What is an MUA/MUP?

What is MUA, MUP and HPSA Designation?
Medically Underserved Area (MUA), Medically Underserved Population (MUP) and Health Professional Shortage Area (HPSA) are federal designations that allow the government to prioritize communities for certain programs. Specifically, to qualify for Section 330 – Federally Qualified Health Center funds, your center must be located in or plan to serve a MUA or MUP locale. HPSA designations qualify organizations and institutions with access to the National Health Service Corps, J-1Visa and Federal Loan Repayment programs that can help with recruitment and retention of key  health professionals to their communities. 

A MUA is based on geographic locations, while a MUP pertains to certain population groups within a geographic location.  Geographic areas can be multi-county, full county or partial county locations.  Populations eligible for this designation are:

  • Low-Income and/or Medicaid Eligible populations
  • Migrant workers
  • Linguistically Isolated Groups
  • Homeless
  • Residents of Public Housing

HPSA designations can be for Primary Care, Dental or Mental Health professionals. These designations can be for urban or rural areas, population groups or medical or other public facilities such a prisons.

What is a Primary Care Organization (PCO)?
PCOs are state-based offices that provide assistance to communities seeking Health Professional Shortage Area (HPSA) designations and funding for health centers such as Community and Migrant Health Centers and Health Care for the Homeless health centers. PCOs work collaboratively with Primary Care Associations, relevant HRSA programs and offices and other organizations to increase access to primary and preventive health care and improve the status of underserved and vulnerable populations.
The contact information for each state’s PCO:

Delaware Primary Care Office
Division of Public Health
Delaware Department of Health & Social Services
417 Federal Street
Dover, DE 19901
Phone:  (302) 744-4555
Fax: (302) 739-3313
PCO Director, HPSA & NHSC Contact: Kathy Collison – (302) 744-4555
J1- Visa Contact: Joan Barnwell –  (302) 744-4555

Maryland Primary Care Office
Primary Care Organization
Office of Health Policy & Planning
Department of Health & Mental Hygiene
201 West Preston Street, Room 423
Fax: (410) 333-7501
PCO Director and HPSA Contact: Elizabeth Vaidya – (410) 767-5695
NHSC and J1 Contact: Judy Gerahty – (410)-767-5046
Email: [email protected]

What is the process to have location or population receive a MUA or MUP designation?
MUA and MUP designations are primarily made on the basis of a weighted score of certain health and socio-demogrpahic variables.  This score is called the Index of Medical Underservice (IMU) scale, and it is from 0 to 100, where 0 represents completely underserved and 100 represents best served or least underserved. Under the established criteria, each service area found to have an IMU of 62.0 or less qualifies for designation as an MUA.

The IMU involves four variables:

  • Ratio of primary medical care physicians per 1,000 population
  • Infant mortality rate
  • Percentage of the population with incomes below the poverty level
  • Percentage of the population age 65 or over.

The same variables are used in both MUA and MUP designations; the difference is MUA uses the population within a geographic area as its population for a MUA while the MUP looks at a specific group of people (i.e. low-income) within a geographic area. 

Governor’s MUP

When, under the standard guidelines, a population is unable to meet the 62.0 threshold, it can still be considered for designation if "unusual local conditions which are a barrier to access to or the availability of personal health services" exist and are documented, and if such a designation is recommended by the chief executive officer and local officials of the State where the requested population resides.

Please click here to learn more about the MUA/MUP designation and scoring process. 

HPSA Guidelines for Designations
Generally speaking, a rational service area must meet the following thresholds for population to full time equivalent (FTE) provider ratios to qualify for a HPSA.

Primary Care: 3,500:1 or have a population to full-time equivalent primary care physician ratio of less than 3,500:1 but greater than 3,000:1 and have unusually high needs for primary care services or insufficient capacity of existing primary care providers or demonstrate that primary medical professionals in contiguous areas are over utilized, excessively distant, or inaccessible to the population under consideration.

Dental5,000:1 or have a population to full-time equivalent dentist ratio of less than 5,000:1 but greater than 4,000:1 and unusually high needs for dental services or show that dental professionals in contiguous areas are over utilized, excessively distant or inaccessible to the population

Mental Health: A population-to-core-mental-health-professional ratio greater than or equal to 6,000:1 and a population-to-psychiatrist ratio greater than or equal to 20,000:1 or a population-to-core professional ratio greater than or equal to 9,000:1 or population-to-psychiatrist ratio greater than or equal to 30,000:1.

Please click here to visit the HRSA website for the full HPSA designation guidelines.