Health Professional Shortage Areas (HPSA) and Medically Underserved Area/Populations (MUA/P) are federal designations that apply to areas, population groups or facilities in which there are unmet health care needs. The designations are given so that limited federal resources can be prioritized and directed to the areas that need them most. Designations are determined as a result of an application process through the Health Resources and Services Administration (HRSA).
What is a HPSA?
Health Professional Shortage Area (HPSA) designations are granted in three disciplines—including primary medical care, dental care and mental health care. Within each discipline, there are three types of HPSA designations:
- Geographic designations are based on the ratio between the number of full-time equivalent (FTE) clinical providers and the patient population within a given area.
- Population designations are based on the ratio of a particular population group (e.g., homeless, migrant, etc.) to the number of FTE clinical providers serving that population group.
- Facility designations are based on unique criteria relating to the type of facility.
Geographic and Population Designations
The basic criteria for geographic and population designations include the requirement that the service area is comprised of an area that is “rational” for the delivery of health services. A rational service area can be a single county, a group of counties with population centers within 30 to 40 minutes of each other, or partial areas of a county or counties. A partial service area must consist of an established neighborhood or community areas that have similar demographic characteristics that isolate them from surrounding regions (such as homeless or low income populations and/or those who have language barriers ); areas with physical barriers that isolate them (such as a major interstate, national forest or airport); or areas that are linked by distinct travel patterns (such as extremely rural areas or mountainous terrains).
The areas that are contiguous to the proposed service area must not contain primary care resources that are accessible to the population of the proposed service area. Any primary care resources in the contiguous areas must be over-utilized, excessively distant or otherwise inaccessible to the population of the proposed service area.
Three types of facilities can be designated, including 1) federal and state correctional institutions and youth detention facilities; 2) public or nonprofit private facilities, and 3) state and county mental hospitals. As community health centers are considered public or nonprofit private facilities, the following focuses on the criteria for facilities under that category type.
Facility HPSAs are subdivided into the three disciplines mentioned above – primary, dental and mental health. In each case, to receive a facility designation, the facility must be serving patients from a previously designated area or population group, and must show that the level of need exceeds the capacity of the facility.
The Health Care Safety Net Amendments of 2002 provides for automatic facility HPSA status for all Federally Qualified Health Centers (FQHCs) and those Rural Health Clinics (RHCs) that meet the requirement of providing access to care regardless of ability to pay. All then-currently-qualified FQHCs were given HPSA status as of the date of the legislation; new FQHCs receive HPSA status on the date in which they become FQHCs, based either on Section 330 funding or on certification as an FQHC Look-Alike. Each is HPSA-designated as an entity, encompassing all service locations included in the approved scope of work.