The GAO identified over 5,500 HPSAs currently designated throughout the United States.  The GAO estimates that slightly more than half of the HPSAs were designated for geographic areas, such as counties or portions of counties, or population groups, such as migrant farmworkers. The remaining HPSAs were designated for facilities, such as rural health clinics.  In fiscal year 2005, more than 30 federal programs relied on HPSA designations, and in some cases HPSA scores, to allocate resources or provide benefits.

By law, HHS is required to annually review HPSA designations in order to determine if the HPSA designations are still applicable.  HHS is also required to publish current designations in the Federal Register as well as publish a list of those HPSAs that have been withdrawn. 

Since 2002, HHS has not annually published a list of HPSAs in the Federal Register.  As a result, some HPSAs that no longer meet the designation criteria have retained their HPSA designation and have received benefits from federal programs that rely on that designation.  HHS has previously recognized the need for improvements in the designation system and has been working since 1998 on a proposal to revise the system.

The GAO concluded that HHS must resume publishing a list of designated HPSAs in the Federal Register and complete a proposal to revise the HPSA designation system.  In its comments to a draft of the report, HHS agreed with all the GAO’s recommendations.