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The Cal-Mortgage Loan Insurance Program (Cal-Mortgage) administers the California Health Facility Construction Loan Insurance Program (Program). Cal-Mortgage provides credit enhancement for eligible healthcare facilities when they borrow money for capital needs. 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. Get more information on Cal-Mortgage history and authorizing legislation.

Loan Insurance Application Process

Eligibility

To be eligible for loan insurance, the borrower must be either a California, nonprofit public benefit corporation or a political subdivision. In addition, it must be organized to own and operate a health facility and assure that its services are, or will be, available to all persons residing in the facility’s service area. Loans may be insured to finance or refinance the construction of new facilities; to acquire existing buildings; to expand, modernize, or renovate existing buildings; or to finance fixed or movable equipment needed to operate the facility. 

Eligibility requirements are detailed in the following legislation:

Steps in the Process

The Application includes a Supporting Documents Checklist outlining the complete list of documentation that must be submitted. The Application and documentation are to be completed and submitted electronically through the Application Portal. The Application and Supporting Documents Checklist is available to review in advance of online submission. Please note that all information and documentation submitted are considered public records under the California Public Records Act and are open to inspection and duplication by the public.

  1. Preliminary Review (No fees due at this time): It is encouraged to apply early in the process for a preliminary review to determine eligibility. In this first step, an Application and specific documents are submitted, including audited financial statements, form 990s, articles of incorporation, and bylaws. Upon review, staff will inform the borrower of their eligibility status and provide guidance on how to proceed through the application process. A site visit may be scheduled.
  2. Application Submission and Review: When eligibility is determined, the next step is to submit all documentation outlined in the Supporting Documents Checklist (documentation may be submitted incrementally) and, if applicable, update the Application. A $500 non-refundable application fee is due at this stage. After review of the complete Application and supporting documents, staff will prepare a Project Summary and Feasibility Analysis (PSFA). The PSFA includes a recommendation for the Application with a proposed set of conditions that must be met prior to the issuance of loan insurance. The Cal-Mortgage Deputy Director will determine if the Application should be recommended for review by the Advisory Loan Insurance Committee (Committee). 
  3. Review by the Advisory Loan Insurance Committee: The Application will be scheduled for presentation at a public meeting to the Committee for review. The Committee, composed of healthcare and finance industry experts, provides the Department of Health Care Access and Information (HCAI) Director with additional analysis and advice with respect to the Application. After deliberation, including input from the borrower, staff, and the public, the Committee will decide whether to recommend the Application for final approval to the HCAI Director. The final decision and approval to grant loan insurance is at the full discretion of the HCAI Director.
  4. Issuance of Conditional Loan Insurance Commitment: After the HCAI Director approves the Application, HCAI will issue a letter of commitment to insure the loan. This letter of commitment specifies conditions that must be met prior to the pricing and closing of the insured loan transaction. The letter of commitment is valid for approximately six months; and may be extended one time upon request by the borrower. A sample letter of commitment with typical conditions is available for review.

Blackout Period

Please note that insured bond transactions may not be priced or issued during the State’s blackout periods, roughly December 1 through January 10 and from May 1 through the date of the enactment of the State budget.

Fees

Reports

Monthly Report

The Monthly Report includes a list of insured loans and information regarding applications for loan insurance.

Annual Reports to the Legislature

Report 1 – Financial Status of the Program 
Health and Safety Code, Section 129045 requires Cal-Mortgage to report the financial status of its insured portfolio, including the status of all borrowers in each stage of default and the office’s efforts to collect from borrowers that have defaulted on their debt service payments. 

Report 2 – Borrowers’ Compliance with their Community Service Obligations 
Health and Safety Code, Section 129075 (c) requires Cal-Mortgage to report the extent of borrowers’ compliance with their community service obligations pursuant to subdivision (j) of Section 129050, Section 129055, and Section 129065.

Report 1 – Financial Status of the Program and Report 2 – Borrowers’ Compliance with their Community Service Obligations are combined into one document.

