One thing that plagues the healthcare industry is an overabundance of acronyms and terms that can leave the heads of the uninitiated spinning. This is especially true for the plethora of designations and terms developed by the Health Resources and Services Administration (HRSA) to identify unserved and underserved areas and populations. In many cases, applicant eligibility or project service area is limited to certain geographic areas, or must be targeted at certain demographic groups. Thus, it is very important to understand what these terms mean and how they are leveraged in the context of HRSA grant programs.
Rural, Rural Health Clinics (RHCs), & Critical Access Hospitals (CAHs)
An area that is designated as rural by HRSA is automatically considered to be an underserved area by nature of the definition. Counties or individual census tracts within counties that are not considered to be in census-designated urbanized areas or clusters are deemed to be rural for the purposes of HRSA grants. Many grants aimed at rural health either require the lead applicant to be in a HRSA-designated rural area, or require that an urban lead applicant exclusively delivers services to such areas within the proposed project. HRSA grant funds are available to develop health delivery networks in rural areas, coordinate ambulatory health services and address the opioid epidemic. HRSA provides a tool so that you can determine whether a county or specific address is in a HRSA-defined rural area: https://datawarehouse.hrsa.gov/tools/analyzers/geo/Rural.aspx.
The rural designation is also a precursor for the Center for Medicare and Medicaid Services (CMS) to certify clinics a Rural Health Clinics (RHCs) and hospitals as Critical Access Hospitals (CAHs). These providers are eligible for enhanced reimbursement rates for services delivered to Medicare and Medicaid patients. These enhanced payments are essential to make these rural providers economically sustainable given the problems inherent to their geography. Applicants that have such certifications will be able to demonstrate substantial need within grant applications and make excellent project partners for entities that do not have such designations.
Health Professional Shortage Areas (HPSAs) & Federally Qualified Health Centers (FQHCs)
If an area is rural they will also likely be in a Health Professional Shortage Area (HPSA). However, many urban locations across the United States are also considered to fall within HPSA boundaries. HPSA designations are determined based on shortages of three types of providers: primary care, dental care, and mental health. The shortage can be based on geography (e.g. a county or service area), population (e.g. low income or Medicaid eligible), or facilities (e.g. federally qualified health centers, state or federal prisons). Federally qualified health centers (FQHCs) are clinics that receive federal grant funds through HRSA to deliver health services to underserved populations in shortage areas. HPSAs are determined based on a formula that varies based on the type of service (primary, dental, mental health). Common measures across all three provider types include: population-to-provider ratio, percent of population below the federal poverty line, and travel time to the nearest health service center. When applying to HRSA for grants, most of the competitions will be targeting services areas that are designated as HPSAs. Thus, it is important to use local statistics and information that documents the need for project funding beyond HPSA status. For other funders, documenting HPSA designations can be an important differentiator for your proposal. HPSA designations can be researched at https://datawarehouse.hrsa.gov/tools/analyzers/hpsafind.aspx. Like RHCs and CAHs, FQHCs are prime targets for grant funding and important partners to include in projects for which you are targeting grant funds. HRSA provides a tool to locate FQHCs at https://findahealthcenter.hrsa.gov/.
Medically Underserved Areas (MUAs), Medically Underserved Populations (MUPs) and Index of Medical Underservice (IMU)
Another set of terms used to indicate a deficit of healthcare services for a region or population includes Medically Underserved Area (MUA) and Medically Underserved Population (MUP). The MUA/P designations are based on the Index of Medical Underservice (IMU). The IMU is calculated based on the area (e.g. the northeast side of Example City) or population (e.g. Medicaid recipients) that is proposed for the designation. The IMU is based on four criteria:
1. Ratio of health care providers per 1,000 population,
2. Percent of the population at or below the federal poverty line,
3. Percent of the population age 65 or over, and
4. Infant mortality rate.
The IMU produces a score from zero to one hundred. Any score of 62 or below is designated as a MUA/P. More than that, the lower the score, the more underserved the area or population is designated - with zero indicating the area is completely unserved. MUA/P designations are critical to document in grant proposals, along with the actual score, since they represent a scale of service. Understanding the components of the formula can also help applicants describe the relevance of the score to a program or project. In other words, if you are proposing a project around infant immunization, it may be especially prudent to play up the MUA/P designation since infant mortality rate is part of the formula and is directly relevant to the proposed project. Utilize HRSA’s MUA tool to determine if your project serves a MUA: https://datawarehouse.hrsa.gov/tools/analyzers/muafind.aspx