Notice2026-02130
Request for Public Comment on the Updated Criteria for Determining Maternity Care Health Professional Target Areas
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Published
February 3, 2026
Issuing agencies
Health and Human Services DepartmentHealth Resources and Services Administration
Abstract
The Public Health Service (PHS) Act directs HHS, through HRSA, to identify maternity care target areas (MCTAs; geographic areas within health professional shortage areas (HPSAs) that have a shortage of maternity care health professionals) for the purpose of assigning National Health Service Corps participants who are maternity care health professionals to HPSAs with a shortage of such professionals. On September 27, 2021, HRSA published a Federal Register notice (FRN) soliciting feedback on proposed criteria to be used to identify MCTAs. On May 19, 2022, HRSA published an FRN that summarized and responded to the comments received during the 60-day comment period and presented the final criteria which are used to identify and score MCTAs. One of the criteria selected was the Social Vulnerability Index (SVI). SVI was used to assign points based on the relative level of social vulnerability within an area. Areas with SVI values at or above the 75th percentile received 2 points. Areas with SVI values between the 50th and 75th percentiles received 1 point. Areas with SVI values below the 50th percentile received 0 points. HRSA is now proposing to change the criteria and point scales for MCTAs by removing the criterion for SVI and reallocating its two points as follows: one point to population-to-full-time-equivalent maternity care health professional ratio and one point to score for travel distance/time to nearest source of accessible care outside of the MCTA.
Full Text
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<title>Federal Register, Volume 91 Issue 22 (Tuesday, February 3, 2026)</title>
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[Federal Register Volume 91, Number 22 (Tuesday, February 3, 2026)]
[Notices]
[Pages 4927-4931]
From the Federal Register Online via the Government Publishing Office [<a href="http://www.gpo.gov">www.gpo.gov</a>]
[FR Doc No: 2026-02130]
[[Page 4927]]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Resources and Services Administration
Request for Public Comment on the Updated Criteria for
Determining Maternity Care Health Professional Target Areas
AGENCY: Health Resources and Services Administration (HRSA), Department
of Health and Human Services (HHS).
ACTION: Request for public comment on the updated criteria for
determining maternity care health professional target areas.
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SUMMARY: The Public Health Service (PHS) Act directs HHS, through HRSA,
to identify maternity care target areas (MCTAs; geographic areas within
health professional shortage areas (HPSAs) that have a shortage of
maternity care health professionals) for the purpose of assigning
National Health Service Corps participants who are maternity care
health professionals to HPSAs with a shortage of such professionals. On
September 27, 2021, HRSA published a Federal Register notice (FRN)
soliciting feedback on proposed criteria to be used to identify MCTAs.
On May 19, 2022, HRSA published an FRN that summarized and responded to
the comments received during the 60-day comment period and presented
the final criteria which are used to identify and score MCTAs. One of
the criteria selected was the Social Vulnerability Index (SVI). SVI was
used to assign points based on the relative level of social
vulnerability within an area. Areas with SVI values at or above the
75th percentile received 2 points. Areas with SVI values between the
50th and 75th percentiles received 1 point. Areas with SVI values below
the 50th percentile received 0 points. HRSA is now proposing to change
the criteria and point scales for MCTAs by removing the criterion for
SVI and reallocating its two points as follows: one point to
population-to-full-time-equivalent maternity care health professional
ratio and one point to score for travel distance/time to nearest source
of accessible care outside of the MCTA.
DATES: Submit comments no later than March 5, 2026.
ADDRESSES: Electronic comments should be submitted to the Shortage
Designation Branch by email at <a href="/cdn-cgi/l/email-protection#33405751735b4140521d545c45"><span class="__cf_email__" data-cfemail="bfccdbddffd7cdccde91d8d0c9">[email protected]</span></a>.
FOR FURTHER INFORMATION CONTACT: Matthew Patterson, Senior Advisor,
Division of Policy and Shortage Designation, Bureau of Health
Workforce, HRSA, 5600 Fishers Lane, phone number: (301) 594-5110, Mail
Stop 15SWH03, Rockville, Maryland 20857, or <a href="/cdn-cgi/l/email-protection#a9dacdcbe9c1dbdac887cec6df"><span class="__cf_email__" data-cfemail="64170006240c1617054a030b12">[email protected]</span></a>.
