North Carolina Health Care Opportunities in 2027

Summary — The 2027 Proposed State Medical Facilities Plan (SMFP) for North Carolina, once finalized, is likely to offer a range of health care development opportunities for those seeking to establish or expand operations in North Carolina. The SMFP, together with the 2025-26 Certificate of Need (CON) law changes, can be expected to set the stage for continued growth in health care in North Carolina.

North Carolina’s Healthcare Planning Section is hard at work on a new State Medical Facilities Plan (SMFP), which can be expected to include a range of 2027 health care development opportunities in counties across North Carolina.

As part of this year’s efforts, the various planning committees will convene their meetings in September as follows:

Once all changes are approved by the SHCC, the Healthcare Planning Section staff will present the 2027 Proposed SMFP to Governor Josh Stein for his review and approval. With Governor Stein's approval, the SMFP will become the official document for health facility and health service planning in North Carolina for 2027.

Hospitals

Despite the challenges facing North Carolina’s urban and rural hospitals, in its current form, the 2027 Proposed SMFP identifies significant opportunities for the development of new hospital beds in counties across the state. In addition to small bed needs in rural Bertie and Macon counties, the 2027 Proposed SMFP identifies a need for 86 new hospital beds in the service area that includes Fayetteville, as well as 173 new beds in the service area that includes Winston-Salem. Bed needs are also forecasted for Onslow County (46 new beds), Orange County (73 new beds), and the multi-county service area that includes Pitt County (61 new beds). 

The 2027 Proposed SMFP identifies no need for new operating rooms. New hospital proposals may nonetheless be a possibility in various North Carolina service areas.

Ambulatory Surgery Centers

CON reforms effective in the fall of 2025 allowed for the development of new ambulatory surgery centers (ASCs) in North Carolina counties with a population of 125,000+ (Urban Counties) without CON approval. Providers licensed to operate Qualified Urban Ambulatory Surgical Facilities can seek a No Review determination to add additional operating rooms. The 2027 Proposed SMFP now includes Table 6D showing the Qualified Urban Ambulatory Surgical Facility Inventory for the state. 

Nursing Homes and Assisted Living Facilities

Once again, North Carolina’s Healthcare Planning Section staff have so far concluded that North Carolina has no need for new nursing home beds other than a 30-bed need in Davie County and a 20-bed need in Hoke County. Likewise, planners project no need for any new adult care or assisted living facility beds anywhere other than in the Counties of Alleghany (10 beds) and Chowan (30 beds). As has been the case for years, providers will most likely need to look to acquire existing beds in the absence of identified opportunities for CON approvals for new nursing home or assisted living beds.

Hospice Home Care and Home Health

The 2027 Proposed SMFP indicates a new hospice home care office need in Gaston County. No new home health agencies are identified as needed in the 2027 Proposed SMFP.

Fixed Cardiac Catheterization Equipment

The 2027 Proposed SMFP indicates a need for new fixed cardiac catheterization equipment in Alamance and Durham Counties as well as in the multi-county service area of Craven/Jones/Pamlico.  No need is shown for new Lithotripter equipment anywhere in the state. 

Linear Accelerators

Significant linear accelerator (LINAC) need determinations have been identified across the state, with the only exception being no identified LINAC need in Health Service Area II (the Forsyth/Guilford area).  The largest 8-LINAC need is shown for the service area incorporating Mecklenburg County (HSA III). A 2-LINAC need is shown for the Western North Carolina Service Area (HSA I), for the Durham/Wake Service Area (HSA IV), and for the Cumberland/New Hanover Service Area (HSA V). One LINAC is shown as needed in the Eastern North Carolina Service Area (HSA VI). 

MRI Scanners

The 2027 Proposed SMFP shows a new MRI scanner need in a range of North Carolina service areas, including Beaufort/Hyde, Chatham, Cleveland, Henderson, Scotland, and Watauga Counties.

In late 2026, the CON restriction for new MRI scanners will be lifted in Urban Counties; a new MRI in any of the lower-population counties will continue to require CON approval. Providers interested in establishing an MRI in Beaufort/Hyde, Chatham, Cleveland, Henderson, Scotland, or Watauga Counties can expect to see an opportunity for such approval in next year’s SMFP.

PET Scanners

New PET scanners are expected to be identified as a 2027 need in the three Health Service Areas that include Winston-Salem/Greensboro (one PET scanner for HSA II), Charlotte (one PET scanner for HSA III), and Fayetteville/Wilmington (two PET scanners for HSA V).