Summary
Health Professional Shortage Areas (HPSAs)
Throughout the U.S., there are geographic areas, populations, and facilities with too few primary care, dental, and mental health providers. As part of efforts to alleviate these shortages, the federal government designates health professional shortage areas (HPSAs) and ties certain program eligibility or awarding preference to these designations.
How HPSA designations help to alleviate shortages
HPSAs receive priority for grants (e.g., certain rural health and oral health programs).
Certain health providers can receive scholarships or loan repayment through the National Health Service Corps (NHSC) or through the NURSE Corps in exchange for providing two or more years of care in a HPSA. Priority for being assigned these providers is given to facilities/areas with higher HPSA scores.
Outpatient facilities in HPSAs certified as rural health clinics or federally qualified health centers receive higher Medicare and Medicaid payment rates.
Providers in areas designated as HPSAs can receive Medicare bonus payments.
How HPSAs are designated The majority of areas, populations, and facilities must apply for a HPSA designation. The Health Resources and Services Administration (HRSA), within the Department of Health and Human Services (HHS), and State Primary Care Offices (PCOs) work together using public, private, and state-provided data to determine when such a shortage qualifies for designation as a HPSA. Certain facilities are automatically designated as HPSAs (e.g., health centers and facilities that serve American Indians and Alaska Natives), and governors may designate shortage areas.
Application process
(Facilities or governor-designated areas that are automatically designated as HPSAs skip to the scoring process.)
State PCO identifies potential HPSA
State PCO gathers relevant data and submits application
Interested partiesare given 30 days to comment on the proposed designation
HRSA makes a determination whether the area/facility or population is a HPSA
Designated areas/populations move on to the Scoring Process
How HPSAs are scored Each type of HPSA—primary care, dental health, and mental health—is scored differently. HPSAs scores range from 0 to 25 for primary care and mental health, and 0 to 26 for dental health. A higher HPSA score indicates a greater shortage and may be given priority in programs that use HPSA scores for award-making criteria (e.g., NHSC). Below is an example of Primary Care HPSA Scoring:
Populationto provider ratio
Share of population below federal poverty level
Infant health (rates of infant mortality and low birth weight births)
Travel timeto nearest source of care
Primary Care HPSA Score
How many
HPSAs
are there?
Next Steps: Shortage Designation Modernization Project
The criteria used to designate HPSAs have not been updated since 1978. However, between 2013 and 2019, HRSA has undertaken the Shortage Designation Modernization Project, which aims to standardize the data used to designate and score HPSAs. Some designated HPSAs saw their scores increase or decrease as a result of this process.
Information prepared by Elayne Heisler, Specialist in Health Services, and Mari Y. Lee and Amber Wilhelm, Visual Information Specialists. For more information, see HRSA, "Shortage Designation," https://bhw.hrsa.gov/shortage-designation.