HUD Section 242 hospital mortgage insurance, independently tracked
Every FHA-insured hospital loan, and the tests HUD applies
FHA insures long-term, fixed-rate mortgages for hospitals that clear a short list of financial tests. Here is every hospital loan in HUD's public files, the tests to run on your own numbers, and what the programs cost.
Independent: operated by Janover Capital LLC, a commercial mortgage advisory firm. Not affiliated with, endorsed by or acting for HUD, FHA, HUD's Office of Hospital Facilities, any government agency or any hospital named here.
Every hospital loan FHA has insured, 1968 to 2026
One mark per loan, by the year HUD first endorsed it: 493 in all. Filled marks are still active, outlined ones were paid off or refinanced, and the 32 red ones ended in an insurance claim.
- Active
- Paid off or refinanced
- Insurance claim
Most recent endorsements
- Medical University Hospital Authority241(a) supplemental · $310.2 million · Summerville, South Carolina · June 25, 2026
- Kaleida Health241(a) supplemental · $125.0 million · Buffalo, New York · June 9, 2026
- Care New England Health System242 construction or renovation · $215.5 million · Providence, Rhode Island · April 7, 2026
- Medical University Hospital Authority241(a) supplemental · $251.2 million · Indian Land, South Carolina · December 18, 2025
- St. Barnabas Hospital223(f) refinance or purchase · $59.1 million · Bronx, New York · July 1, 2025
- Health Care Authority of the City of Anniston223(f) refinance or purchase · $33.3 million · Anniston, Alabama · September 30, 2024
All 47 insured hospitals and systems · Every loan since 1968, and the claims
Short answers
What is HUD Section 242?
Section 242 of the National Housing Act lets FHA insure mortgages on hospitals, mainly acute care hospitals, for construction, renovation, expansion and refinancing. The loans are fixed-rate, fully amortizing, limited to 90% of replacement cost and to 25 years from the start of amortization.
Which hospitals qualify?
Public, nonprofit and for-profit hospitals providing inpatient acute care, with no more than half of patient days in chronic, psychiatric, substance use and similar categories. They need a three-year operating margin of at least zero and average debt service coverage of at least 1.25 (1.4 for a 223(f) refinance), with limited turnaround exceptions, and must follow their state's certificate-of-need process where one exists (24 CFR Part 242).
What does HUD hospital mortgage insurance cost?
Under HUD's 2022 premium notice, a Section 242 loan pays 0.70% a year and 0.70% up front. 223(f) refinancing pays 0.65% a year and 1% up front, 223(a)(7) 0.55% and 0.50%, and 241(a) 0.65% and 0.65%. HUD's 2025 cut to 0.25% applied to apartment programs, not hospitals.
Is this site part of HUD?
No. It is operated by Janover Capital LLC, a commercial mortgage firm, and is not affiliated with or endorsed by HUD, FHA, the Office of Hospital Facilities or any hospital named here.
Considering FHA for a hospital project?
Send it to the commercial mortgage team at Janover Capital for a first read on the tests and the timeline.