Our Leadership

Cal-Mortgage Loan Insurance

Administers the California Health Facility Construction Loan Insurance Program and provides credit enhancement for eligible nonprofit healthcare facilities when they borrow money for capital needs.



The Cal-Mortgage Loan Insurance Program was authorized by an initiative in 1968. This initiative added Article XIII, Section 21.5 to the California State Constitution, which has been renumbered to Article XVI, Section 4. The California Legislature enacted the California Health Facility Construction Loan Insurance Law (Insurance Law), Chapter 1, Part 6, Division 107, commencing with Section 129000 of the Health and Safety Code. The Insurance Law became effective on November 10, 1969.

In 1971 the California Supreme Court ruled that the Constitutional amendment and the enabling legislation creating the Program were constitutional.

Cal-Mortgage insured loans are guaranteed by the “full faith and credit” of the State of California. This guarantee permits borrowers to obtain lower interest rates, similar to the rates received by the State of California.

Eligible Health Facilities must be owned and operated by private nonprofit public benefit corporations or political subdivisions such as cities, counties, healthcare districts or joint powers authorities. Health facilities eligible for Cal-Mortgage Loan Insurance include:

  • Hospitals, of any type
  • Skilled nursing facilities
  • Intermediate care facilities
  • Public health centers
  • Clinics and other outpatient facilities
  • Multi-level facilities (which include a residential facility for the elderly operated in conjunction with an intermediate care facility, a skilled nursing facility, or a general acute care hospital)
  • Laboratories
  • Community mental health centers
  • Facilities for the treatment of chemical dependency
  • Child day care facilities in conjunction with a health facility
  • Adult day health centers
  • Group homes
  • Facilities for the developmentally disabled or mentally disordered
  • Offices and central service facilities operated in connection with a health facility

Loans may be insured to finance or refinance the construction of new facilities; to acquire existing buildings; to expand, modernize, or renovate existing buildings; and to finance fixed or moveable equipment needed to operate the facility.

Facilities Development

Regulates the design and construction of healthcare facilities to ensure they are safe and capable of providing services to the public.



The Sylmar Earthquake of 1971 caused the collapse of several hospitals, endangering the lives of patients in those hospitals at the time and rendering the hospitals incapable of providing emergency care to people injured in the earthquake.

Hospitals, unlike other buildings, must not only be safe for the public, but must remain functional and able to provide care to the community in the event of a major disaster, including earthquakes. As a result, in order to ensure that hospitals in California conform to high construction standards, the Legislature passed the Alfred E. Alquist Hospital Facilities Seismic Safety Act (HSSA) in 1973. The intent of the HSSA is to assure that hospitals are reasonably capable of providing services to the public after a disaster.

In 1983, the HSSA (Health and Safety Code, Section 129675) was significantly amended and ultimately preempted local building departments from all hospital construction plan review responsibility and transferred it to the Department of Health Care Access and Information (HCAI) and the Division of the State Architect. This essentially created a building department within the Department of Health Care Access and Information, called the Facilities Development Division (FDD).

In 1991, recognizing the need to consolidate health facility plan review and construction observation functions, the Legislature established a single point of accountability and authority for plan review and construction observation activities relating to hospitals by transferring all duties and functions to HCAI, FDD. Now the hospital design and construction industry has a single enforcement agency to provide all services and technical guidance with regard to the construction of health facility projects.

Senate Bill 1953 (SB 1953) was introduced on February 25, 1994. It was signed into law on September 21, 1994 and filed by the Secretary of State on September 22, 1994. The bill was an amendment to and furtherance of the Alfred E. Alquist Hospital Seismic Safety Act of 1983(Alquist Act). SB 1953 (Chapter 740, 1994), is now chaptered into statute in Sections 130000 through 130070 of the Alfred E. Alquist Hospital Facilities Seismic Safety Act, and part of the California Health and Safety Code. The regulations developed as a result of this statute are deemed to be emergency regulations and became effective upon approval by the California Building Standards Commission and filing with the Secretary of State on March 18, 1998.

Other bills amending the HSSA


Pursuant to the Hospital Seismic Safety Act, HCAI′s responsibilities are carried out by its Facilities Development Division (FDD). FDD is responsible for overseeing all aspects of general acute care hospital, psychiatric hospital, skilled nursing home and intermediate care facility construction in California. See what this responsibility includes

Health Workforce Development

Collects, analyzes, and publishes data about California’s healthcare workforce and health professional training, identifies areas of the state in which there are shortages of health professionals and service capacity, and coordinates with other state departments in addressing the unique medical care issues facing California’s rural areas.


Information Services

Integrates and centralizes enterprise data operations with healthcare analytics, using common technology infrastructure to improve data accessibility and usage to better serve all HCAI clients and stakeholders. HCAI produces datasets and data products from a variety of sources, including reports submitted to HCAI by over 8,700 licensed healthcare facilities as well as facility construction and healthcare workforce data managed in the administration of HCAI programs.


Office of Health Care Affordability

Established in 2022, the Office of Health Care Affordability (OHCA) analyzes California’s health care market for cost trends and drivers of spending, enforces health care cost targets, and conducts cost and market impact reviews of proposed health care consolidations. A new Health Care Affordability Board will advise on key activities and approve specific aspects of OHCA’s work, with input from an Advisory Committee and the public. To prevent unintended consequences associated with the cost targets, OHCA will measure and publicly report on quality, equity, adoption of alternative payment models, investment in primary care and behavioral health, and workforce stability.