Actuarial Study

Health and Safety Code, Section 129330 requires  Cal-Mortgage to obtain, in each even numbered year, an actuarial study to determine the reserve sufficiency of funds. The purpose of the study is to examine the portfolio of existing insured loans and provide an estimate of reserve funds necessary to respond adequately to potential foreseeable risks, including extraordinary administrative expenses and actual defaults.

State Plan

Health and Safety Code, Section 129020 requires Cal-Mortgage to develop a state plan every odd-numbered year. The State Plan provides a summary of the Cal‑Mortgage , identifies current trends that affect the Cal‑Mortgage Program, and specifies goals and objectives in order to facilitate access to safe, quality healthcare environments.

Advisory Loan Insurance Committee

The Advisory Loan Insurance Committee (Committee) is a nine-member citizen advisory committee to the program. The Director of Finance appoints one member. The remaining eight are appointed by, and serve at the pleasure of, the HCAI Director. Of these eight, one is from state government. The remaining seven members represent various public sectors. The Committee:

  • Reviews loan insurance applications that have been recommended for approval by Cal-Mortgage.
  • Recommends to the HCAI Director whether an application should be approved, and whether conditions should be attached to that approval.
  • Assists the HCAI Director in formulating policy concerning financial analysis, management, operation, construction, improvement, and expansion of healthcare facilities.

Committee Members

  • David Kears, Chairman
    Special Assistant, Alameda County Health Care Services Agency
    Alameda
  • Jay Harris, Vice Chair
    Healthcare Strategy & Business Development Consultant
    San Francisco
  • Jonathon Andrus
    CEO, Fairchild Medical Center
    Yreka
  • David Berg
    Retired CEO of Sequoia Living Sacramento
  • Derik Ghookasian
    COO, Ararat Home of Los Angeles
    Mission Hills
  • Soyla Reyna-Griffin
    CEO, Valley Health Team
    Fresno
  • Richard Tannahill
    Senior Architect, Department of Health Care Access and Information
    Sacramento
  • John Woodward
    CEO, Front Porch Communities
    Glendale
  • Vacant
  • Designee
    Department of Finance
    Sacramento

Public Meetings

The ALIC public meeting schedule can be found on HCAI Public Meetings.

The Notice and Agenda for the next meeting is posted approximately ten days prior to the ALIC Meeting on the Public Meetings page. If any special accommodations are needed, such as TTY, sign language, etc. please contact us at (916) 319-8828. Requests should be made at least five days before scheduled meetings.

Additional information regarding future Notices and Agendas may be obtained by email, or calling (916) 319-8800.

Featured Projects


San Francisco Campus for Jewish Living

November 2016 insured $135,920,000 of California Statewide Communities Development Authority (CSCDA) Insured Revenue Bonds for Jewish Home of San Francisco. The bond proceeds will be used for the construction of two new buildings to be licensed as residential care facilities for the elderly and improvements of other buildings on campus. The final maturity of the bonds is November 1, 2046 and the All-In True Interest Cost is 4.42 percent. Additionally, in November 2021 insured $28,030,000 of CSCDA Insured Revenue Bonds. The San Francisco campus features a brand new 220-unit independent living building, and an acute psychiatric hospital and skilled nursing facility totaling almost 400 beds. The 2021 Bonds allow the Corporation to reimburse construction cost overages related to the recently completed residential building and capital improvement of the existing facility. The All-In True Interest cost inclusive of fees is 2.83 percent with a final maturity of November 2051. The total loan amount origination was $163,950,000.

Valley Health Team Clinic Site Fresno

Valley Health Team

October 2021 insured $15,365,000 of California Municipal Finance Authority Insured Revenue Bonds for Valley Health Team,which operates 12 federally qualified health centers throughout the Central Valley. The loan will be used to construct two new health centers located in the rural, medically underserved communities of Kerman and Firebaugh. Valley Health Team was able to attain a 3.42 percent all-in interest rate on this new 30-year financing.


