Health Professional Shortage Areas (HPSAs) are designations that indicate health care provider shortages in:

• Primary care;
• Dental health; or
• Mental health

These shortages may be geographic-, population-, or facility-based:

• Geographic Area
  • A shortage of providers for the entire population within a defined geographic area.
• Population Groups
  • A shortage of providers for a specific population group(s) within a defined geographic area (e.g., low income, migrant farmworkers, and other groups)
• Facilities
  • 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)—a facility that is automatically designated as a HPSA by statute or through regulation without having to apply for a designation:
    • Federally Qualified Health Centers (FQHCs)—health centers that provide primary care to an underserved area or population, offer a sliding fee scale, provide comprehensive 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. Find additional information and requirements (PDF - 259 KB) from the Centers for Medicare and Medicaid Services (CMS).
    • FQHC Look-A-Likes (LALs)—LALS are 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), 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 that are certified as RHCs by CMS and meet NHSC Site requirementsincluding accepting Medicaid, CHIP, and providing services on a sliding fee scale.

Aside from Auto HPSAs and HPSAs for federal correctional facilities, state Primary Care Offices (PCOs) must submit applications to designate all HPSAs.

HRSA reviews these applications to determine if they meet the eligibility criteria for designation. The main eligibility criterion is that the proposed designation meets a threshold ratio for population to providers.

Once designated, HRSA scores HPSAs on a scale of 0-25 for primary care and mental health, and 0-26 for dental health, with higher scores indicating greater need.

Find out more about the HPSA designation process.

Medically Underserved Areas (MUAs) and Medically Underserved Populations (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 are specific sub-groups of people living in a defined geographic area with a shortage of primary care health services. These groups may face economic, cultural, or linguistic barriers to health care. Examples include, but are not limited to, those who are:

• homeless;
• low-income;
• Medicaid-eligible;
• Native American; or
• migrant farmworkers.

MUA/P designations are based on the Index of Medical Underservice (IMU). IMU is calculated based on four criteria:

• the population to provider ratio;
• the percent of the population below the federal poverty level;
• the percent of the population over age 65; and
• the infant mortality rate.

IMU can range from 0 to 100, where zero represents the completely underserved. Areas or populations with IMUs of 62.0 or less qualify for designation as an MUA/P.