Appeals challenge Mission Hospital’s approved 95-bed expansion in Buncombe County

AdventHealth and UNC Health West have put Mission Hospital’s 95-bed expansion on hold in a fight that could affect wait times, hospital choice and where patients in Buncombe County end up when beds run short.

The appeal was filed April 23, within the 30-day window allowed under North Carolina’s certificate-of-need law after the state’s March 27 approval. That means Mission cannot simply move ahead while the case is reviewed by an administrative law judge, who has 270 days to issue a decision.

The state let Mission develop no more than 95 additional acute-care beds, for a total of no more than 828 acute-care beds, with an approved capital expenditure of $198,522,000. If the approval survives the appeal, Mission will be able to keep building toward a larger inpatient footprint in Asheville. If the challengers prevail, the award could be reversed or sent back for more review, opening the door for AdventHealth or UNC Health West to press their own claims on the region’s bed capacity.

That matters because this is not just a corporate turf battle. Mission is the largest hospital west of Charlotte, with 682 licensed acute-care beds, and the region’s only Level 2 trauma center. It has also applied to become western North Carolina’s only Level 1 trauma center. Any delay in expanding its bed count can ripple through emergency departments, admission decisions and transfers, especially when inpatient beds are tight.

The dispute grew out of the 2025 State Medical Facilities Plan, which identified a need for 129 acute-care beds in Buncombe, Graham, Madison and Yancey counties. Four systems competed: Mission, AdventHealth, Novant Health and UNC Health West. The state’s November notice said UNC Health West proposed a new 129-bed hospital in Asheville, Novant proposed 34 beds in Arden, AdventHealth proposed 129 additional beds in Weaverville, and Mission proposed 129 additional beds in Asheville.

In the end, the state awarded Mission 95 beds and Novant 34. AdventHealth and UNC Health West, the losing applicants, appealed. AdventHealth has said its Buncombe County project already had approval for 93 beds and that the new proposal would bring its site to 222 beds total. Mission has argued the extra beds would ease capacity strain and let patients get advanced care locally.

For Buncombe County patients, the appeal keeps the bigger question unresolved: who will have the beds, the specialists and the staying power to meet demand as western North Carolina keeps growing.