Certificate of Need Laws in Delaware — What Patients Need to Know
Delaware is one of the states that maintains a Certificate of Need (CON) law, requiring healthcare providers to obtain state approval before building new facilities, expanding services, or making major capital investments. First enacted in 1978, Delaware’s CON program is administered by the Delaware Health Resources Board and covers a broad range of healthcare services. Understanding how these regulations work can help patients and communities evaluate the ongoing debate about healthcare access, competition, and costs in the First State.
DELAWARE — KEY FACTS
| CON Law Status | ACTIVE CON LAW |
| Programme Scope | active |
| Year Enacted | See agency |
| Services Requiring Approval | hospitals, nursing homes, dialysis facilities, hospice providers, psychiatric facilities |
| Governing Agency | Delaware Health Resources Board |
| Hospitals in State (CMS data) | Data not available |
The Arguments
WHAT SUPPORTERS ARGUE
Defenders of Delaware’s CON law argue that it helps prevent the unnecessary duplication of expensive healthcare services, which could drive up costs for patients and insurers across the state. They contend that the review process, managed by the Delaware Health Resources Board, ensures that new facilities and services are located where they are most needed, particularly in underserved communities. Supporters also maintain that CON oversight helps protect existing safety-net hospitals from losing financially viable services to new competitors, thereby preserving access to care for all Delawareans.
WHAT CRITICS ARGUE
Critics of Delaware’s CON law argue that requiring state approval to open or expand healthcare facilities limits competition, which can lead to higher prices and fewer choices for patients. They contend that incumbent providers may use the CON process to block potential competitors, ultimately reducing innovation and slowing the development of new services. Some opponents also argue that the 2018 reforms did not go far enough and that further deregulation, particularly for additional outpatient and ambulatory services, could improve access and affordability in the state.
The Data
WHAT THE DATA SHOWS IN DELAWARE
No CMS hospital charge data is currently available for Delaware facilities in the datasets reviewed for this analysis, making direct cost comparisons with non-CON states difficult at this time. Delaware’s CON program continues to regulate a broad set of services, and the state’s relatively small size and limited number of hospital systems may influence both healthcare market dynamics and patient options independently of CON requirements.
Recent Developments
In 2018, Delaware amended its CON law to narrow its scope, exempting certain outpatient services from the requirement to obtain a Certificate of Need. This reform reflected a broader national trend of states reconsidering which healthcare services should be subject to CON review. No significant additional legislative activity related to Delaware’s CON laws has been reported since that amendment.
What This Means For Patients in Delaware
For patients in Delaware, the CON law means that new hospitals, nursing homes, dialysis centers, hospice providers, and psychiatric facilities must receive approval from the Delaware Health Resources Board before they can be established or significantly expanded. This may affect how quickly new healthcare options become available in a given area, though proponents argue the process ensures services are distributed equitably and responsibly across the state.
THE BOTTOM LINE
Delaware maintains a full-scope Certificate of Need law that was modestly narrowed in 2018, and the ongoing debate centers on whether the regulatory approval process better serves patients by promoting orderly healthcare development or limits their options by restricting market competition.
Frequently Asked Questions
Does Delaware have a Certificate of Need law?
Yes, Delaware has had a Certificate of Need law since 1978. The law requires healthcare providers to obtain approval from the Delaware Health Resources Board before establishing or significantly expanding certain healthcare facilities and services.
What services require CON approval in Delaware?
Delaware’s CON law covers hospitals, nursing homes, dialysis facilities, hospice providers, and psychiatric facilities. Following the 2018 amendment, some outpatient services were exempted from the CON approval requirement.
How do Delaware CON laws affect hospital costs?
Proponents argue that CON laws help control costs by preventing unnecessary duplication of expensive services, while critics contend the laws reduce competition and can lead to higher prices. No CMS hospital charge data is currently available for Delaware to provide a direct cost comparison.
Can I find out if a facility has CON approval in Delaware?
Yes, the Delaware Health Resources Board, which administers the state’s CON program, is the governing agency responsible for reviewing and tracking CON applications. You can find more information and contact the board through the Delaware Department of Health and Social Services at https://dhss.delaware.gov/dhss/dhrb/.