Small and medium nursing homes constitute the backbone of India’s healthcare delivery, particularly in semi-urban and rural areas. However, increasing regulatory burdens, compliance complexities, and rising operational costs are threatening their sustainability. Policies relating to clinical establishment registration, biomedical waste, fire safety, and insurance empanelment often disproportionately impact these facilities. This session will examine whether current regulatory frameworks are enabling or stifling decentralized healthcare access. It will also explore the need for differentiated regulation, financial incentives, and legal protection to ensure that these institutions continue to serve as accessible, affordable healthcare providers