HPSA Designation
 Health Professional Shortage Areas
Each year the United States Department of Health and Human Services designates Health Professional Shortage Areas (HPSA) throughout the United States The Shortage Designation Branch develops shortage designation criteria and uses them to decide whether or not a geographic area or population group is a shortage area. A HPSA may have shortages of primary medical care, dental or mental health providers and may be urban or rural areas, population groups or medical or other public facilities. For primary medical care HPSA uses three criteria for determination;
- The area is a rational area for delivery of primary care.
- The area has a population to primary care physician ration of 3500:1 or higher.
- Primary care physicians in area are over utilized or inaccessible to the population.
About 20 percent of the U.S. population reside in a HPSA. The majority of states participate in the Conrad State 30 Program, Appalachian Regional Commission, and the Delta Regional Authority all require areas to be in a designated HPSA location.
Medically Underserved Areas
The United States Department of Health and Human Services designates Medically Underserved Areas (MUA) . MUAs may be a whole county or a group of contiguous counties, a group of county or civil divisions or a group of urban census tracts in which residents have a shortage of personal health services. MUAs are determined by 4 criteria;
- 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.
These criteria are weighed to determine which areas will be designated an MUA. Some state Conrad State 30 Programs and the Delta Regional Authority require areas to be in a designated MUA location.
Delta Regional Authority
The Delta Regional Authority ( DRA ) is a federal-state partnership serving a 240-county/parish area in an eight state region. The participating states are Alabama, Arkansas, Illinois, Kentucky, Louisiana, Mississippi, Missouri, and Tennessee. The DRA is dedicated to helping residents of these areas to have access to quality, affordable primary health care as a core part of the Region's economic development. The DRA will recommend a waiver of the foreign residence requirement on behalf of primary care physicians holding J-1 Visas under certain conditions, including treating indigent uninsured patients.
Appalachian Regional Commission
The Appalachian Regional Commission ( ARC ) is a federal-state partnership dedicated to improving access to primary health care for residents of participating states. ARC participating states are Alabama, Georgia, Kentucky, Maryland, Mississippi, New York, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Virginia, and West Virginia. There are designated ARC counties within each of these states. ARC is prepared to consider recommending a waiver of the foreign residence requirement on behalf of primary care physicians holding J-1 Visas under certain conditions.
Conrad State 30 Program
Conrad State 30 Program : Each state is allowed to recommend 30 waivers per year to the U.S. Department of State and the Bureau of Citizenship and Immigration Services. International Medical Graduates who have come to the United States for residency and fellowship may request a "waiver" of the two-year home residency requirement if they are willing to practice primary care, and in some states specialty care, full time, for at least three years in a Health Professional Shortage Area or a Medically Underserved Area. Each state has it's own requirements and guidelines. The objective of the Conrad State 30 Program is to assist all residents in each state with access to quality, affordable health care services.
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