ASHEVILLE, N.C. (828newsNOW) — Four major health systems are competing to build or expand hospitals in Buncombe County after the state determined the region needs 129 additional acute-care beds.
According to the 2025 State Medical Facilities Plan (SMFP), published annually by the North Carolina Department of Health and Human Services, Buncombe, Graham, Madison and Yancey counties have a combined need for 129 new beds. The SMFP uses population and hospital data to determine medical resource needs across the state each year.
The process is part of North Carolina’s Certificate of Need (CON) program, which requires state approval before major health care construction projects can move forward. The deadline for CON applications is Wednesday, Oct. 15, 2025, and the state review process is expected to begin in November.
Four systems in the running
AdventHealth, Mission Health, Novant Health and UNC Health have all submitted plans for the 129-bed allocation.
AdventHealth has proposed adding the 129 acute-care beds to its already approved 93-bed hospital in Weaverville, which is under development near U.S. 25/70. The expansion would bring the facility to 222 beds total, including intensive care, surgical suites, maternity care and a full-service emergency department. The system has also held a series of community meetings about its Weaverville plans.
UNC Health and UNC Health Pardee announced they are seeking approval to build a new facility — UNC Health West Medical Center — in Buncombe County. The proposed 129-bed hospital would include emergency services, labor and delivery, inpatient acute care and adult psychiatry.
“UNC Health West builds on UNC Health Pardee’s record of public service and proven experience and dedication to the western region and UNC Health’s commitment to the health and wellness of our state, resulting in increased access and improved care for the residents of Buncombe and surrounding counties,” Alan M. Wolf, director of media relations for UNC Health, said.
Novant Health also plans to apply for a portion of the available beds.
“We remain deeply committed to extending high-quality, compassionate care to Western North Carolina,” a Novant Health spokesperson said in a statement. “We’ve worked closely with the community and local physicians to grow our specialty care network in the region and look forward to applying in October for additional beds.”
Mission Health, which previously challenged an earlier CON decision favoring AdventHealth’s expansion, has also entered the competition for the 129-bed project.
What’s next
The state review process for the CON applications begins in November. A decision is expected sometime in 2026.
If approved, the winning proposal will bring significant new hospital capacity to Western North Carolina, where local officials and residents have long voiced concerns about access, competition and patient choice.