SUPPLEMENTARY INFORMATION: Section 332 of the PHS Act (42 U.S.C. 254e),
provides that the Secretary of HHS designate HPSAs based on criteria
established by regulation. HPSAs are defined in statute to include (1)
urban and rural geographic areas which the Secretary determines have
shortages of health professionals, (2) population groups with such
shortages, and (3) public or private medical facilities or other public
facilities with such shortages. The required regulations setting forth
the criteria for designating HPSAs are codified at 42 CFR part 5.
Section 332(k)(1) of the PHS Act provides that the Secretary,
acting through the HRSA Administrator, shall identify shortages of
maternity care health services ``within health professional shortage
areas.'' Section 332(k)(1) further requires HRSA to identify MCTAs and
distribute maternity care health professionals within HPSAs using the
MCTAs so identified.
In a September 27, 2021, FRN (86 FR 53324), HRSA requested feedback
on six proposed criteria to identify MCTAs: (1) ratio of females ages
15-44 to full time equivalent maternity care health professional; (2)
percentage of females 15-44 with income at or below 200 percent of the
federal poverty level (FPL); (3) travel time and distance to the
nearest provider location with access to comprehensive maternity care
services; (4) fertility rate; (5) SVI; and (6) four maternal health
indicators (pre-pregnancy obesity, pre-pregnancy diabetes, pre-
pregnancy hypertension, and prenatal care initiation in the first
trimester). HRSA finalized the MCTA criteria on May 19, 2022 (87 FR
30501).
Change to the MCTA Scoring and Criteria
HRSA is changing the criteria and point scales for MCTAs by
removing the SVI criterion, which had a point value of 0-2. Congress
established MCTAs to ensure shortage areas identified as in need of
maternity care health services had access to care. The SVI is used to
help public health officials and local planners better prepare for and
respond to emergency events, not to necessarily determine access to
care. In recognition of the congressional intent, HRSA will reallocate
one SVI point to the population to full time equivalent maternity care
health professional ratio and the other SVI point to score for travel
distance/time to nearest source of accessible care outside of the MCTA.
Reallocating a point to the population-to-provider ratio strengthens
the weight of areas with provider shortages, which is a key aspect of
shortage designation, and reallocating a point to the travel time/
distance strengthens the weight of geographic barriers, which directly
impacts access to care especially in rural communities.
HRSA considered the impact of this change on existing MCTAs. As of
September 2025, there were over 7,600 designated MCTAs--19 percent
received 2 points towards the SVI criterion, 41 percent received 1
point, 33 percent received 0 points, and 6 percent did not have SVI
criterion scores. Based on internal analysis of the proposed changes,
by removing SVI and redistributing the points, MCTA scores will
increase overall by 6.6 percent. In total, 200 of the more than 7,600
MCTAs may be subject to a decrease in MCTA score. These largely include
MCTAs designated for Medicaid eligible population, low-income migrant
seasonal worker population, low-income migrant farmworker population,
and other population primary care HPSAs.
Primarily, HRSA uses MCTA's to distribute awards to eligible
maternity care health professionals through the National Health Service
Corps Loan Repayment Programs. HRSA awards these providers using either
the primary care HPSA or the MCTA score of their site, whichever is
higher. Although a decrease in MCTA score could potentially result in
some maternity care professionals applying with lower MCTA scores, the
impact may be mitigated since these providers can apply using either
the primary care HPSA or the MCTA score of their site, whichever is
higher.
The impact analysis is detailed in the chart below.
----------------------------------------------------------------------------------------------------------------
Current Change in % Change in
HPSA subtypes with a MCTA N average MCTA New average average MCTA average MCTA
score MCTA score score score
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HRSA-funded Health Center....... 1,359 18.1 19.3 + 1.2 + 6.6
[[Page 4928]]
Health Center Look-Alike........ 168 15.9 17.3 + 1.3 + 8.4
HPSA geographic................. 919 12.8 14.1 + 1.3 + 10.5
HPSA geographic high needs...... 324 17.8 18.0 + 0.2 + 0.9
HPSA population................. 2,239 14.6 15.4 + 0.8 + 5.4
Indian, tribal, and urban Indian 919 15.3 16.2 + 0.8 + 5.5
Rural health clinic............. 1,749 16.0 17.3 + 1.3 + 8.2
-------------------------------------------------------------------------------
Total....................... 7,677 15.6 16.6 + 1.0 + 6.6
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Note: Data is rounded to the first decimal point. Differences in the ``Change in Average MCTA Score'' and ``%
Change in Average MCTA Score'' columns are due to rounding.
