Wisconsin Primary Care Programs: What Are Shortage Designations?

There are three basic categories of shortage designations:

1. Health Professional Shortage Area (HPSA) designation

• Indicates a significant shortage of health providers in the service area and in surrounding areas, and it is measured by a population to provider ratio.
• Three different types of HPSAs - each type indicates a shortage of either primary care, dental, or mental health providers.
• HPSA service areas can be based on geographic areas, a population or a facility (community health centers, rural health clinics, tribal health centers, correctional facilities).
• Each HPSA must be reviewed for re-designation every three years.
• Federal criteria, guidelines and process for HPSA designation

2. Medically Underserved Area/population (MUA/P) designation

• Indicates significant underservice for an area and is measured by an Index of Medical Underservice (IMU). The score is calculated by combining weighted values for four indicators of access to care barriers: population below the federal poverty level, population age 65 or older, infant mortality rate, and population to primary care provider ratio. NOTE: It is frequently more difficult for an area to qualify for a MUA/MUP than for a HPSA.
• Three different types - MUA is calculated for an entire service area, MUP is calculated for a specific population in an area, an Exceptional/Governor's MUP for populations with documented unusual local needs.
• MUA/Ps currently do not need to be re-designated.
• Federal criteria, guidelines and process for MUA/MUP designation

3. Governor's Shortage Designation for Rural Health Clinics (RHCs)

• Indicates a significant shortage of providers and high needs for the population in a "rural area" which does not meet federal criteria for a HPSA designation.
• A Governor's Shortage Designation for RHCs can help a rural clinic meet the federal certification requirement that a RHC must be located in a federally designated shortage area (e.g., HPSA, MUA, Governor's Designation).
• The federal Office of Shortage Designation has approved the State's process and criteria for designating a shortage area for Rural Health Clinic purposes, and must also approve State applications for individual RHC service areas to be designated as a Governor's Shortage Area for RHCs.
• Existing certified Rural Health Clinics and new rural clinics which do not have a current HPSA designation can request that the Wisconsin Primary Care Office review their area to see if they qualify for a Governor's Designation for RHCs
• Each Governor's Designations for a RHC must be reviewed for re-designation every four years.
• Governor Designated and DHHS Secretary Certified Shortage Areas for RHCs

Federal and State Partnership:

• Bureau of Health Workforce in HRSA is responsible for reviewing and making final decisions on shortage designation applications per federal regulations, and maintaining a web-searchable database of designations.
• State health departments are responsible for: coordinating with clinics that request shortage designations, collecting and analyzing provider FTE and other designation data, and submitting state applications for federal designation of shortage areas. The Wisconsin Primary Care Office is responsible for shortage designation applications in Wisconsin.

Shortage Designations in Wisconsin:

• HPSAs in Wisconsin (June 2012) = 106 primary care, 74 dental, and 109 mental health
• HPSA searchable database—Select state, then select county and specialty, and select "show me the HPSAs"
• MUA/Ps in Wisconsin (2012) = 76
• MUA/P searchable database—Select state, then select county and "show me the MUA/Ps"