Types of Designations

The authorizing statute for the National Health Service Corps (NHSC) created Health Professional Shortage Areas (HPSAs) to fulfill the statutory requirement that NHSC personnel be directed to areas of greatest need. 

HPSAs are used to identify areas, populations groups, or facilities within the United States that are experiencing a shortage of health care professionals. There are three categories of HPSAs based on health discipline: primary care, dental health, and mental health.

As part of Health Resources and Services Administration’s (HRSA) cooperative agreement with the State Primary Care Offices (PCOs), the PCOs conduct needs assessment in their states, determine what areas are eligible for designations, and submit designation applications to HRSA.  HRSA reviews the HPSA applications submitted by the State PCOs, and—if they meet the designation eligibility criteria—designates a HPSA. There are three main types of HPSAs – geographic, population and facility.

Geographic HPSAs

Geographic HPSAs have a shortage of services for the entire population within an established geographic area.

Population HPSAs

Population HPSAs have a shortage of services for a specific population subset within an established geographic area.

Frequently Designated Population HPSAs include:

  • Medicaid eligible
  • Low income
  • Migrant farmworker
  • Native American/Alaskan Native
  • People experiencing homelessness

Facility HPSAs

Facility HPSAs include these categories:

  • Other Facility (OFAC)
    Public or non-profit private medical facilities serving a population or geographic area designated as a HPSA with a shortage of health providers.
  • Correctional Facility
    Medium to maximum-security federal and state correctional institutions and youth detention facilities with a shortage of health providers.
  • State Mental Hospitals
    State or county hospitals with a shortage of psychiatric professionals (mental health designations only).
  • Automatic Facility HPSAs (Auto-HPSAs)
    Facilities that HRSA automatically designates these as HPSAs by based on statute or through regulation. These include:
    • Federally Qualified Health Centers (FQHCs)
      These are Health centers that:
    • FQHC Look-A-Likes (LALs)
      Community-based health care providers that meet the requirements of the HRSA Health Center Program, but do not receive Health Center Program funding.
    • Indian Health Facilities
      Federal Indian Health Service (IHS), tribally run, and Urban Indian health clinics that provide medical services to members of federally recognized tribes and Alaska Natives.
    • IHS and Tribal Hospitals
      Federal Indian Health Service (IHS) and tribally run hospitals that provide inpatient and outpatient medical services to members of federally recognized tribes and Alaska Natives.
    • Dual-funded Community Health Centers/Tribal Clinics
      Health centers that receive funding from tribal entities and HRSA to provide medical services to members of federally recognized tribes and Alaska Natives.
    • CMS-Certified Rural Health Clinics (RHCs) that meet National Health Service Corps (NHSC) site requirements
      Outpatient clinics located in non-urbanized areas which CMS certifies as RHCs and meet NHSC Site requirements including accepting Medicaid, CHIP, and providing services on a sliding fee scale.

Medically Underserved Areas (MUAs) and Medically Underserved Populations (MUPs)

MUAs and MUPs identify geographic areas and populations with a lack of access to primary care services.

  • MUAs have a shortage of primary care health services for residents within a geographic area such as:
    • a whole county;
    • a group of neighboring counties;
    • a group of urban census tracts; or
    • a group of county or civil divisions.
  • MUPs have a shortage of primary care health services for a specific population subset within an established geographic area. These groups may face economic, cultural, or linguistic barriers to health care.

    Some examples include:

    • People experiencing homelessness
    • Low-income
    • Medicaid-eligible
    • Native American
    • Migrant farmworkers

Governor’s Designated Secretary Certified Shortage Areas for Rural Health Clinics

A State Governor or designee designates these areas as having a shortage according to the state-established shortage plan for the establishment of a Rural Health Clinic.

Which federal programs use shortage designations?

Many federal programs use different types of shortage designations to determine eligibility. Below is a snapshot:

Primary Care

Shortage Designation Option

National Health Service Corps (NHSC)

Nurse Corps

Health Center Program

IHS Loan Repayment Program

CMS HPSA Bonus Payment Program

CMS Rural Health Clinic Program

J-1 Visa Waiver

Geographic HPSA

X

X

 

X

X

X

X

Population HPSA

X

X

 

X

 

X

X

Facility HPSA

X

X

 

X

 

 

X

Dental Care

Shortage Designation Option

National Health Service Corps (NHSC)

Nurse Corps

Health Center Program

IHS Loan Repayment Program

CMS HPSA Bonus Payment Program

CMS Rural Health Clinic Program

J-1 Visa Waiver

Geographic HPSA

X

 

 

X

 

 

 

Population HPSA

X

 

 

X

 

 

 

Facility HPSA

X

 

 

X

 

 

 

Mental Health

Shortage Designation Option

National Health Service Corps (NHSC)

Nurse Corps

Health Center Program

IHS Loan Repayment Program

CMS HPSA Bonus Payment Program

CMS Rural Health Clinic Program

J-1 Visa Waiver

Geographic HPSA

X

X

 

X

X

 

X

Population HPSA

X

X

 

X

 

 

X

Facility HPSA

X

X

 

X

 

 

X

Medically Underserved Areas/Populations

Shortage Designation Option

National Health Service Corps (NHSC)

Nurse Corps

Health Center Program

IHS Loan Repayment Program

CMS HPSA Bonus Payment Program

CMS Rural Health Clinic Program

J-1 Visa Waiver

Exceptional MUP

 

 

X

 

 

 

X

MUA

 

 

X

 

 

X

X

MUP

 

 

X

 

 

 

X

State Governor's Certified Shortage Areas for RHCs

 

 

 

 

 

 

 

Date Last Reviewed:  May 2020


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