La Maestra Community Clinic

October 2021 insured $12,295,000 of California Municipal Finance Authority Insured Revenue Bonds for La Maestra Community Clinic. The clinic is a Federally Qualified Health Center and serves more than 45,000 individuals annually, many of whom live in designated Medically Underserved Areas and are considered part of the Medically Underserved Populations in San Diego County. The new funding will be used to finance the acquisition and renovation of three new clinic sites in the San Diego area. La Maestra was able to lock in much lower interest rates than if it went into the bond market without Cal-Mortgage loan insurance. The 2021 bonds have a 30-year term, and an interest rate inclusive of all fees of 3.51 percent.

La Maestra Community Health Centers exterior view of main clinic
Open Door Community Health Centers_2021 Bonds_New Construction

Open Door Community Health Centers

September 2021 insured $30,580,000  of California Municipal Finance Authority Revenue Bonds for Open Door Community Health Center. The 2021 bonds will finance the construction of a new clinic site in Arcata that will allow Open Door to consolidate two existing sites. In addition, bond proceeds were used to refinance existing debt, fund a debt service reserve account, and pay for other costs of issuance. The interest rate, including all the fees and other costs, is 3.03 percent and the 2021 Bonds have a final maturity date of September 15, 2051. an 


San Benito Health Care District

February 11, 2021 insured $12,570,000 of San Benito Health Care District Insured Revenue Refunding Bonds for Hazel Hawkins Memorial Hospital. The new loan refinanced a prior Cal-Mortgage insured loan for the District who manages a 25 bed critical access hospital, a 119 bed skilled nursing facility, and three rural health clinics in San Benito County. The 2021 Bonds mature in 2029 and priced with an All-In True Interest Cost of 1.58 percent. The refinance will save the District over $380,000 in annual debt service payments, with a net present value savings of 10.0 percent.

San Benito Health Care District 2021 Bonds_Refinance
LA Jewish Homes senior apartment project

Los Angeles Jewish Home of Aging

August 8, 2019 insured $13,785,000 of California Statewide Communities Development Authority Insured Revenue Refunding Bonds for Los Angeles Jewish Home for the Aging. The new loan refinanced a prior Cal-Mortgage insured loan used to construct a 108-unit senior living facility. The 2019 Bonds mature in November 2037 and priced with an All-In True Interest Cost of 3.08 percent. The refinance will save the Home over $3.2 million in debt service payments, with a net present value savings of 18.7 percent.


Town And County Manor

June 13, 2019 insured $34,385,000 of California Municipal Finance Authority Insured Revenue Bonds for Town and Country Manor. The 2019 Bonds will finance the construction of a new 88 bed memory care facility at its existing multi-level continuing care retirement community located in Santa Ana, CA. The memory care project is expected to be completed in early 2021. Bond proceeds also used to refinance $7,00,000 in debt not currently insured by Cal-Mortgage.  The 2017 Bonds mature on May 15, 2049 and was priced with an All-In True Interest Cost of 3.98 percent. 

Town and Country Manor senior living facility
The Ridge at Paradise Valley construction site.

Paradise Valley Estates

March 30, 2019 insured $95,600,000 of California Municipal Finance Authority Insured Revenue Bonds for Paradise Valley Estates. The 2019 Bonds will finance 70 new independent living units within the 76-acre Paradise Valley Estates multi-level continuing care retirement community located in Fairfield, CA. The project is expected to be completed in early 2021.  By utilizing both short-term entry fee bonds and traditional 30-year maturities, the project was able to secure financing with an All-In True Interest Cost of 4.44 percent.

North Kern – South Tulare Hospital District

November 20, 2019 insured Refunding Revenue Bonds, Series 2019 for $4,300,000 for North Kern – South Tulare Hospital District.  The financing was used to refinance existing Insured 2010B Series Bonds, which had been used to construct and equip a new community clinic and reimbursed the District for an emergency generator at their skilled nursing facility. The 2019 Bonds mature in September 2040 and priced with an All-In True Interest Cost of 3.85 percent.  The net present value savings was 12.34 percent.

