The Center for Health Workforce Studies (CHWS), under contract with the New York State Department of Health (NYSDOH), develops federally designated shortage area applications and provides technical assistance to organizations and other stakeholders on the designation process, current designation rules, service obligated programs, and on other questions related to shortage designations. Part of this work includes updating provider data as necessary to ensure that the most accurate provider data is available for shortage designation analysis. In addition to shortage area designations, provider information is used by CHWS for understanding general access issues, state and local health care planning, placement of providers, and allocation of limited health care resources. It can also be used for research and health care reporting by state and local government.
Federally designated shortage areas include Health Professional Shortage Areas (HPSAs), Medically Underserved Areas (MUAs), and Medically Underserved Population (MUPs). These designations identify areas or facilities that have shortages of primary care, dental, and mental health providers, and are established under the US Public Health Service Act (Sections 330 and 332). CHWS staff works with both NYSDOH, Office of Primary Care and the U.S. Department of Health and Human Services, Health Resources and Services Administration, Shortage Designation Bureau on these designations.
Health Professional Shortage Areas
HPSAs are both area, population, and facility designations and need periodic updating. To receive approval for a HPSA designation, there must be a proposed rational service area (RSA), the application must meet minimum population-to-provider ratio thresholds, and services in contiguous areas must be inaccessible to the population of the RSA.
HPSA Disciplines and Provider Definitions
- Physicians (MDs or DOs) practicing in family or general practice, general internal medicine, OB/GYN, pediatrics, or general geriatrics.
- Dentists (DDSs or DMDs) practicing in general and/or pediatric dentistry.
- Psychiatrists (MDs or DOs) practice in general psychiatry, including adult and child psychiatry.
- Geographic – Count the total population in an area and the total number of providers serving that area.
- Population – Count the specific type of population in an areas such as low-income, Medicaid-eligible, migrant farm workers, homeless, and Native Americans and the hours of the providers serving the designated population.
- Facility – Federal/state correctional institutions, state mental health hospitals, and public or non-profit medical facilities, including Federally Qualified Health Centers (FQHCs), FQHC look-a-likes, Rural Health Clinics, Indian Health Facilities, and other not-for-profit health care facilities.
For geographic or special population HPSAs, the RSAs can be:
- Partial county
- One or more census tracts in an urban area
- One or more townships in a rural area
- Full county
- Multiple counties
RSAs are defined as:
- Single whole counties if population < 250K; or aggregate of townships (rural); or aggregate of census tracts (urban).
- Service area must consider geography within 30 minutes of population center by drive time or public transportation under certain conditions.
- Service area may be further limited by:
- Physical barriers
- Established neighborhoods
- Existing designations or over-utilization
Analysis of Data
Data analysis for shortage area designations is a complicated process with many requirements depending on the discipline and type of designation. CHWS staff works with community providers and a variety of data sets to identify providers and their practice characteristics in a given area. For analysis of the population in HPSA or MUA/P designations, the 5-year estimates of the American Community Survey are used.
Ratios and Qualifications
The needed population-to-provider for designations vary depending on the discipline (primary care, dental health, or mental health) and the type of designation (geographic, special population, or facility). Please work with CHWS staff to understand the type of designation needed and the qualifying ratio.
HPSAs are scored on a scale of 1 to 25 for primary care and for mental health HPSAs and 1 to 26 for dental health HPSAs. Scores are based on a number factors including population-to-provider ratio, percent of the population at or below 100% of the federal poverty level, travel time to the nearest source of undesignated care, and a number of discipline specific factors, including:
- Infant health index (infant mortality rate or low birth rate) for primary care HPSAs;
- Percent of the population with fluoridated water for dental health HPSAs; and
- Alcohol abuse, substance abuse, elderly ratio, and youth ratio for mental health HPSAs.
The higher the HPSA score, the higher the need. Service obligated programs such as the National Health Service Corps Loan Repayment and the Nursing Corps use the scores to place service obligated providers. Certain state funded service obligated programs also use HPSA scoring as part of the program review or for provider placement.
Medically Underserved Areas or Populations
These designations are for primary care only. They include geographic and special population designations but do not include facility designations. Unlike HPSAs, they do not expire and do not need an analysis of contiguous areas. MUAs and MUPs also need to be developed based on a rational service area and need a weighted score of less than 62 to qualify for designation.
Designation scores are based on an index value that includes:
- Infant mortality rate
- Poverty rate
- Percentage of elderly
- Population to primary care physician ratio
Once the shortage area designation requirements are met, CHWS sends the request to the Health Resources and Services Administration, Shortage Designation Bureau (SDB). SDB notifies stakeholder of the request and that there is a 30-day waiting period that allows them to submit comments or other data. After that, HRSA will begin processing the request. The average turnaround time for approvals is between 4 and 5 months.
Designations are important because they make you eligible to apply for over 30 state and federal programs.
Some of these programs include:
- National Health Service Corp loan repayment and scholarship program
- Federally Qualified Health Centers
- Rural Health Clinics
- J-1 Visa waiver programs
- Medicare Incentive Payment
- New York State Doctors Across New York
- New York State Primary Care Service Corps
Please note that benefits differ by type of shortage area designation.
How to Request a Designation
To Get Started
Please send a written request by e-mail to the Center for Health Workforce Studies. CHWS does not charge for this work, and CHWS will work with your staff to understand the data needed to completed designation request.
Your request needs to identify:
- The type of HPSA you are requesting (primary care, dental or mental health).
- The geographic service area for your request.
- Why your community needs a HPSA – which HPSA-linked benefits your community needs (federal loan repayment, Rural Health Clinic certification, Medicare provider bonus payments, a new access point for an FQHC).
- Plan ahead – It can take 6-12 months to review your request, collect the required provider data, submit a state application to HRSA, and for HRSA to approve a new designation.
- No guarantees – CHWS works very hard to see if communities can meet federal criteria for a shortage designation but cannot guarantee that an area will meet the criteria required by federal law.
- To determine if your area is already a HPSA, please check the HRSA website at https://data.hrsa.gov/tools/shortage-area/hpsa-find.
- To determine if your area is already a MUA or MUP, please check the HRSA website at https://data.hrsa.gov/tools/shortage-area/mua-find.