UNC Health seeks approval for new Asheville hospital beds

UNC Health asked state regulators on June 15 for permission to build a 92-bed acute-care hospital in Asheville called UNC Health West, near Westgate Mall and Patton Avenue. The state-owned, nonprofit academic health system is trying to enter a market where every bed has become part of a larger fight over access, wait times and which system will control growth in Buncombe County.

The request arrives as North Carolina’s planning process has already put hard numbers on the region’s need. The 2025 State Medical Facilities Plan found a need for 129 acute-care beds in the service area that includes Buncombe, Graham, Madison and Yancey counties. In a separate review tied to this year’s planning cycle, state regulators identified a need for 92 acute-care beds in Buncombe County, the figure UNC Health used in its application for the new Asheville hospital.

That process is the Certificate of Need system run by the North Carolina Department of Health and Human Services. The agency’s Certificate of Need Section issues conditional approvals or disapprovals and publishes decisions and findings each month, a structure meant to weigh community need against existing capacity and competing proposals before new hospital beds are built.

The current fight is already producing appeals. AdventHealth and UNC Health have challenged findings that allowed Mission Hospital and Novant Health to expand their Buncombe County services. Mission, meanwhile, won approval to add 95 more acute-care beds to its main Asheville facility. One projection put that expansion at a 13% increase in patient capacity while staffing would grow 3.7%, with the project expected to cost about $1.6 million.

For Buncombe County patients, the difference between those plans is not abstract. A new hospital on the west side of Asheville could give residents another place to go for inpatient care, spread demand across more beds and ease pressure on Mission’s long-standing role as the central hospital in the city. It could also affect how far people travel for care, especially for patients in west Asheville and along the Patton Avenue corridor.

The stakes extend beyond geography. In a county where one system has long dominated hospital care, another acute-care hospital could change negotiating leverage with insurers and employers, while also creating more room for specialists and support services if regulators ultimately approve the project. The same approval fight also determines whether the region gets more capacity at all, or just more legal and regulatory conflict before any new beds open.

With Mission, Novant, AdventHealth and UNC Health all pressing their cases through the state process, Buncombe County’s hospital future is being decided bed by bed.