HRSA requests public comments on the agency's decision to eliminate
the SVI criterion and to reallocate the corresponding two-point value
by assigning one point to the population-to-full-time-equivalent
maternity care health professional ratio and one point to the travel
distance/time to the nearest source of accessible care outside of the
MCTA.
Updated Approach for Determining MCTAs
An MCTA score will be generated for each primary care HPSA using
the HPSA's service area. The following five scoring criteria will be
included in a composite scale that will be used to identify MCTAs with
the greatest shortage of maternity care health professionals: (1) ratio
of females ages 15-44 to full time equivalent maternity care health
professional ratio; (2) percentage of females 15-44 with income at or
below 200 percent of the FPL; (3) travel time and distance to the
nearest provider trained and licensed to provide the necessary care;
(4) fertility rate; and (5) maternal health index which contains the
following six indicators: pre-pregnancy obesity, pre-pregnancy
diabetes, pre-pregnancy hypertension, prenatal care initiation in the
first trimester, cigarette smoking, and the behavioral health factor.
Each of these five criteria will be assigned a relative weight based on
the significance of that criterion relative to all the others.
The weighted scores will be summed to develop a composite MCTA
score ranging from zero to 25, with 25 indicating the greatest need for
maternity care health professionals in the MCTA. Accordingly, the
higher the composite score, the higher the degree of need for maternity
care health services.
Score for Population-to-Full-Time-Equivalent Maternity Care Health
Professional Ratio
The population-to-provider ratio will measure the number of women
of childbearing age in the service area compared to the number of
maternity care health professionals in the service area. Women of
childbearing age will be defined as women between the ages of 15-44
years old and maternity care health professionals will be defined as
Obstetricians-Gynecologists (OB-GYN) and Certified Nurse Midwives
(CNMs). A population-to-provider ratio of 1,500:1 will be used as a
minimum requirement for a population to be considered reasonably served
by OB-GYNs and CNMs.
Population-to-provider ratio point values will be distributed as
follows:
------------------------------------------------------------------------
Population-to-provider ratio Points
------------------------------------------------------------------------
Ratio >=6,000:1, or No CNMs or OB-GYNs and Population 6
(Pop) >=500............................................
6,000:1 > Ratio >=5,000:1, or No CNMs or OB-GYNs and Pop 5
>=400..................................................
5,000:1 > Ratio >=3,000:1, or No CNMs or OB-GYNs and Pop 4
>=300..................................................
3,000:1 > Ratio >=2,000:1, or No CNMs or OB-GYNs and Pop 3
>=200..................................................
2,000:1 > Ratio >=1,500:1, or No CNMs or OB-GYNs and Pop 2
>=100..................................................
Ratio <1,500:1, or No CNMs or OB-GYNs and Pop <100...... 0
------------------------------------------------------------------------
HRSA invites public comment on the revised methodology for the
scoring distribution.
Score for Percentage of Population With Income at or Below 200 Percent
of the Federal Poverty Level
The percentage of women of childbearing age living in the service
area at or below 200 percent of the FPL will be used to score MCTAs,
based on poverty data from the U.S. Census Bureau.
Population with income at or below 200 percent of the FPL point
values will be distributed as follows:
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Population with income at or below 200% FPL ratio Points
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Percentage of population with income at or below 200% 5
FPL >=50%..............................................
50% > Percentage of population with income at or below 4
200% FPL >=45%.........................................
45% > Percentage of population with income at or below 3
200% FPL >=40%.........................................
40% > Percentage of population with income at or below 2
200% FPL >=35%.........................................
35% > Percentage of population with income at or below 1
200% FPL >=30%.........................................
Percentage of population with income at or below 200% 0
FPL <30%...............................................
------------------------------------------------------------------------
[[Page 4929]]
This scoring methodology was finalized in the May 19, 2022, FRN (87
FR 30501), and HRSA is not proposing any changes.
Score for Travel Distance/Time to Nearest Source of Accessible Care
Outside of the MCTA
The nearest source of accessible care is defined as the nearest
provider trained and licensed to provide the necessary care, as
determined by the Esri StreetMap Premium road network. Travel time and
distance is defined as the average time to travel by road miles or the
actual distance in road miles to the nearest source of care.
