National Shortage Designation Update

The Shortage Designation Modernization Project and National Shortage Designation Updates


The Shortage Designation Modernization Project, started in 2013, is a Health Resources and Services Administration (HRSA) initiative to modernize current shortage designation processes while maintaining transparency, accountability, and parity. In addition, the project aims to reduce the burden of data collection on State Primary Care Offices by using publicly available data sets.

The first component of the project is the National Shortage Designation Update (NSDU). This involves an update to existing geographic, population and some facility HPSA designations, at a single point in time, using national, standardized data sets – 2014 American Community Survey Data, 2014 Centers for Disease Control Data, and ESRI Data — along with PCO validated National Provider Identified (NPI) data.

The second component is the National Shortage Designation Update of Auto-HPSAs that occurred in August 2019

Phase 1

The first National Shortage Designation Update (NSDU) Occurred in October 2017

Impact to HPSA Designations

Although it is not uncommon for HPSA scores to increase, decrease or be withdrawn, this is the first time that a large number of HPSA designations were updated at a single point in time.

In preparation for the National Shortage Designation Update, HRSA conducted impact analyses to identify what changes may occur to 526 of Texas’ existing geographic, population and Other Facility (OFAC) primary care, dental and mental health HPSA designations when the update takes place.

As of November 4, 2017, the impact analysis indicated that following the National Shortage Designation Updates, for Texas:

  • 222 HPSA scores would increase
  • 157 HPSA scores would decrease
  • 48 HPSA scores would remain the same
  • 98 HPSA scores would be proposed for withdrawal because they would no longer meet the federal criteria for a HPSA.  

Designations Proposed for Withdrawal on October 28, 2017 were officially Withdrawn on July 2, 2018 unless additional updates were made to the designation.

Phase 2

The National Shortage Designation Update of Auto-HPSAs occurred in August 2019. All Auto-HPSA facilities included in this update:

  • Federally Qualified Health Centers (FQHC) (funded under Sec. 330)
  • Federally Qualified Health Center Look-Alikes (LAL)
  • Tribally-Run Clinics
  • Urban Indian Organizations
  • Dual-Funded Tribal Health
  • Federally-Run Indian Health Service Clinics 
  • Rural Health Clinics (RHC) that meet National Health Service Corps (NHSC) site requirements; and are approved NHSC sites

The Auto-HPSA Portal was also implemented to allow organizations and facilities to request a rescore of their Auto-HPSAs


The 2020 National Shortage Designation Update 2.0, using updated data sets has been rescheduled for Summer 2021.

Impact on Incentive and Other Programs

As with any update to a HPSA designation, site and participant eligibility for federal and state programs that use shortage designation to determine eligibility may be impacted. These include National Health Service Corp (NHSC) Nurse Corps, State-funded loan repayment programs, Conrad 30 J-1 Visa Waiver Program, Rural Health Clinic (RHC) Certification, CMS Bonus Payments and others. Please visit our Frequently Asked Questions or contact our office if you have specific questions related to one of these programs.



Texas Primary Care Office
Phone: (512) 776-7518  

HRSA Shortage Designation Branch


Definitions for commonly used terms and acronyms are on the TPCO Definitions page

Last updated June 30, 2020