The leaves are starting to turn, and the mornings are growing crisp. For those of us who follow North Carolina health planning, autumn also means the State Medical Facilities Plan (SMFP) is nearly complete. On September 30, the State Health Coordinating Council (SHCC) met and approved all standing committee recommendations, giving healthcare organizations a firm picture of the 2027 SMFP. Officially, the plan still requires the governor's signature, but changes at this stage are rare.
Last year, we called 2026 the Year of the Beds. If 2027 has a theme, it is the Year of Technology and Equipment. Acute care bed needs are down substantially from the historic levels in the 2026 SMFP, while technology and equipment needs are up. That holds even after the committees reduced several categories from the Proposed 2027 SMFP.
A Smaller Bed Need and a Different Map
The 2027 SMFP includes 456 acute care beds across eight service areas. By comparison, the 2026 SMFP included 1,742 beds across 16 service areas, one of the largest bed needs in the history of the North Carolina planning process. Those 2026 needs continue to drive significant expansions of existing facilities and proposed new hospitals across the state.
The geography has shifted as well. The large 2026 needs in Mecklenburg, Wake, and New Hanover counties do not reappear, and the Durham County need declines from 236 beds to four. Forsyth/Yadkin and Orange carry needs for a second consecutive year, each larger than in 2026. Bertie, Cumberland, Macon, Onslow, and Pitt/Greene/Hyde/Tyrrell have needs that did not appear in the 2026 SMFP.
The Year of Technology and Equipment
Technology and equipment needs tell a different story. Cardiac catheterization needs return after none in the 2026 SMFP, with four need determinations in Alamance, Craven/Jones/Pamlico, Davidson, and Durham. Dedicated fixed positron emission tomography (PET) scanner needs double from two to four, and the plan adds a statewide need for one mobile PET scanner. Five fixed magnetic resonance imaging (MRI) scanner needs appear, all in counties with fewer than 125,000 residents. This reflects the change that, beginning in November 2026, fixed MRI scanners in larger counties no longer require a CON.
Linear accelerators (LINACs) saw the most change. Under a revised methodology, LINAC need determinations are now based on Health Service Areas (HSAs) rather than the LINAC service areas used in prior plans. The new approach generated 15 LINAC needs in the Proposed 2027 SMFP. Following committee review, the SHCC approved a proposal from the North Carolina Division of Health Service Regulation to limit need determinations to one per HSA showing a deficit, resulting in five LINAC needs statewide. The LINAC workgroup is expected to reconvene in the spring to continue refining the methodology. Hospitals with established cancer programs may also wish to review new Policy TE-6, which allows qualifying programs to acquire a LINAC without a need determination.
In total, technology and equipment need determinations moved from 28 in the Proposed 2027 SMFP to 19 in the final plan.
Hospice: A Reversal From 2026
Last year, hospice home care generated extensive discussion, with nine initial needs reduced to three. The 2027 SMFP includes no hospice home care needs. The only need in the Proposed 2027 SMFP, in Gaston County, was eliminated. Approved petitions added 11 hospice inpatient beds across three counties (Brunswick, Surry, and Yadkin). Other long-term care needs include nursing care beds in Davie and Hoke counties and adult care home beds in Alleghany and Chowan counties.
Regulatory Changes Continue to Evolve
No operating room need determinations appear, consistent with the methodology changes adopted after qualifying ambulatory surgical facilities (QUASFs) became exempt from CON review. Inpatient rehabilitation beds are no longer subject to CON as of October 1, 2026, and the MRI threshold change takes effect in November.
Looking Ahead
The plan now moves to the governor for signature by year-end. We will also be watching for the schedule of application filing dates, which may be released anytime from November to early December. Last year brought an early Halloween surprise, with the schedule released on October 31, and we will be on the lookout again this year.
After several years of numerous need determinations, a smaller plan may present an opportunity for providers to focus on long-term health planning for the communities they serve. As we often say, it is never too early to start robust health planning.
Zheng-Liann Schuster provided extensive research for this analysis.
