Tool · HUD Handbook 4232.1, Section II, Chapter 3
HUD 232 refinance sizer
Put in your underwritten NOI, appraised value and an interest rate. The sizer runs the same loan tests HUD's MILC worksheet runs for a 223(f) or 223(a)(7) refinance and shows which one sets your loan.
How HUD sizes a 232 refinance
HUD insures the lowest of several loan amounts, each one a separate test on Form HUD-92264A-ORCF, rounded down to the nearest $100. For a 232/223(f) refinance (Handbook 4232.1, Section II, 3.8) the tests are:
- Loan to value. Appraised value times 80% for skilled nursing or existing assisted living, 85% for a qualifying nonprofit. New assisted living is 75% and 80%, but new construction is not a 223(f).
- Debt service. NOI divided by 1.45, less ground rent, divided by the annual loan constant plus the annual MIP. The MIP counts as debt service.
- Cost to refinance. 100% of the payoff plus eligible repairs and closing costs, less any reserve for replacement already on deposit. There is no cash out: "Borrowers and Operators may not receive any cash proceeds from the refinance," in the handbook's words.
- The amount requested.
A 223(a)(7) (section 3.9) drops the value test and lowers coverage to 1.11, but caps the new loan at the original principal of the FHA loan being refinanced.
The fees built into the cost test
| Item | 232/223(f) | 223(a)(7) |
|---|---|---|
| Upfront MIP (financed) | 1.00% | 0.50% |
| Annual MIP | 0.65% | 0.55% |
| HUD application fee | 0.30% | 0.15% |
| HUD inspection fee | $30 a bed; 1% of repair costs when repairs exceed $3,000 a bed | None |
| Lender fee cap | 3.5% | 2% |
| Minimum DSCR | 1.45 | 1.11 |
MIP rates are for loans without low-income housing tax credits, from the Federal Register notice of June 26, 2025 (90 FR 27330), which kept HUD's healthcare rates and ended the 25-basis-point green rate for applications received on or after August 25, 2025. The separate cut to 0.25% for multifamily programs that took effect October 1, 2025 does not list Section 232. Fees, LTV and DSCR are from HUD Handbook 4232.1 REV-1, effective January 19, 2017, which is still the current revision.
What the sizer leaves out
It does not model special assessments, tax abatements, the 223(f) purchase test, or the lender's own underwriting of NOI, which is usually lower than the operator's. It treats the first year's interest plus principal as the loan constant, close to but not exactly how the MILC computes the initial curtail. HUD also expects 3 years since the building was completed or substantially rehabbed before a 223(f), and debt that does not meet HUD's eligible-debt rules needs 2 years of seasoning.
This sizer is an estimate, not a commitment or an offer of credit. HUD, an FHA-approved lender and the lender's underwriting decide the actual loan. SNF Register is operated by Janover Capital LLC and is not affiliated with HUD, FHA or CMS. MIP and fee figures as of HUD's notices above; facility data as of CMS September 2026.
Questions
What debt service coverage does HUD require on a 232 refinance?
HUD Handbook 4232.1 sets a minimum of 1.45 for Section 232 projects, including 223(f) refinances, and 1.11 for 223(a)(7) streamlined refinances of loans HUD already insures. The coverage is calculated with the mortgage insurance premium included in debt service.
How much can I borrow against a nursing home under 223(f)?
The lowest of four numbers: the amount you request, 80% of appraised value (85% for a qualifying nonprofit), the loan that NOI divided by 1.45 can carry, and 100% of the cost to refinance, which is the payoff plus eligible repairs and closing costs. A 223(f) cannot return cash to the borrower.
What is the mortgage insurance premium on a HUD 232 loan?
For applications received on or after August 25, 2025, HUD charges 1.00% upfront and 0.65% a year on a 232/223(f) refinance without tax credits, and 0.50% upfront and 0.55% a year on a 223(a)(7). The Federal Register notice of June 26, 2025 sets those rates.