A HUD Section 232 loan is an FHA-insured, non-recourse mortgage for skilled nursing, assisted living, memory care and board-and-care facilities. Section 232/223(f) buys or refinances an existing facility with a fixed rate for up to 35 years at up to 80% of value for for-profit owners and 85% for nonprofits. Qualifying low-leverage refinances can use HUD's Express Lane, which targets a firm commitment in about 10 to 15 days.
Which 232 program fits
| 232/223(f) acquisition or refinance | 232 new construction or substantial rehab | |
|---|---|---|
| Use | Buy or refinance an existing facility | Build or substantially rehab a facility |
| Term | Up to 35 years, fixed, fully amortizing | Construction period plus up to 40 years |
| Max loan-to-value | 80% for-profit, 85% nonprofit | 80% skilled nursing, 75% assisted living |
| Max loan-to-cost | 85% acquisition for-profit (90% nonprofit) | 90% |
| Min debt service coverage | 1.45x | 1.45x |
| Mortgage insurance premium | 1% at closing, then 0.65% a year | 0.77% at closing and annually (0.45% for assisted living with LIHTC) |
| Commercial space limit | 20% of rentable area and 20% of income | 10% of floor area and 15% of income |
Section 232 premiums were not part of HUD's October 2025 multifamily cut to 0.25%; rates shown are from HUD's notice at 90 FR 27330 (June 26, 2025).
HUD's Express Lane for 232/223(f) refinances
HUD announced Express Lane in July 2025 to speed low-risk healthcare refinances. HUD said qualifying applications move to a firm commitment in about 10 to 15 days, against up to 150 days before. HUD's published criteria include:
- Loan-to-value of 70% or less, plus minimum coverage and quality-of-care standards
- An operator that has run the facility for at least two years
- A loan of no more than $50 million, or $70 million in the greater New York City area
- A complete, ready-to-underwrite application
Bravo's Express Lane Qualifier checks a facility against these criteria before you order reports.
What HUD looks at beyond the numbers
- The operator: experience, licensure, staffing, financial capacity and survey history
- CMS star ratings, census and payor mix
- Professional liability insurance and the operating lease between owner and operator
- Third-party reports: appraisal, environmental report and Capital Needs Assessment
Bravo in healthcare
Bravo Capital is a HUD LEAN-approved lender for Section 232. Since September 2025, Bravo has received six Section 232/223(f) skilled nursing commitments in Virginia and West Virginia totaling $143.2 million, and all six have closed, including Blue Ridge Therapy Connection in Stuart, Virginia ($41.7 million, March 2026) and Wyndhurst Health and Rehabilitation in Lynchburg, Virginia ($34.2 million, July 2026). Bridge-to-HUD loans from Bravo Property Trust can fund an acquisition or operator transition now and refinance into 232 later.
Check Express Lane eligibility Talk to an underwriter
Questions borrowers ask
Can assisted living and memory care use HUD 232?
Yes. Section 232 covers skilled nursing, assisted living, memory care and board-and-care facilities, with somewhat lower leverage for assisted living on new construction.
What is HUD's Express Lane?
Express Lane is HUD's fast track for low-risk Section 232/223(f) refinances, announced in July 2025. Qualifying loans of up to $50 million ($70 million in the greater New York City area) at 70% loan-to-value or less can reach a firm commitment in about 10 to 15 days.
How is HUD 232 different from HUD 223(f)?
HUD 223(f) finances existing apartments, while Section 232/223(f) finances existing healthcare facilities. Section 232 adds operator, licensing and quality-of-care review, requires 1.45x coverage, and carries a higher mortgage insurance premium.
Does the operator matter in a HUD 232 loan?
Yes. HUD underwrites the operator alongside the real estate, reviewing its experience, licensure, survey history, staffing and finances, and the owner-operator lease.
About the author
Aaron Krawitz is the founder and CEO of Bravo Capital, a HUD-approved MAP and LEAN lender in New York City. He founded Bravo in 2021 after serving as president of Dwight Capital. Bravo and its affiliate, Bravo Property Trust, have closed more than $2.5 billion in financing, and Bravo closed every HUD firm commitment it received in 2025.
