Working with HUD, Joshua Rosen of Capital One originated a $5.9 million refinance for a 95-bed skilled nursing facility in Princeton, Indiana. Originally built in 1968, with an addition in 1974, the facility features 45 semi-private units and five private rooms, and was operated by a local hospital. It was certified by Medicare and Medicaid, which led Rosen to work with HUD on Medicaid’s Upper Payment Limit program. Available in only a few states, the program is a federal limit on fee-for-service reimbursement of Medicaid providers. This incentivizes the owner to have a local hospital serve as operator, thereby increasing Medicaid payments, which can be taken into consideration during the underwriting process for the loan. The borrowers, skilled nursing specialists with a portfolio of properties in Illinois, Indiana, Michigan, Ohio, Oklahoma and Texas, received a fixed-rate 35-year term.