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What is Shortage Designation?

Shortage designation identifies an area, population, or facility experiencing a shortage of health care services.

There are several types of shortage designations:

What is a Health Professional Shortage Area (HPSA)?

HPSAs (PDF - 398 KB) can be geographic areas, populations, or facilities. These areas have a shortage of primary, dental or mental health care providers.

What is a geographic HPSA?

A shortage of providers for an entire group of people within a defined geographic area

What is a population HPSA?

A shortage of providers for a specific group of people within a defined geographic area (e.g., low-income, migrant farm workers)

What is a facility HPSA?

Other Facility (OFAC)

Public or non-profit private medical facilities. They serve a population or geographic area with a shortage of providers.

Correctional Facility

Medium- to maximum-security federal and state correctional institutions

Youth detention facilities with a shortage of providers

State/County Mental Hospitals

State or county hospitals with a shortage of mental health providers (mental health designations only)

Automatic Facility HPSAs (Auto-HPSAs)

Facilities that we automatically designate as HPSAs based on statue or through regulation. These include:

  • Federally Qualified Health Centers (FQHCs)

    • Provide primary care to an area or group of people in need.
    • Offer a sliding fee scale.
    • Provide complete services.
    • Have an ongoing quality assurance program; and
    • Have a governing board of directors.

    All organizations receiving grants under Health Center Program Section 330 of the Public Health Service Act are FQHCs.

    Read the Centers for Medicare and Medicaid Services (CMS)’s [Medicare Benefit Policy Manual: Rural Health Clinic (RHC) and Federally Qualified Health Center (FQHC) Services (PDF - 410 KB).

  • FQHC Look-A-Likes (LALs)

    • Community-based health care providers
    • Meet the requirements of the HRSA Health Center Program
    • Don’t receive Health Center Program funding
  • Indian Health Facilities

  • IHS and Tribal Hospitals

    • Federal Indian Health Service (IHS) and tribally run hospitals
    • Provide 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
    • Provide medical services to members of federally recognized tribes and Alaska Natives
  • CMS-Certified Rural Health Clinics (RHCs)*

    • Outpatient clinics located in non-urbanized areas that are Centers for Medicare and Medicaid Services (CMS) certified and meet NHSC Site requirements (e.g., accept Medicaid and CHIP and provide services on a sliding fee scale).

Which federal programs use HPSAs?

The National Health Service Corps (NHSC) created shortage designation. It helps us distribute participants to where they’re needed most.

Other federal programs use shortage designations for resource distribution.

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

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      

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

What is a Medically Underserved Area/Population (MUA/P)?

MUAs and MUPs identify geographic areas and populations with a lack of access to primary care services. These designations help establish health maintenance organizations or community health centers.

MUAs have a shortage of primary care health services within geographic areas 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 a geographic area. These groups may face economic, cultural, or language barriers to health care.

Some examples include:

  • People experiencing homelessness
  • People who are low-income
  • People who are eligible for Medicaid
  • Native Americans
  • Migrant farm workers

Which federal programs use MUA/Ps?

Many federal programs use MUA/Ps for distributing resources. We created MUA/Ps to help establish health maintenance organizations and community health centers.

These are some examples of programs that use MUA/Ps:

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
MUA     x     x x
MUP     x       x

What is an Exceptional Medically Underserved Population (Exceptional MUP)?

An Exceptional MUP identifies a specific population within a defined geographic area that doesn’t qualify as a MUP. Unusual circumstances prevent the population from having access to primary care services.

What is a Governor-Designated Secretary-Certified Shortage Areas for Rural Health Clinics?

Governor-Designated Secretary-Certified Shortage Areas for Rural Health Clinics (RHCs) are areas that a state governor or designee identifies as having a provider shortage. A state-established shortage plan is used to establish an RHC.

How to contact us

Shortage Designation Questions

Email SDB@hrsa.gov

SDMP Questions

Email SDMP@hrsa.gov

Questions about Providers in your Auto-HPSA Update Preview

Contact your State PCO

NHSC or Nurse Corps Questions

Submit a help form or call 1-800-221-9393

CMS Bonus Payment Questions

Contact your Medicare Administrative Contractor (MAC)

SDMP Webinars

Auto-HPSA Portal Training Webinars

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