HPSA: Health Professional Shortage Area Defined
A Health Professional Shortage Area (HPSA) is a HRSA designation for a shortage of primary care, dental or mental health providers (HRSA). The shortage can apply to a geographic area, a population group or a facility. Each discipline is designated separately.
Types of HPSA
| Type | What is short | Notes |
|---|---|---|
| Geographic | Providers for everyone in a defined area | Service areas include counties, groups of contiguous counties, parts of counties and metropolitan neighborhoods (42 CFR Part 5, App. A) |
| Population | Providers for a specific group within a defined area | Applies only to that group, not to every resident |
| Facility | Providers for a facility's patients | Correctional facilities, state or county mental hospitals, other public or nonprofit facilities, and auto-HPSAs |
Auto-HPSAs are facilities designated by statute or regulation. They include FQHCs, FQHC Look-Alikes, Indian Health facilities, IHS and tribal hospitals, and dual-funded health centers or tribal clinics. CMS-certified Rural Health Clinics in non-urbanized areas qualify if they meet NHSC site requirements (HRSA).
How HPSAs are designated and scored
State Primary Care Offices submit applications through HRSA's Shortage Designation Management System (SDMS) (HRSA). The criteria are in the appendices to 42 CFR Part 5.
For primary care, a geographic area qualifies at a population-to-FTE primary care physician ratio of at least 3,500:1 (eCFR). An area between 3,000:1 and 3,500:1 qualifies if it has unusually high needs or insufficient capacity. Providers in contiguous areas must also be overutilized, excessively distant or inaccessible.
Dental and mental health thresholds are listed in the provider-to-population ratio entry.
After designation, HRSA calculates a score (HRSA):
| Discipline | Score range | Components (maximum points) |
|---|---|---|
| Primary care | 0–25 | Population-to-provider ratio (10); population below 100% FPL (5); infant health index (5); travel time to nearest care outside the HPSA (5) |
| Dental | 0–26 | Ratio (10); population below 100% FPL (10); water fluoridation (1); travel time (5) |
| Mental health | 0–25 | Ratio (7); population below 100% FPL (5); elderly ratio (3); youth ratio (3); alcohol abuse (1); substance abuse (1); travel time (5) |
Higher scores mean greater need. HRSA scores "the relative need of HPSAs," and the National Health Service Corps reviews loan repayment applications in descending HPSA score order (NHSC).
Where to look them up
HPSA Find on data.hrsa.gov searches by location or HPSA ID. It filters by discipline, status, type, score and rural status. It also displays Maternity Care Target Area (MCTA) scores (HRSA).
Section 332 of the Public Health Service Act requires an annual Federal Register list of HPSAs. The 2026 notice covers HPSAs designated as of April 30, 2026 (Federal Register).
Common pitfalls
- Ignoring status. HPSAs that did not pass the September 2025 National Shortage Designation Update are "proposed for withdrawal." They remain recognized HPSAs until HRSA's final decisions, expected by July 1, 2027 (HRSA). Report them separately.
- Mismatched boundaries. The 2025 update applied 2020 Census geographies (HRSA). Join HPSA records to boundary files of the same vintage.
- Reading a population HPSA as area-wide. A population HPSA applies to one group, and a facility HPSA describes one site.
- Comparing scores across disciplines. Dental scores run to 26, and each discipline weights different factors.
- Confusing HPSAs with MUA/Ps. They use different tests and feed different programs; see MUA/MUP.
Using HPSAs in access-gap and needs-assessment work
- Download HPSA Find records for your service area by discipline, keeping the status field.
- Map geographic HPSA boundaries next to your own provider-to-population ratios and drive times.
- Cite the HPSA ID, discipline, type, score and status in your report.
- Note program eligibility. HRSA lists these users of geographic primary care HPSAs: NHSC, Nurse Corps, IHS loan repayment and CMS HPSA bonus payments. The Rural Health Clinic program and J-1 visa waivers also use them (HRSA).
Frequently asked questions
What is the difference between a geographic, population and facility HPSA?
A geographic HPSA has a provider shortage for everyone in a defined area. A population HPSA covers one group in an area. A facility HPSA covers a site such as a correctional facility or an FQHC (HRSA).
How is a HPSA score calculated?
HRSA scores primary care and mental health HPSAs from 0 to 25 and dental HPSAs from 0 to 26. Points come from the population-to-provider ratio, poverty, travel time to care outside the HPSA and discipline-specific factors.
Where can I look up official HPSA designations?
Use HRSA's HPSA Find on data.hrsa.gov. It searches by location or HPSA ID and filters by discipline, status, type, score and rural status.
What does 'proposed for withdrawal' mean on a HPSA record?
HRSA has flagged the designation for possible removal, but it remains a HPSA until a final decision. For HPSAs that did not pass the September 2025 update, HRSA intends to decide by July 1, 2027.
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Sources
- HRSA Bureau of Health Workforce: What Is Shortage Designation? (accessed November 2, 2026)
- HRSA Bureau of Health Workforce: Scoring Shortage Designations (accessed November 2, 2026)
- HRSA Bureau of Health Workforce: Reviewing Shortage Designation Applications (accessed November 2, 2026)
- HRSA Data Warehouse: HPSA Find (accessed November 2, 2026)
- eCFR: 42 CFR Part 5, Appendix A (Primary Medical Care Shortage Criteria) (accessed November 2, 2026)
- Cornell LII: 42 CFR Appendix A to Part 5 (accessed November 2, 2026)
- HRSA: HRSA Extends Timeline for Review of Certain HPSA Designations (July 1, 2026) (accessed November 2, 2026)
- Federal Register (public inspection): Lists of Designated Primary Medical Care, Mental Health, and Dental HPSAs, FR Doc. 2026-13309 (accessed November 2, 2026)
- NHSC: Understanding Loan Repayment Funding Priorities (accessed November 2, 2026)