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 2026 health care development opportunities in counties across North Carolina. Long-awaited changes to the CON law promise to open even more doors for North Carolina health care projects.
As part of this year’s efforts, the various planning committees will convene their meetings in September: the Technology and Equipment Committee meets September 3, the Acute Care Services Committee meets September 9, and the Long Term and Behavioral Health Committee meets September 11. The full State Health Coordinating Council (SHCC) will then conduct its final meeting of the year on October 1. Once all changes are approved by the SHCC, the Healthcare Planning Section staff will present the 2026 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 2026.
Despite the challenges facing North Carolina’s urban and rural hospitals, in its current form, the 2026 Proposed SMFP identifies significant opportunities for the development of new hospital beds in counties across the state. In addition to bed needs in a range of rural counties, the 2026 Proposed SMFP identifies a need for 92 new hospital beds in the service area that includes Asheville, as well as 199 new beds in the service area that includes Durham. Substantial bed needs are forecasted in Mecklenburg County (369 new beds), New Hanover County (225 new beds), and Wake County (239 new beds). Rural Pender County shows a need for a whopping 605 new beds.
At the same time, the 2026 Proposed SMFP identifies no need for new operating rooms. New hospital proposals may nonetheless be a possibility in various North Carolina service areas.
Once again, North Carolina’s Healthcare Planning Section staff have so far concluded that North Carolina has no need for new nursing home beds anywhere in the state. Likewise, planners project no need for any new adult care or assisted living facility beds anywhere other than in Halifax and Perquimans Counties. 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 nursing home or assisted living beds. No new home health agencies are identified as needed in the 2026 Proposed SMFP.
As a result of CON reform, as of the fall of 2025, a new ambulatory surgery center (ASC) can be developed in any of the North Carolina counties with a population of 125,000+ (Urban Counties) without CON approval. Providers long constrained by CON requirements will no doubt move quickly on new ASC projects in Urban Counties across North Carolina.
The 2026 Proposed SMFP indicates a need for a new MRI scanner in thirteen North Carolina service areas, including Cabarrus, Dare, Davidson, Durham, Forsyth/Yadkin, Guilford, Henderson, Lincoln, Mecklenburg, Moore, Pitt/Greene/Hyde/Tyrell, Union, and Wake.
In late 2026, the CON restriction for new MRI scanners will lift 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 Dare, Yadkin, Henderson, Lincoln, Moore, Greene, Hyde, or Tyrell Counties can expect to see an opportunity to seek such an approval in next year’s SMFP.
New PET scanners are expected to be identified as a 2026 need in the three Health Service Areas that include Charlotte, Raleigh/Durham, and Wilmington/Fayetteville. A need for a new linear accelerator for Service Area 7 (Anson, Mecklenburg, Union) is also shown in the 2026 Proposed SMFP.
In a surprising development, the 2026 Proposed SMFP shows a need for a new hospice home care office in each of the following nine counties: Burke, Cleveland, Cumberland, Guilford, Haywood, Johnston, McDowell, Randolph, and Rockingham.
In sum, the 2026 Proposed SMFP, 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 CON law changes, can be expected to set the stage for continued growth in health care in North Carolina.
