MUA/MUP: Medically Underserved Areas and Populations
A Medically Underserved Area (MUA) or Population (MUP) is a HRSA designation for an area or group lacking access to primary care (HRSA). HRSA scores both with the Index of Medical Underservice (IMU).
MUA, MUP and Exceptional MUP
- MUA: a primary care shortage across a geographic area (HRSA). Examples are a whole county, a group of neighboring counties, a group of urban census tracts, or a group of county or civil divisions.
- MUP: a primary care shortage for a specific population subset within a geographic area.
- Exceptional MUP: a population that does not qualify as an MUP, but where unusual circumstances prevent access to primary care services.
How the Index of Medical Underservice works
The IMU ranges from 0 to 100 (HRSA). An area or population with an IMU of 62.0 or below qualifies for designation, so lower scores mean greater underservice.
| IMU component | Maximum points |
|---|---|
| Providers per 1,000 population | 28.7 |
| Percent of population at 100% of the federal poverty level | 25.1 |
| Percent of population age 65 and over | 20.2 |
| Infant mortality rate | 26 |
The four maximums sum to 100 (HRSA).
How MUA/P differs from a HPSA
| HPSA | MUA/P | |
|---|---|---|
| Disciplines | Primary care, dental, mental health | Primary care |
| Types | Geographic, population, facility (including auto-HPSAs) | Area, population, Exceptional MUP |
| Core test | Population-to-provider ratio thresholds in 42 CFR Part 5 | IMU of 62.0 or below |
| Score | 0–25 (dental 0–26), calculated after designation | IMU, 0–100 |
| Programs HRSA lists | NHSC, Nurse Corps, IHS loan repayment, CMS HPSA bonus payments, Rural Health Clinic program, J-1 visa waiver (geographic primary care HPSAs) | Health Center Program, J-1 visa waiver; Rural Health Clinic program for MUAs |
| Lookup tool | HPSA Find | MUA Find |
Sources for scores and programs: HRSA scoring and HRSA shortage designation. HRSA says MUA/P designations help establish community health centers and health maintenance organizations.
Data source
MUA Find on data.hrsa.gov looks up designations by location or identifier. It filters by status, type and rural status. HRSA's scoring page points users to data.hrsa.gov for MUA/P scores (HRSA).
Common pitfalls
- Reading the IMU backward. A low IMU signals need. HPSA scores work the other way: NHSC reviews applications in descending HPSA score order (NHSC).
- Applying it to dental or mental health. MUA/P measures primary care access only.
- Treating an MUP as area-wide. An MUP covers a population subset, not every resident.
- Using the designation as current data. A designation reflects the data used when it was made. Recompute supply, poverty, age and infant mortality before describing today's conditions.
- Assuming HPSA and MUA/P overlap. They come from different tests, so check both layers.
Using MUA/P in needs-assessment work
- Pull MUA/P and HPSA records for the same service area and map them together.
- Use the four IMU components as an indicator checklist. Draw poverty and age from ACS 5-year estimates and supply from NPI data.
- In aging-services work, note that the share of residents age 65 and over is one of the four IMU inputs.
- If a partner plans a new health center site, check MUA/P status early, since the Health Center Program uses these designations (HRSA).
Frequently asked questions
What IMU score qualifies an area as medically underserved?
An area or population with an Index of Medical Underservice of 62.0 or below qualifies. The IMU runs from 0 to 100. Because areas qualify at 62.0 or below, lower scores mean greater underservice.
What is the difference between an MUA and a HPSA?
An MUA/P measures primary care access with a four-part index. A HPSA can cover primary care, dental or mental health and rests on population-to-provider ratio thresholds. They also feed different federal programs.
What is the difference between an MUA and an MUP?
An MUA covers everyone in a geographic area. An MUP covers a specific population subset within a geographic area (HRSA).
Where do I find MUA/P designations?
Use HRSA's MUA Find on data.hrsa.gov. It searches by location or ID and filters by status, type and rural status.
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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 Data Warehouse: MUA Find (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)
- NHSC: Understanding Loan Repayment Funding Priorities (accessed November 2, 2026)