AdventHealth Weaverville breaks ground after CON delay

On March 26, construction began on AdventHealth Weaverville, a 67-bed hospital in Madison County, expected to create over 1,300 jobs in Madison and Yancey counties. The hospital received approval through North Carolina’s Certificate of Need (CON) process in 2022, a regulatory system requiring state permission before opening or expanding health care facilities. But an extended appeals process delayed their ability to break ground until now.

“Wherever people get sick in North Carolina, they deserve to be able to get to a good, nearby hospital,” Gov. Josh Stein said in a press release announcing the groundbreaking. “This new hospital in Weaverville is an investment in the health and economic future of western North Carolina. It will create good-paying jobs, reduce transport times for first responders, and expand access to care for families across the region.”

The project is partially supported by federal funding, after the state was awarded a $213 million under the Rural Health Transformation Program (RHTP) in December. The funding is from the Centers for Medicare & Medicaid Services (CMS) through a $50 billion initiative that allocates funds to all 50 states for rural health care services under RHTP.

“This is a meaningful moment for our region,” said Mike Thompson, president of AdventHealth’s Southeast Region. “The vision for AdventHealth Weaverville starts to take physical shape today. And we see the opportunity for this investment to grow to a $1 billion entity for this very site to serve as a tertiary and trauma response for the region. Our goal is not just to build a hospital, but to be a part of a bigger collective vision that brings healing, wholeness and hope to Western North Carolina.”

But the Certificate of Need (CON) process and subsequent appeals have impacted the timeline for Adventhealth Weaverville, according to Victoria Dunkle, a spokesperson for Adventhealth. The state first approved the 67-bed CON for the facility in 2022, but then a rival sought to block their project.

HCA/Mission appealed that decision, and the state administrative judge upheld the state’s approval of AdventHealth’s application. HCA/Mission’s additional efforts to appeal through the State Court of Appeals and NC Supreme Court were also unsuccessful. The legal process delayed ability to begin construction on the hospital until this year.

“What’s absurd is that AdventHealth had to first get permission from the state — due to North Carolina’s Certificate Need laws — before breaking ground,” Brian Balfour, vice president of research at the John Locke Foundation, said in an interview with the Carolina Journal. “This approval process held up construction, delaying much-needed access to care for area residents for months or possibly years. The assistance provided by the federal government grant underscores how intertwined government at all levels is with our health care system that is unaffordable for far too many.”

HCA/Mission is also opposing AdventHealth’s CON for adding 26 other beds to the Weaverville facility, in a decision that AdventHealth told CJ would come in the coming weeks.

In 2025, AdventHealth applied for another CON, to add 129 beds “to provide a new choice for tertiary care including trauma, advanced cancer and cardiac care and a Level II NICU at AdventHealth Weaverville.” The NCDHHS rejected this CON in late March.

In response to the decision, AdventHealth provided a statement to CJ:

AdventHealth’s commitment to serving Western North Carolina remains unchanged… Based on the recent health care access and quality concerns in our region, we do not believe the decision is in the best interest of our community and will have profound impacts. We are currently evaluating appeal options that honor the community’s needs and voice. Phase one of AdventHealth Weaverville is currently under construction. Additional phases of inpatient beds are vital to the vision of offering advanced trauma and tertiary care to our community closer to home. 

Policy analysts, like Balfour, agree, noting that regulatory and government involvement can affect the cost and accessibility of health care services.

“The more involved the government has become, the less affordable and less accessible health care is,” said Balfour. “Unpacking countless layers of government interference and bureaucracy would go a long way toward making health care more affordable and available for people in need.”

The March hospital groundbreaking coincides with the third anniversary of Medicaid expansion in North Carolina, under which able-bodied adults ages 19-64 with incomes up to roughly 138% of the federal poverty level became eligible for coverage beginning Dec. 1, 2023. Since then, enrollment in the expansion population has grown, adding 720,000 residents to the state’s Medicaid rolls that serve more than 3 million people.

“AdventHealth Weaverville breaks ground after CON delay” was originally published on www.carolinajournal.com.