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H H S Department of Health and Human Services
U.S. Department of Health and Human Services
Health Resources and Services Administration

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American Indian/Alaska Native Health

Shortage Designation

HRSA has two shortage designations: Health Professional Shortage Area (HPSA) and Medically Underserved Area/Population (MUA/MUP). Many Federal and state programs use the designations as a determinant of eligibility. The most-often referenced are:

  • Health Center Program (MUA/MUP)
  • National Health Service Corps (HPSA)
  • Rural Health Clinic Program (HPSA and MUA)
  • Medicare Incentive Payment for Physicians (HPSA)
  • J-1 Visa Waiver (HPSA and MUA/MUP)

Designation Criteria

  • Members of Indian Tribes as defined in section 4(d) of PL 94-437 are automatically designated as population HPSAs
  • Outpatient health programs or facilities operated by a Tribe or tribal organization under the Indian Self-Determination Act or by an urban Indian organization receiving funds under Title V of the Indian Health Care Improvement Act are considered Federally Qualified Health Centers and so automatically designated HPSAs.

HPSAs can be primary care medical, dental or mental health. Each has its own set of specific designation criteria. All include

  • A rational service area,
  • Population to provider ratio (for primary care physicians, 3,500:1 or 3,000:1 in areas of high need), and
  • Unavailable contiguous area resources.

The MUA/MUP designation is also based on a rational service area and an index of medical under service, which is based on health status, demographic factors and the population-to-provider ratio.

How to be Designated

There is not a standard application form to apply for HPSA or MUA designation, but there is a process. It starts with your state Primary Care Office, which has the expertise, data and access to the on-line application system, which accelerates the application and review process. Your state Primary Care Office also is the primary contact for HRSA in developing and reviewing designation requests and updates.