At a joint meeting of the Legislature’s Joint Committee on Health, state officials, hospital executives, economists and policy advocates presented competing views on West Virginia’s certificate-of-need (CON) regulatory program and its effects on access, cost and quality of health care.

Justin Cox, executive director of the West Virginia Health Care Authority, gave an overview of the agency’s responsibilities and operations. The authority administers the CON program and a financial-disclosure unit under West Virginia Code §§16‑2D and 16‑2‑9B. Cox told the committee the office processed three main types of requests in 2024: 36 requests for determinations of reviewability (all but two were found not reviewable), 35 full CON applications (either approved or pending) and 239 exemption requests (all completed and approved). He described the agency’s batching and review timeline: applications are batched twice monthly (the 15th and 30th), a 30‑day notice period for affected parties follows the batch date, and the board decision is due by the sixtieth day of the review cycle — about 70 days from a letter of intent in uncontested cases. Cox said exemption requests are typically handled on a 14‑day goal and confirmed a fee schedule exists for applications, which ranges from roughly $1,500 to $35,000 depending on total capital expenditures.

Hospital leaders urged caution about loosening or repealing CON. Skip Yolberg, president and CEO of WVU Medicine St. Joseph’s Hospital and chair of the West Virginia Hospital Association, and David Goldberg, president and CEO of Mon Health and vice chair of the association, said hospitals are a major employer in many communities and that West Virginia’s payer mix relies heavily on government payers. Goldberg described the payer mix as dominated by Medicare, Medicaid and PEIA, saying that combination accounts for roughly three‑quarters of hospital revenue in many places and stressing that margins are thin. The hospital representatives cited recent changes to the CON law — including what they characterized as modernization steps in 2017 and 2023 — and argued that CON has helped preserve services in rural communities and protected local systems from out‑of‑state entrants they said might not sustain local care.

Researchers and reform advocates presented contrary empirical evidence and policy recommendations. Matthew Mitchell of the Knee Regulatory Research Center summarized peer‑reviewed research on CON laws, saying the literature includes more than a hundred studies and hundreds of empirical tests. Mitchell told the committee that a majority of quantitative tests find CON laws are associated with reduced availability of some services (ambulatory surgery centers, hospice, dialysis and others), higher prices for many procedures, and little or no consistent evidence of quality improvements. He cited examples from other states, including studies showing lower reimbursements for some procedures after repeal in neighboring states, and he described the empirical findings as mixed by outcome but broadly pointing to higher costs and reduced access in many CON states.

Legal and policy groups argued for repeal or significant rollback. Jamie Kavanaugh of the Pacific Legal Foundation described a national trend of recent CON reform or repeal in several states (including examples cited for 2021–2024) and encouraged the committee to consider changes that would increase facility entry and competition. Jessica Dobrinsky of the Cardinal Institute focused on West Virginia data and local stories: she said the state has more than 40 CON requirements, noted a state moratorium on several types of licensed treatment beds and described individual cases where patients traveled out of state for care after local services closed. Dobrinsky also presented a Mercatus estimate cited to the committee estimating about $232 in per‑person annual health spending reduction for West Virginia if CON were repealed, which she converted to an illustrative aggregate savings of approximately $400 million based on the state population; she urged the committee to weigh access and affordability impacts as part of any reform.

Committee members questioned presenters on standards, timelines and local impacts. Senator Dietz and other legislators asked Cox about the statutory standards and their update cadence; Cox replied that some standards (for example, home health and hospice) require annual review while others have not been updated since inception and that the code, rather than the agency alone, determines review cadence. Members asked hospital representatives about workforce and rural access; hospital leaders acknowledged acute staffing shortages, argued the workforce problem is separate from CON, and said many hospitals are operating on thin margins. Mitchell recommended phased or targeted rollbacks as an option (for example, varying time horizons tied to capital depreciation or immediate relief for low‑capital services such as substance‑use treatment).

No formal votes or committee decisions were recorded during the hearing. Committee leaders asked presenters to remain after the public session for follow‑up questions. The hearing included back‑and‑forth on empirical interpretation, state‑specific constraints (payer mix, workforce shortages, federal designations such as critical‑access status) and legal pathways for modernization or repeal. The committee did not adopt legislation during the session and signaled it would continue review and follow‑up with presenters and staff.