HUD 232/223(f) Healthcare acquisition & refinance

Acquire or refinance an established care facility with long-term, fixed-rate healthcare financing.

Program at a glance Documents & videos Program details

Program at a glance

Up to 35 years: Fully amortizing; limited to 75% of the property’s remaining economic life.
Fixed interest rate: Long-term financing with pricing established at rate lock.
Acquisition or refinance: For existing eligible healthcare properties; substantial rehabilitation uses HUD 232.
Nonrecourse: Subject to standard carve-outs.
Repairs & reserves: Capital needs, repair escrows and replacement reserves are reviewed in underwriting.
Property + operator: Operating results, licensing and the management team are evaluated together.

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Documents & videos

HUD 232/223(f) term sheetOpen PDF

Ownership & closing

Healthcare development team experience

Documentation of borrower, operator and management experience, including facility types, locations and responsibilities.

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Program details & considerations

HUD 232/223(f) provides long-term financing to acquire or refinance an eligible operating healthcare facility. We review the property and operator together, including operating history, licensing, capital needs and the proposed ownership structure.

Start with historical and year-to-date operating statements, occupancy, payer mix, licensed beds or units and existing debt terms. For an acquisition, include the proposed purchase price. For a refinance, let us know what you want to accomplish with the new loan.

We'll review the borrower, operator and management agent's relevant experience, along with required repairs and reserves. Loan proceeds depend on several HUD sizing limits, not just appraised value. The healthcare team handout below lists the experience information we typically need.

New construction or substantial rehabilitation should be reviewed under HUD 232. If the facility already has a HUD-insured loan, HUD 232/223(a)(7) may offer a streamlined refinance option.

Eligible uses & property features

Existing eligible healthcare facilities
Acquisition and refinancing
Eligible improvements and reserves
Long-term, fixed-rate financing

What to consider

Eligibility and proceeds are determined through healthcare-specific underwriting. Facility licensing, operating performance, management and any independent living component need review early in the process.

Eligibility, proceeds, terms and timing depend on the property, underwriting and current HUD requirements. This overview is not a loan commitment.