Medically Underserved Areas ⁄ Population

Shortage designations are based on the evaluation of criteria established through regulation to identify geographic areas or population groups with a shortage of primary health care services. The type of shortage designation is linked to a federal Bureau of Primary Health Care activity or function. The medically underserved areas/populations (MUA/Ps) designation is a prerequisite to requesting grant awards to plan, develop, and operate a community health center under section 330 of the Public Health Service Act.

Federal Programs Using MUA/MUP Designations Include:

  1. Recipients of Community Health Center (CHC) grant funds are legislatively required to serve areas or populations designated by the Secretary of Health and Human Services as medically underserved. Grants for the planning, development, or operation of community health centers under section 330 of the Public Health Service Act are available only to centers which serve designated MUAs or MUPs.
  2. Systems of care which meet the definition of a community health center contained in Section 330 of the Public Health Service Act, but are not funded under that section, and are serving a designated MUA or MUP, are eligible for certification as a Federally Qualified Health Center (FQHC) and thus for cost-based reimbursement of services to Medicaid-eligibles.
  3. Clinics serving rural areas designated as MUAs are eligible for certification as Rural Health Clinics by the Health Care Financing Administration under the authority of the Rural Health Clinics Services Act (Public Law 95-210, as amended).
  4. PHS Grant Programs administered by HRSA´s Bureau of Health Professions – gives funding preference to Title VII and VIII training programs in MUA/Ps.

MUA Designation

The designation of Medically Underserved Areas (MUAs) and Populations (MUPs), based on the Index of Medical Underservice (IMU), published in the Federal Register on October 15, 1976. This involves application of the Index of Medical Underservice (IMU) to data on a service area to obtain a score for the area. The IMU scale 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, and percentage of the population age 65 or over. The value of each of these variables for the service area is converted to a weighted value, according to established criteria. The four values are summed to obtain the area's IMU score. This involves application of the Index of Medical Underservice (IMU) to data on an underserved population group within an area of residence to obtain a score for the population group. Population groups requested for MUP designation should be those with economic barriers (low-income or Medicaid-eligible populations), or cultural and/or linguistic access barriers to primary medical care services.

MUP Designation

The Medically Underserved Population (MUP) process involves assembling the same data elements and carrying out the same computational steps as stated for MUAs in section I above. The population is now the population of the requested group within the area rather than the total resident civilian population of the area. The number of FTE primary care physicians would include only those serving the requested population group. The ratio of the FTE primary care physicians serving the population group per 1,000 persons in the group is used. The weighted value for poverty is to be based on the percent of population with incomes at or below 100 percent of the poverty level in the area of residence for the population group. The weighted values for percent of population age 65 and over and the infant mortality rate would be those for the requested segment of the population in the area of residence, if available and statistically significant; otherwise, these variables for the total resident civilian population in the area should be used. If the total of weighted values is 62.0 or less, the population group qualifies for designation as an MUP.

More information regarding the eligibility of areas for Medically Underserved Areas ⁄ Populations can be found at the Bureau of Primar Health Care Division of Shortage Designation website at: