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Access To Health Care

Access to Health Care

In Colorado, the healthcare safety net acts as the primary health care resource for uninsured and underinsured Coloradans.  According to The Colorado Trust and the Colorado Health Institute, its reported that nearly 800,000 Coloradans are uninsured.  Currently, Colorado’s uninsured and underinsured total more than 1.5 million people, or nearly 30% of the state’s population.  Even with implementation of the Affordable Care Act, many Coloradoans who are currently uninsured will be enrolled in Medicaid, or will remain uninsured, placing an ongoing dependence on our safety net.  Moreover, many Coloradans live in rural or frontier areas, where access to health care is severely limited.  Colorado’s safety net includes Federally Qualified Health Centers, community mental health centers, community-based dental clinics, community-funded safety net clinics, Critical Access Hospitals, hospital emergency departments, public health departments and public nursing services, Rural Health Clinics, and school-based health centers, and is critical in ensuring access to high quality medical, dental, and mental health care.

Shortage designation is the primary means by which a community can communicate health care needs to the state government, the federal government, and some private foundations that make grants to communities for the development of health care service capacity.  There are two broad categories of shortage designation, each serving a different purpose. Health Professional Shortage Areas (HPSA) tend to describe the needs of the community in terms of the numbers of providers available to the population or a subset of the population. Medically Underserved Areas (MUA/MUP) tend to describe the health status and health needs of a population or subset of the population.  Once an area or population group has been designated, the benefits of that designation are available to anyone in the area.


Nearly all Colorado counties have some part of the county designated as having   a shortage of health care providers. Some counties have few or no doctors, dentists, or mental health providers.  Also, people without health insurance, with low incomes, or with language barriers may experience added difficulty accessing basic health services, even in areas where health care providers are more available generally. The Colorado Rural Health Center and the Colorado Health Institute have additional data available on the health services capacity needs of Colorado.
To receive a federal shortage designation of any kind, an application describing how an area or facility meets federal shortage criteria is required. A shortage application is typically prepared at the local level, in consultation with the state Primary Care Office, and then submitted to the federal Shortage Designation Branch for approval. The complete application and approval process typically takes from three to nine months. Because of the length of time required to complete a designation, communities are well advised to begin the application process as soon as a health care provider shortage is recognized.
Step 1:  Is your community already designated as a Health Professional Shortage Area or Medically Underserved Area?


Step 2: Review the one page 'Shortage Designation Overview' or the 'Community Application Guide' to get a sense of what is required.

Shortage Designation Overview pdf file    

Community Guide to Shortage Designation pdf file  


Step 3:  Contact the Primary Care Office at 303-692-2298.  The Primary Care Office can:

  • Provide technical assistance and survey strategy
  • Provide health care provider data necessary to complete an application evaluation
  • Assure the best possible outcome for your community
Step 4:  Collect provider survey data in consultation with the Primary Care Office.
Step 5:  Submit the survey data and rationale for the service area to the Primary Care Office for review and analysis.  The Primary Care Office will further develop your application and submit it to the federal Shortage Designation Branch at the Health Resources and Service Administration. 

Benefits of HPSA or MUA Designation
Once an area or population group is designated, the benefits of that designation are available to any organization or person in that area. More than 34 federal and state programs depend on shortage designation to determine program eligibility or funding preference. Below are select examples:
Designation Required
Scholarship, loan repayment
10% bonus on Medicare Part B
Geographic HPSA
Cost-based reimbursement
Federal funding
Cost-based reimbursement
Recruitment of physicians
Loan repayment

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The goal of the Colorado State Health Workforce Development Strategy is to improve the health status of all Coloradans by developing the health workforce, emphasizing the primary care access needs of vulnerable, low income and geographically isolated communities. Colorado's Health Workforce Development strategy was affirmed by the members of the Colorado Health Care Professions Workforce Policy Collaborative in September of 2011 with a subsequent revision completed in the summer of 2012. Through consultation with many of Colorado's innovative thought leaders in the health workforce community, key recommendations emerged. The Colorado Health Workforce Development Strategy groups these recommendations under four heading Organize, Educate, Retain and Advocate.