North Kern South Tulare clinic building
Cal Armenian senior living facility

The California Armenian Home

November 20, 2018 insured California Municipal Finance Authority Revenue Bonds, Series 2018 for $24,665,000 for The California Armenian Home, a multi-level continuing care retirement community located in Fresno, CA .  The financing was used to refund variable rate private placement taxable loan.  The bond structure matures on May 15, 2033 and was priced with an All-In True Interest Cost of 4.16 percent.  The net present value savings was 6.93 percent.


Lincoln Glen Manor

November 8, 2018 insured $6,375,000 of California Municipal Finance Authority Insured Revenue Bonds for Lincoln Glen Manor, a multi-level continuing care retirement community located in San Jose, CA. The 2018 Bonds will finance the conversion of 12 independent living units to 17 memory care units, in addition to other facility capital improvement projects at the community. The insured bonds mature in 2043 and the True Interest Cost is 3.81 percent.

Lincoln Glen Manor front signage
Exterior photo of the Asian Community Center of Sacramento Valley

ACC Senior Service

July 26, 2018 insured $26,915,000 of California Municipal Finance Authority Insured Revenue Bonds for ACC Senior Services. The 2018 Bonds have a final maturity of April 1, 2048 and an All-In True Interest Cost of 4.17 percent. The proceeds of the bonds will be used to construct the Maple Tree Court Assisted Living and Memory Care Center, an approximately 64,082 square foot facility with 72 assisted living units and 30 memory care living units, in Sacramento.

Viamonte

May 24, 2018 insured $187,230,000 of California Statewide Communities Development Authority Bonds for Viamonte Senior Living. The 2018 Bonds will finance the construction of a new state-of-the-art 191-unit multi-level continuing care retirement community in Walnut Creek. By utilizing both short-term entry fee bonds and traditional 30-year maturities, the project was able to secure financing with an All-In True Interest Cost of 4.18 percent.

Rendering of Viamonte at Walnut Creek
Exterior photo of the Casa de las Campanas multi level senior living facility in Rancho Bernardo

Casa de las Campanas

August 24, 2017 insured $39,000,000 of California Enterprise Development Authority Insured Revenue Bonds for Casa de las Campanas in Rancho Bernardo. The 2017 Bonds will finance the construction of a new state-of-the-art 72-bed skilled nursing facility. Casa de las Campanas is a nonprofit corporation that owns and operates a life care, multi-level continuing care retirement community just outside of San Diego, and has an investment grade credit rating of A-. The 2017 Insured Bonds are a direct placement with City National Bank. Under the drawdown bond structure during the 18-month construction period, the interest rate will be variable. Once construction of the new skilled nursing facility is completed, the interest rate on the bonds will lock at an estimated rate of 2.63 percent. The bonds mature in September 2022.


St. John’s Well Child & Family Center

July 12, 2017 insured $5,250,000 of California Municipal Finance Authority Insured Refunding Revenue Bonds for St. John’s Well Child. The refunded bonds mature on December 1, 2041 and were priced with an All-In True Interest Cost of 3.76 percent. The refinance resulted in a net present value savings of $541,540.67 or, 11.02 percent.

Exterior photo of the St. Johns clinic facility in Los Angeles
Exterior photo of the Institute on Aging facility in San Francisco

AgeOn Institute on Aging

May 31, 2017 insured $34,355,000 of California Municipal Finance Authority Insured Revenue Refunding Bonds for Institute on Aging (IOA). The financing was used to refinance existing Insured 2008 Bonds, which had been used to construct a mixed-use affordable senior apartment building with an onsite senior health service facility. The 2017 Bonds mature in August 2038 and priced with an All-In True Interest Cost of 3.92 percent. The refinance will save IOA over $4 million in debt service payments, with a net present value savings of 11.8 percent.


Channing House

April 18, 2017 insured $54,045,000 of California Municipal Finance Authority Insured Revenue Refunding Bonds for Channing House. The financing was used to refinance existing Insured 2010 Bonds, which had been used to construct a Health Center with 27 assisted living beds, a 26-bed skilled nursing facility, and to add an additional 14 independent living units to the residential tower. Channing House now has 191 independent living units. The 2017 Bonds mature on May 15, 2040 and was priced with an All-In True Interest Cost of 4.04 percent. The net present value savings was 9.4 percent.

