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Designating Medically Indigent Population (MIP) HPSAs in states without, or transitioning to, Medicaid Expansion: A Virginia case study

Anna Riggan, M.S – Social Epidemiologist, Virginia Department of Health


Prior to expanding Medicaid in January 2019, Virginia was one of almost 20 states that had not expanded Medicaid under the provisions of the Affordable Care Act. Furthermore, Virginia had among the most stringent Medicaid eligibility requirements. Almost 700,000 Virginians under the age of 65 were uninsured in 2016. In many cases, the working poor, defined as working individuals living at or below 200% FPL, rely on Sliding Fee Scale (SFS) services. A federally designated Health Professional Service Area (HPSA) can be transformative for a community. Not only does a competitive HPSA score (reflecting the degree of healthcare provider shortage) give practice sites access to student loan repayment or scholarship recruitment resources, but also requires that sites receiving these funds offer SFS payment options. This incentive to increase SFS services makes HPSAs a primary method to address the healthcare coverage gap. A Medically-Indigent Population HPSA (MIP HPSAs) is a special HPSA designation that examines only the uninsured population living between 139% and 200% of the Federal Poverty Level. However, MIP HPSA designations are rarely pursued due to complexity and data limitations. Using state-level data sources, Virginia has had two MIP HPSAs designated in the past 12 months.

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