Certificate of Need Laws in Hawaii — What Patients Need to Know
Hawaii is one of the states that maintains a full-scope Certificate of Need (CON) program, requiring healthcare providers to obtain government approval before establishing or expanding certain medical facilities and services. First enacted in 1974, Hawaii’s CON law covers a wide range of healthcare services and remains in effect today. This explainer presents both sides of the debate surrounding these regulations so patients and stakeholders can form their own informed opinions.
HAWAII — KEY FACTS
| CON Law Status | ACTIVE CON LAW |
| Programme Scope | active |
| Year Enacted | See agency |
| Services Requiring Approval | hospitals, nursing homes, ambulatory surgery centres, imaging equipment (MRI/CT), dialysis facilities, hospice providers, psychiatric facilities, home health agencies |
| Governing Agency | Hawaii Health Systems Corporation / Certificate of Need Program |
| Hospitals in State (CMS data) | Data not available |
The Arguments
WHAT SUPPORTERS ARGUE
Defenders of Hawaii’s CON laws argue that the program is essential for a geographically isolated island state where healthcare resources must be carefully planned to ensure equitable access across multiple islands. Proponents contend that CON requirements help prevent the unnecessary duplication of expensive medical services, which could drive up costs for all patients in Hawaii’s relatively small healthcare market. They also argue that the regulatory framework helps ensure that existing healthcare facilities, particularly in rural and underserved island communities, remain financially viable by preventing oversaturation.
WHAT CRITICS ARGUE
Critics of Hawaii’s CON laws argue that requiring government approval to open or expand healthcare facilities restricts competition and limits patient choice, potentially contributing to higher prices and longer wait times. Opponents point out that established healthcare providers may use the CON process to block new competitors from entering the market, effectively protecting incumbent institutions rather than serving the public interest. Some critics also argue that Hawaii’s full-scope CON program is overly broad and that reducing or eliminating these requirements could encourage innovation and expand access to care across the islands.
The Data
WHAT THE DATA SHOWS IN HAWAII
No CMS hospital charge data is currently available for Hawaii facilities in the public dataset, making direct cost comparisons with non-CON states difficult to conduct at this time. Hawaii’s CON program covers a comprehensive range of services including hospitals, nursing homes, ambulatory surgery centers, imaging equipment such as MRI and CT scanners, dialysis facilities, hospice providers, psychiatric facilities, and home health agencies — representing one of the broader CON programs among states that still maintain such laws.
Recent Developments
Hawaii’s CON law was last amended in 2020, though no major structural changes to the program have been enacted in recent years. There has been no significant legislative activity aimed at repealing or substantially modifying the state’s CON requirements during recent legislative sessions. The program continues to operate under its established regulatory framework, with the Hawaii Department of Health overseeing the approval process for covered healthcare services and facilities.
What This Means For Patients in Hawaii
For patients in Hawaii, the CON law means that the establishment of new healthcare facilities or the expansion of existing services must receive state approval before proceeding, which can affect the availability and timing of new healthcare options. Whether this regulatory process ultimately helps patients by ensuring careful resource planning or hinders them by limiting competition and access remains a matter of ongoing debate among healthcare policy experts.
THE BOTTOM LINE
Hawaii maintains a full-scope Certificate of Need program enacted in 1974 and last amended in 2020, and the debate continues over whether the law best serves patients by managing healthcare resources in an island state or whether it limits competition and access to care.
Frequently Asked Questions
Does Hawaii have a Certificate of Need law?
Yes, Hawaii has a Certificate of Need law with full scope that has been in effect since 1974. The law was last amended in 2020 and is administered through the Hawaii Certificate of Need Program under the Hawaii Department of Health.
What services require CON approval in Hawaii?
Hawaii’s CON program covers a broad range of healthcare services including hospitals, nursing homes, ambulatory surgery centers, imaging equipment (MRI and CT scanners), dialysis facilities, hospice providers, psychiatric facilities, and home health agencies. This full-scope coverage makes Hawaii’s program one of the more comprehensive CON frameworks among states that maintain such laws.
How do Hawaii CON laws affect hospital costs?
Proponents argue that CON laws help control costs by preventing unnecessary duplication of expensive healthcare services, while critics contend that limiting competition can lead to higher prices for patients. No CMS hospital charge data is currently available for Hawaii facilities in public datasets, making direct empirical comparisons with non-CON states difficult at this time.
Can I find out if a facility has CON approval in Hawaii?
Yes, the Hawaii Department of Health administers the Certificate of Need Program and maintains information about CON applications and approvals. Patients and stakeholders can visit the program’s website at https://health.hawaii.gov/con/ or contact the agency directly for information about specific facilities.