The Section 232 Handbook, Section II, Production, Chapter 2, sets forth the programmatic requirements for insuring Board and Care Homes pursuant to Section 232. Those requirements largely originate in the 232 statute itself. Key among those are the statutory requirements that the state where the facility is located is in compliance with Section 1616e of the Social Security Act (known as the “Keys Amendment”), AND that the facility itself is regulated by the state pursuant to Section 1616e. Note on this last point that the requirement is not only that the facility be regulated, but that it be regulated specifically pursuant to 1616e.

States report compliance with 1616e annually to the Social Security Administration (SSA), and, per the statute, the lender must verify that such certification of compliance has been provided. The certification itself, however, does not necessarily address the other matter, namely, whether the particular facility type at issue is in fact within the state’s 1616e regulatory scope. If the state’s certification does not make that clear, the lender must do sufficient investigation to present evidence establishing that this statutory requirement is fulfilled. The lender must resolve this issue clearly before submitting the application, or the application will be at risk of rejection for statutory non-compliance.

HUD has received notification from SSA that the states below with X's are in compliance for the respective calendar year. Beginning in 2018, HUD has also received permission from SSA to provide copies of these letters for your convenience. Each X is a hyperlink to that state’s Keys Amendment compliance certification.

As of November 20, 2025: