The four Section 232 programs
HUD's Section 232 insures loans on licensed nursing homes, assisted living and board and care homes. Which program applies depends on two questions: does the building already have an FHA-insured loan, and is it built and open three years.
| Program | For | Max LTV (for-profit) | Min DSCR | Annual MIP | Max term |
|---|---|---|---|---|---|
| 232/223(f) | Refinance or buy an existing facility open 3+ years | 80% | 1.45 | 0.65% | 35 years |
| 223(a)(7) | Refinance an existing FHA-insured 232 loan | no value test; capped at original principal | 1.11 | 0.55% | remaining term + up to 12 years |
| 232 NC/SR | Build, or rehab beyond 25% of value | 75% new assisted living; 80% skilled nursing | 1.45 | 0.77% | 40 years |
| 241(a) | Add to or improve a property with an FHA loan | 90% of the value added | 1.45 after the primary loan | 0.72% | term of the primary loan |
HUD Handbook 4232.1 REV-1; premiums from the Federal Register notice of June 26, 2025, without tax credits.