UNC Health Johnston seeks 63 more beds for Clayton, Smithfield hospitals.
By: Zac Ezzone
Reporter, Triangle Business Journal
Feb 23, 2026
As work gets underway on UNC Health's $100 million expansion in Johnston County, the health system is eyeing more investments in its medical centers in Clayton and Smithfield as the county's population approaches 250,000.
UNC Health Johnston has filed two applications to add 63 acute care beds across its facilities. The proposal builds on the health system's 2024 approval to develop 24 beds, split evenly between the two campuses.
UNC Health Johnston filed applications this month with the N.C. Department of Health and Human Services in response to the 2026 State Medical Facilities Plan, which identified a need for 63 beds in Johnston County. No competing applications were filed.
Under the proposals, UNC Health Johnston would add 35 beds in Clayton and 28 beds in Smithfield. The expansion would grow the health system to 118 beds in Clayton and 151 beds in Smithfield.
Splitting the beds between two applications allows the health system to better serve the county's growing population, said Tommy Williams, CEO of UNC Health Johnston.
"We really feel like that's the best plan to totally serve the county, where it would help people not to travel a greater distance for care and for inpatient beds," Williams said.
The new filings build directly on the expansion UNC Health Johnston won approval for in 2024.
In Clayton, the health system is developing a 3-story building with construction likely beginning by April. Under the earlier approval, the health system planned to develop 12 acute care beds on the building's second floor, along with 12 observation beds that could later be converted to licensed beds.
In its newest application, the health system proposes converting the 12 observation beds into acute care beds, building out the third floor and adding four postpartum beds on the first floor.
The new project is expected to cost approximately $13.5 million. Combined with the previously approved Clayton project, total costs are expected to reach above $122 million, according to application documents.
Williams expects to open the new Clayton facility in early 2028. If NCDHHS approves this recent application, those additional beds could be operational by July 2028.
"We're essentially in construction phase right now for that tower," Williams said. "So, I think that'll really help the county, because we can turn (the additional beds) on so quickly."
Some of the health system's plans in Smithfield are contingent on completing work in Clayton first.
Under its 2024 approvals, UNC Health Johnston plans to consolidate its women's and maternal care services to its Clayton facility, relocating obstetrics beds, a C-section room and some neonatal beds from the Smithfield campus. This move will free up space in Smithfield to renovate other areas and add the 12 beds granted in 2024 — a project Williams expects to be operational by late 2028.
In its recent applications, UNC Health Johnston proposes two additions to a hospital in Smithfield that will require 54,616 total square feet of construction. The health system plans to add 24 general beds and four intensive care unit beds to the hospital.
This new project is expected to cost $62.6 million. Combined with the previously approved Smithfield project, total costs are expected to reach $70.5 million, according to application documents.
"That plan that we submitted will also allow us some shell space for future growth as beds continue to come online for Johnston County," Williams said. "We felt like that'd be a quick and efficient way to add beds on that side of the county as well."
No other health systems filed applications this cycle, but Williams believes future allocations could attract competition as the county grows.
"(Other health care systems) certainly already see the growth, just like I do," Williams said. "They understand how attractive Johnston County is and what the need is. And a lot of health care systems see Johnston County as part of the greater Triangle region and they want to be part of it."
UNC Health Johnston also filed a separate application to develop a positron emission tomography (PET) scanner at its Smithfield campus.
The 2026 State Medical Facilities Plan identified a need for two PET scanners across an 11-county region that includes much of the Triangle. Other providers are pursuing the scanners, with seven applications filed. PET scanners are used to detect cancer, heart disease and brain disorders.
For UNC Health Johnston, securing the scanner would mean no longer relying on a contract mobile service only available on weekends.
"Quite honestly, if someone wants it, they've got to travel, and that's something we try to avoid," Williams said. "We've got to improve access for care here in Johnston County, for all the patients that are here now and for the continued growth that we have."
From the Triangle Business Journal
