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- In finding portions of Mississippi’s home health agency “Certificate of Need” laws unconstitutional, U.S. District Court judge Carlton Reeves said, “the Court cannot escape the absurdity in maintaining an out-right moratorium for over forty years.”
A federal judge on Wednesday struck down Mississippi’s decades-old moratorium on new home health agencies, ruling the state’s blanket ban on new licenses violates the Fourteenth Amendment.
U.S. District Judge Carlton W. Reeves held that Mississippi’s longstanding refusal to issue or even consider new certificates for home health agencies cannot survive, ordering the moratorium lifted after more than 40 years.
In his ruling, Reeves underscored that moratoria are generally intended as temporary pauses, not permanent walls. The Supreme Court has warned courts to look skeptically at moratoria longer than a year.
“The Court cannot escape the absurdity in maintaining an out-right moratorium for over forty years,” he wrote.
The decision came in a lawsuit brought by Dr. Charles Slaughter, a Mississippi physical therapist who wants to open a home health care agency. The case was filed against State Health Officer Dr. Daniel Edney. The Mississippi Association for Home Care, representing existing home health providers, intervened to help defend the current system.
American Dream Legal founder and CEO Aaron Rice — the attorney representing Slaughter — framed the win as both a patient-access issue and a constitutional rebuke of economic favoritism.
“This is a major victory for patients and aspiring health care entrepreneurs in Mississippi,” said Aaron Rice, founder and CEO of American Dream Legal, the public interest law firm representing Slaughter. “The moratorium was nothing more than pure political favoritism, designed to help industry insiders line their pockets at the expense of patients and entrepreneurs.”
The state and MAHC defended the law primarily on policy grounds, including arguments tied to controlling costs, promoting quality of care, ensuring public health oversight, and limiting administrative burdens that might arise if new providers entered the market.
Not a Complete Victory for Slaughter, Not a Complete Loss for the State
Rice said, “The Court’s decision sends a clear message that the Constitution rejects this kind of naked protectionism.”
But it was not a complete victory for his client.
While the ruling struck down the moratorium, the court rejected Slaughter’s broader constitutional attack on Mississippi’s “Certificate of Need” program, as applied to home health agencies.
“The Certificate Law survives review,” Reeves wrote.
In concert, this means the state may continue requiring healthcare providers to obtain government approval before opening or expanding, but it can no longer enforce an outright ban on new home health agencies.
American Dream Legal criticized that aspect of the ruling and said it plans to appeal.
“While we are pleased with the Court’s decision to strike down the moratorium, we are disappointed that, when it came to the CON law, the Court ruled in favor of a badly broken status quo and against patient care,” Rice said. “We intend to appeal that ruling.”
Mississippi adopted its Health Care Certificate of Need Law in 1979, setting up a regulatory system requiring a “certificate of need” before new healthcare facilities or services can be established or expanded. Under the statutory scheme, home health agencies are included within the facilities and services subject to CON review.
CON programs were originally pushed nationally in the 1970s as a means of controlling healthcare costs by preventing “duplicative” facilities and services. In 1986, Congress repealed the federal framework. States have diverged significantly since, with 14 states fully repealing their CON laws and many others narrowing their application.
Critics of CON laws say that in practice they operate as a gatekeeping system that limits competition. Under CON laws, providers must obtain state approval before opening new healthcare facilities, adding beds, offering certain services, or purchasing high-cost equipment — often after navigating an administrative process in which incumbent providers may intervene and oppose new market entrants.
Opponents contend that this structure restricts supply and entrenches the market power of existing players, reducing incentives to improve service, expand capacity, or lower costs. They argue that CON programs can delay or block new providers, even in areas where patient need is obvious, limiting access to care and reducing consumer choice.
The result, according to think tanks like The Mercatus Center at George Mason University, is a healthcare marketplace shaped more by regulatory protectionism than by patient demand, with predictable consequences — less competition, fewer options, and barriers that fall hardest on patients in underserved communities.
