Governor-Designated and Secretary-Certified Shortage Areas for Rural Health Clinics

Governors may designate areas of their state as shortage areas specifically for the purpose of Rural Health Clinic (RHC) certification. These areas must meet specific criteria.

State-created and HRSA-certified plans outline how to identify areas that need RHC services, but do not otherwise qualify for HPSA or MUA/P designation.

What are the criteria for Governor’s Designated Shortage Areas?

The process for governor's designation for Rural Health Clinic certification requires the governor, or designee, submit a Shortage Area plan that contains the criteria a state will use. As these are governor's designated shortage areas, the criteria is determined by the governor and approved by HRSA, however, the governor's criteria typically include the following requirements:

  • The service area must be located in a non-urbanized area and be a contiguous area;
  • The applicant clinic must not be eligible for, or located in, a HPSA or MUA designated within the last 4 years (with the caveat that the RHC's service area may include a portion of an existing HPSA service area);
  • The applicant clinic must accept patients covered by Medicare, Medicaid and the state's Children's Health Insurance Program and have a sliding fee scale for patients below 200% of poverty;
  • The service area must have a population-to-primary care physician ratio of at least 2,400:1, or a ratio between 2,000:1 and 2,399:1 and meet one or more of the following high-need health indicators:
    • Service area's percent of population under 200 percent of poverty is higher than state average;
    • Percent of population age 65 and older is higher than the state average;
    • Percent of population that is unemployed is higher than the state average; or
    • Percent of population that is uninsured is higher than the state average.
    • Percent of population with unusually high health indicator rates, such as heart disease, diabetes, chronic respiratory disease, and/or cancers.

What are the current states’ Governor-Certified Rural Health Clinics?

Date Last Reviewed:  November 2019

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