West Virginia runs one of the most restrictive Certificate of Need regimes in the country, and the fight over it has been almost entirely about hospitals. A new Cardinal Institute paper by Jessica Dobrinsky shifts the lens to the services that rarely make the debate: hospice, nursing homes, and home health.
The stakes there are higher than the hospital argument suggests. West Virginia is the fourth-oldest state in the nation. Roughly one in five residents is 65 or older, and that share is climbing toward one in four by 2035. These are the residents who depend on post-acute and long-term care, and CON governs the supply of all of it, across 44 regulated services.
The paper walks through each sector: hospice, where a median length of service near 17 days leaves little room for delay; nursing homes, where CON states show lower bed capacity, higher prices, and weaker quality; and home health, where approval barriers thin out the provider pool patients most prefer. The throughline is simple. Reforming CON through a hospital-only lens misses where the system binds hardest.