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

Governors may designate areas of their state as shortage areas 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 Health Professional Shortage Area (HPSA) or Medically Underserved Areas/Populations (MUA/P) designation.

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

States wishing to acquire a Governor’s Designated Shortage Area for an RHC must submit:

  • A signed letter from the governor requesting the designation; and,
  • A state-specific Shortage Area Plan detailing, at minimum state’s rational service area criteria and component guidelines for HRSA’s approval.
    Examples of Shortage Area Plan criteria previously approved by HRSA include:
    • 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 four years
      *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 these high-need health indicators:
      • Service area's percent of population under 200% 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:  May 2020