Four major health systems are competing to expand hospital services in Western North Carolina, a service area that includes Madison and Yancey counties.
The North Carolina Department of Health and Human Services says Buncombe, Graham, Madison, and Yancey counties together need 129 new acute-care hospital beds. The need was outlined in the state’s 2025 Medical Facilities Plan, which tracks population growth and hospital capacity across the state.
The process is part of North Carolina’s Certificate of Need program, which requires state approval before major healthcare construction can move forward.
Four major systems — AdventHealth, Mission Health, Novant Health, and UNC Health — have all submitted plans for the 129-bed allocation.
AdventHealth wants to add those beds to its new 93-bed hospital under construction in Weaverville, while UNC Health and UNC Pardee are proposing a brand-new facility called UNC Health West Medical Center. Novant Health also plans to apply for a share of the beds, and Mission Health, which already operates more than 800 beds, is also competing for the allocation.
The decision could mean greater access to hospital care without having to travel as far for treatment.
The state review process begins in November, and a final decision is expected sometime in 2026.
