Certain health facilities, including nursing homes, are governed by state Certificate of Need (CON) laws. Although, these laws were formerly administered at the federal level, the government eventually dropped them. However, 36 states – including Connecticut – continue to use CON laws.

What are CON laws? They require health care providers to get state approval before investing in new equipment or facilities, expanding the number of beds they have, and adding or discontinuing a service. Theoretically, CON laws provide consistent and high-quality services, control healthcare costs and prevent unnecessary duplications.

Without CON laws, states believe that hospitals would continue to expand without oversight and these costs would then be passed on to those seeking care. However, multiple studies show this isn’t the case and, in fact, the laws’ restrictions could negatively be impacting nursing homes.


elderly woman and daughter upsetWhy did the federal government discontinue use of CON laws? While they were instituted back in 1974, analysts found they no longer assisted with controlling healthcare costs by 1987. Examining the 36 states with and the 14 states without CON laws, researchers behind the article Certificate of Need: Does It Actually Control Healthcare Costs? found that, while CON laws have decreased costs associated with acute care, these costs don’t go up in states without CON laws. Also, Medicare and Medicaid expenses actually grew in CON states for nursing homes and long-term care costs increased as well.

Instead, the Affordable Care Act had more of an impact. The ACA’s payment reforms, coupled with Congressional Debt Supercommittee deadlocks, halted any unneeded expansions, which could have increased what patients have to pay.


Multiple studies have found that CON laws restrict expansion, which fails to meet the needs of those seeking treatment. Particularly, laws that prevent new facilities from being created, which limit the number of homes and beds available, while driving up costs.

Those against CON repeals tend to be hospitals, insurers and other healthcare providers. Essentially, these laws allow existing systems to monopolize an area or certain healthcare services, which means patients have fewer options and more advanced services get denied. Additionally, consumers don’t get a choice between lower-cost and higher-quality. Rather, only one or two hospitals offer a standard service – often at a high price.

Ignoring the Needs of the Growing Elderly Population

As more and more Baby Boomers enter retirement age, the potential pool of individuals who need nursing home care has started growing. However, CON laws often limit bed growth by using a need-based method for new construction. Certain states even have a moratorium, which prevents any new facilities from being built.

Furthermore, a recent critique of CON laws went beyond this assessment, pointing out how forced-restrictions make nursing care stagnant and low-quality. Particularly, the author pointed out:

  • Homes that have no incentive to expand their facilities also don’t invest in any improvements or services, essentially keeping a low baseline for the care offered.
  • Homes stick with a set number of beds, with the assumption that offering more care to patients will increase their Medicare and Medicaid expenses.
  • They increase private pay prices. Loved ones wanting better care for their elderly family member may turn to a private facility, thinking that a higher cost means better-quality care.
  • They result in overcrowding. Data shows that homes in CON states tend to offer 131 beds, while those in states without CON laws have an average of 110 beds. As a result, patients in a CON state face the possibility of overworked staff and greater potential for negligence.

If your loved one is continually ignored in a nursing home and his or her health is suffering, you may have a case. For further information, contact us to speak with a nursing home negligence lawyer today.