Understanding HPSAs and MUAs

Health Professional Shortage Areas (HPSAs) and Medically Underserved Areas (MUAs) are designations based upon Federal standards. By existing in one of these designated areas, clinics are qualified to receive advantages. If your clinic is located in a rural setting in particular, it is paramount that you understand HPSA and MUA designations.

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Health Professional Shortage Areas (HPSAs)
Medically Underserved Areas (MUAs)


A HPSA is a federally designated geographic area that meets the criteria for a primary care health professional shortage area. HPSAs are defined to include urban and rural geographic areas, population groups, and facilities with shortages of health professionals.

The criteria used to assess geographic primary medical care HPSAs are:

  • The area is a rational area for the delivery of primary medical care services.
  • One of the following two conditions prevails within the area:
    • The area has a ratio of population to full-time equivalent primary care physician of at least 3,500:1.
    • The area has a ratio of population to full-time equivalent primary care physician of less than 3,500:1 but greater than 3,000:1 and has unusually high needs for primary care services or insufficient capacity of existing primary care providers.
  • Primary medical care professionals in contiguous areas are over-utilized, excessively distant, or inaccessible to the population of the area under consideration.

Once an area is determined to meet these criteria, it is assigned a priority level depending on the population/physician ratio and whether there are unusually high levels of infant mortality, fertility rates, and percentage of the population that falls below the federal poverty level. A rating of 1 denotes the greatest need, with ratings of 2 to 4 indicating lesser, but still high, needs.  This is different than the HPSA score, which can range from 1 to 25 for primary care and mental health, 1 to 26 for dental. The higher the score, the greater the priority.  All HPSAs are reviewed and re-designated every three years.

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MUAs and MUPs, like HPSAs, are federally designated. The MUA is a designation for a geographic area while the MUP is for a specific population within a geographic area, such as the medically indigent or migrant and seasonal farmworkers. The criteria for MUA or MUP designation are very specific and are adhered to without exception.

MUAs designations are based on the Index of Medical Underservice Score, an index developed by the Federal government for this purpose. This score measures the following factors based on a weighted formula:

  • Infant mortality rate
  • Proportion of the population above 65 years of age
  • Proportion of the population with income below the federal poverty level
  • Ratio of population to primary care provider

MUP criteria have not yet been published. However, MUP designations are based on the use of the Index of Medical Underservice Score and an evaluation of unusual local conditions and access barriers. An MUP must develop an MUA application using the MUA criteria. It will show that while the area is not underserved, a portion of the population is. The governor and local officials can then request designation of the population as medically underserved and provide material explaining special local circumstances that are barriers to healthcare for the identified population. This application should first go to the State Department of Public Health and Environment for review; from there it will be forwarded to the Division of Shortage Designation.

The Federal government uses the MUA and MUP designations as partial criteria for the following programs:

  • Community and Migrant Health Center (C/MHC) funding is available for communities designated as MUA or MUP. The community must meet additional criteria as well to apply for funding.
  • Rural Health Clinic (RHC) certification requires among other criteria that the clinic be located in either a HPSA or MUA.
  • Federally Qualified Health Center (FQHC) is a federal designation that allows centers to receive 100% of reasonable costs reimbursed by Medicaid. An FQHC must be located in an MUA or MUP and meet additional criteria to apply for designation. Federally funded Community and Migrant Health Centers, Health Care for the Homeless Clinics and certain Indian Tribal-operated facilities and programs are automatically FQHC. Other entities must apply for designation.

Form more information on MUAs and MUPs, please visit the HRSA Shortage Designation: HPSAs, MUAs & MUPs webpage.