Exterior photo of the Channing House Facility in Palo Alto
Exterior view of So Cal Dev Corp VOA building

Volunteers of America

March 15, 2017 insured $4,700,000 of California Municipal Finance Authority Insured Refunding Revenue Bonds for Southern California Development Corporation of VOA, Inc. The financing advance refunded the 2011 Insured Bonds and repaid an insured bank loan from California Bank and Trust. The bonds mature on December 1, 2036 and were priced with an All-In True Interest Cost of 4.09 percent. The refinance resulted in a net present value savings of 8.76 percent.


Paradise Valley Estates

On November 30, 2016 insured $22,080,000 of California Municipal Finance Authority Insured Revenue Bonds for Paradise Valley Estates. The 2016 Bonds financed the completion of 18 private memory care rooms, reimbursed project expenditures related to the construction of a parking structure, and refinanced its Insured 2005 Bonds. The refunded bonds mature in 2047 and the All-In True Interest Cost is 4.51 percent. The refinance resulted in a net present value savings of $669,945, or 7.6 percent.

Exterior view of Paradise Valley Estates
Exterior view of Pilgrim Place

Pilgrim Place

On November 30, 2016 insured $36,055,000 of California Municipal Finance Authority Insured Senior Living Refunding Revenue Bonds for Pilgrim Place in Claremont. The 2016 Bonds financed $9 million dollars in capital improvements, in addition to advance refunding its Insured 2009 Bonds. The bonds mature in 2046 and the All-In True Interest Cost is 4.46 percent. The refinance resulted in a net present value savings of $1.5 million, or 6.35 percent.

Exterior photo of the Hill Country Community Clinic_Round Mountain

Hill Country Health & Wellness Center

November 3, 2016 insured $4,055,000 of California Municipal Finance Authority Insured Refunding Revenue Bonds for Hill Country Community Clinic. The financing was used to refinance existing bonds. The 2016 Bonds mature on November 1, 2037 and was priced with an All-In True Interest Cost of 3.46 percent. The net present value savings was 8.37 percent.


Mountain Shadows Support Group

October 27, 2016 insured $10,350,000 of California Statewide Communities Development Authority Insured Health Facilities Revenue Bonds and $2,890,000 of Taxable Insured Revenue Bonds for Mountain Shadows Support Group. The financing was used to pay off existing bonds and term loans and will be used to upgrade existing facilities housing developmentally disabled clients. The 2016 Bonds mature on January 1, 2041 and was priced with an All-In True Interest Cost of 3.71 percent. The net present value savings was 12.80 percent.

Exterior view of Mountain Shadows Support Group
Exterior view of Petaluma Health Center clinic

September 13, 2016 insured $5,775,000 of California Health Facilities Financing Authority Insured Refunding Revenue Bonds for Petaluma Health Center. The 2016 Bonds refinanced an existing insured loan. The refunded bonds mature in 2040 and the All-In True Interest Cost is 3.14 percent. The refinance resulted in net present value interest savings of $1.06 million, or 19 percent.


Santa Rosa Community Health Centers

July 12, 2016 insured $11,105,000 of California Municipal Finance Authority Insured Refunding Revenue Bonds for Santa Rosa Community Health Centers. The 2016 Bonds refinanced an existing insured loan. The refunding bonds mature on February 1, 2034 and priced with an All-In True Interest Cost of 2.89 percent. The refinance resulted in net present value savings of 31.90 percent.

Exterior view of Santa Rosa Community Health Center

Other Cal-Mortgage Insured Projects

Exterior view of NCPHS San Francisco
Exterior photo of the Chinese Hospital
Exterior photo of the Montecedro_Recently Completed Senior Living Facility financed by Cal-Mortgage
Exterior photo of the Enloe Medical Center Hospital

Testimonials