehensive changes have been enacted. Senate Bill 236 by Senator Larry Stutts proposed changes to the CON process to no longer require certificates for certain services provided in rural areas of the state, where a shortage of access to quality care continues to exist. The bill received a public hearing in the Senate Governmental Affairs Committee but did not proceed to a Senate floor vote. House bill 247 by Representative Ben Harrison would have abolished the CON process entirely but did not advance. Similar proposals were considered during the 2026 legislative session but did not pass, and discussions are expected to continue in future sessions. API will continue to advocate for CON reforms in the future. Eliminating or significantly reforming the CON process remains a key step toward improving healthcare access, increasing competition, and lowering costs for Alabama patients.