New HHS designation system threatens funding for underserved areas

AAFP, along with six other organizations, has appealed to the Department of Health and Human Services to withdraw a proposed regulation that could take Health Professional Shortage Area and Medically Underserved Area designations away from numerous urban and rural areas across the United States.

The proposed rule, issued by HHS earlier this year, would decrease the amount of care to which millions of patients currently have access by changing the measures used to determine if areas are underserved. The current criteria for HPSAs and MUAs would be combined into a new system called the Index of Primary Care Underservice.

According to a news release from Health Resources and Services Administration, the revision is designed to create a simpler system, incorporate better measures of health status and access, improve identification of designated areas and minimize unnecessary disruption.

Currently, HPSA and MUA designations are used to determine underserved areas that qualify for support such as federal funding of community health centers or National Health Service Corps physicians and clinicians. If the new regulations take effect, nearly 29 million people currently living in MUAs would no longer be considered medically underserved, according to a study from the George Washington University School of Public Health and Health Services. With the number of uninsured Americans on the rise, this regulation would diminish the amount of health services being provided across the nation, according to the study.

The new Index of Primary Care Underservice includes three levels of designation: geographic HPSA, population MUP and safety-net facility HPSA. Each of the first two categories is split into two tiers depending on each area’s need for additional resources. According to the study, areas that exceed the population-to-provider ratio threshold with all clinicians counted are placed in tier 1. Areas that exceed the threshold only when federally-sponsored clinicians are excluded qualify under tier 2. Safety-net facility HPSA is a new designation that is given to health centers if 40 percent of patients in metropolitan areas, 30 percent in rural areas and 20 percent in frontier areas are Medicaid-eligible and uninsured. Ten percent of the health center’s total patients must also be uninsured.

Estimations by HRSA, the Robert Graham Center, and the George Washington University study project that Texas will retain 96 percent of HPSA designations compared to a 74-percent retention rate nationwide. Texas would also retain 80 percent of its primary care physicians and 89 percent of its population under HPSAs compared to 36 percent and 59 percent nationwide.

“I think out of all the states, Texas is one of the best [in regard to retention rates],” says Stephen Petterson, Ph.D., senior health policy researcher and chief analyst of AAFP’s impact analysis.

Rural locations are more likely to retain their designations, but they are also smaller, he said. Therefore, even if a large percentage of areas keep their designation, more people than expected will be affected.

According to the HRSA release, 2 percent of the nation’s 6,000 CHCs would lose federal funding, but as many as one-third could lose their MUA designation, Dan Hawkins, National Association of Community Health Centers senior vice president for policy and programs, said in a story from AAFP.