Asheville -- August 20, 2026: In a packed auditorium at A-B Tech on Wednesday, the fight over the future of Western North Carolina healthcare came down to two competing realities: the corporate blueprints of four major health systems and the urgent plea from rural mountain communities desperate for relief.
At the center of the dispute are 92 acute-care hospital beds authorized under the 2026 State Medical Facilities Plan. State regulators designated those beds to serve patients across Buncombe, Clay, Graham, Madison, and Yancey counties. Yet every single applicant—UNC Health, AdventHealth, Novant Health, and Mission Hospital (HCA Healthcare)—has proposed placing their projects inside Buncombe County.
For hours before state regulators, rural emergency workers, county commissioners, and mountain residents testified that this decision cannot just be about adding floor space in downtown Asheville. For them, it is a question of road miles, tied-up ambulances, and whether patient choice will finally break the region's healthcare bottleneck.
The Four Paths on the Table
State regulators with the North Carolina Division of Health Service Regulation are weighing four distinct approaches to regional growth:
UNC Health’s Flagship Campus ($747.3 Million): Seeking the full 92 beds, the state-owned system proposes building a major acute-care hospital near the former Westgate Shopping Center off Patton Avenue. Paired with its regional partner UNC Health Pardee, UNC’s plan covers full-service emergency care, ICU, maternal-infant care, and psychiatric units, while partnering with Western Carolina University to build out regional clinical training.
AdventHealth’s Northern Hub ($272.7 Million): Also applying for all 92 beds, AdventHealth wants to fold the allocation into the hospital it is actively building in Weaverville. That would transform the site into a 185-bed regional hospital by 2030, equipped with advanced trauma capabilities positioned directly along the northern corridor.
Novant Health’s Southern Corridor Buildout ($100.6 Million): Rather than taking the whole batch, Novant is asking for 20 beds to augment its approved 34-bed facility underway in Arden near Biltmore Park, aiming for a 54-bed community hospital by early 2031.
Mission Hospital’s Central Expansion ($66.8 Million): HCA Healthcare is requesting all 92 beds to expand its existing Asheville campus up to 774 licensed beds by 2032. Mission representatives argued that utilizing established tertiary infrastructure provides the fastest, most cost-effective solution without building duplicative facilities.
"Can We Afford to Wait?": Rural Mountain Leaders Speak Out
Public testimony made clear that for outlying counties, healthcare logistics have reached a breaking point:
Ambulance Gridlock: First responders from Madison and Yancey counties highlighted how routine transports to Asheville take local ambulances out of service for hours at a time, leaving remote hollows and mountain passes without local emergency coverage.
The High Cost of Distance: Madison County Health Director Tammy Cody told hearing officers that driving over an hour for essential or specialized care is a direct public health hazard, urging approval for regional access points outside central Asheville.
A Call for Accountability: Yancey County EMS Director Kristy Bryant cut to the core of community sentiment regarding HCA’s ownership of Mission: "The question before this committee is not whether Mission should improve," Bryant said. "The question is whether the people of Western North Carolina can afford to wait for them".
Civic Support for Choice: Asheville Mayor Esther Manheimer joined community advocates in arguing that introducing true competition is essential to restoring patient confidence, easing hospital wait times, and elevating the quality of care across the mountains.
Next Steps in the State Review and How to Comment
Regulatory Review: NCDHHS Project Analyst Greg Yakaboski outlined that each proposal will undergo an independent statutory evaluation before the state conducts a comparative review to select the winning application.
Submit Public Comments: Members of the public can submit written comments by emailing DHSR.CON.Comments@dhhs.nc.gov (referencing the Buncombe County Acute Care Bed review and Project Analyst Greg Yakaboski). Written comments may also be mailed to:
Certificate of Need Section
Division of Health Service Regulation
2704 Mail Service Center
Raleigh, NC 27699-2704
Project Documents: Official applications, review logs, and public filings can be tracked online through the NCDHHS Certificate of Need Section.
Final Ruling: Regulators will review all written submissions, public hearing testimony, and formal applicant rebuttals before issuing a binding Certificate of Need determination.