Travel time and distance to the nearest source of accessible care
point values will be distributed as follows:
------------------------------------------------------------------------
Travel time and distance Points
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Time >=90 min or Distance >=90 miles.................... 6
90 min > Time >=75 min or 90 miles >Distance >=75 miles. 5
75 min > Time >=60 min or 75 miles >Distance >=60 miles. 4
60 min > Time >=45 min or 60 miles >Distance >=45 miles. 3
45 min > Time >=30 min or 45 miles >Distance >=30 miles. 2
Time < 30 min and Distance <30 miles.................... 0
------------------------------------------------------------------------
HRSA invites public comment on the revised methodology for scoring
distribution.
Score for Fertility Rate
Fertility rate has been included to reflect the increased need for
maternity care services among populations that experience a higher rate
of births. Women of childbearing age will be derived from the American
Community Survey and births will be derived from the National Vital
Statistics System.
Fertility Rate point values will be distributed as follows:
------------------------------------------------------------------------
Fertility rate Points
------------------------------------------------------------------------
Fertility Rate >=90th Percentile........................ 2
90th Percentile > Fertility Rate >=50th Percentile...... 1
Fertility Rate <50th Percentile......................... 0
------------------------------------------------------------------------
This scoring methodology was finalized in the May 19, 2022, FRN (87
FR 30501), and HRSA is not proposing any changes.
Score for Maternal Health Indicators
Maternal health indicators are defined as factors associated with
poor maternal health outcomes using data from the National Vital
Statistics System and the Shortage Designation Management System.
Scores will consider pre-pregnancy obesity, pre-pregnancy diabetes,
pre-pregnancy hypertension, cigarette smoking before or during
pregnancy, whether prenatal care began in the first trimester, and
access to behavioral health services. Only women of childbearing age
will be considered for these indicators. HRSA will use the National
Vital Statistics System Natality file as the data source to determine
the sub-score for pre-pregnancy obesity, pre-pregnancy diabetes, pre-
pregnancy hypertension, cigarette smoking before or during pregnancy,
and whether prenatal care began in the first trimester. The Shortage
Designation Management System Mental HPSA file will be the data source
to determine the sub-score for the behavioral health access factor.
Maternal Health Indicator criteria point values will be distributed
as follows:
<bullet> Pre-Pregnancy Obesity
Pre-pregnancy obesity is defined as having a body mass index of 30
or higher. One point will be awarded if the prevalence of pre-pregnancy
obesity in the area is greater than or equal to the 50th percentile
among all counties in the United States. If the prevalence of pre-
pregnancy obesity in the area is less than the 50th percentile among
all counties, zero points will be awarded.
------------------------------------------------------------------------
Pre-pregnancy obesity Points
------------------------------------------------------------------------
Prevalence of pre-pregnancy obesity >=50th percentile... 1
Prevalence of pre-pregnancy obesity <50th percentile.... 0
------------------------------------------------------------------------
This scoring methodology was finalized in the May 19, 2022, FRN (87
FR 30501), and HRSA is not proposing any changes.
<bullet> Pre-Pregnancy Diabetes
One point will be awarded if the prevalence of pre-pregnancy
diabetes in the area is greater than or equal to the 50th percentile
among all counties in the United States. If the prevalence of pre-
pregnancy diabetes in the area is less than the 50th percentile among
all counties, zero points will be awarded.
------------------------------------------------------------------------
Pre-pregnancy diabetes Points
------------------------------------------------------------------------
Prevalence of pre-pregnancy diabetes >=50th percentile.. 1
Prevalence of pre-pregnancy diabetes <50th percentile... 0
------------------------------------------------------------------------
[[Page 4930]]
This scoring methodology was finalized in the May 19, 2022, FRN (87
FR 30501), and HRSA is not proposing any changes.
<bullet> Pre-Pregnancy Hypertension
One point will be awarded if the prevalence of pre-pregnancy
hypertension among women in the area is greater than or equal to the
50th percentile among all counties in the United States. If the
prevalence of pre-pregnancy hypertension among women in the area is
less than the 50th percentile among all counties, zero points will be
awarded.
------------------------------------------------------------------------
Pre-pregnancy hypertension Points
------------------------------------------------------------------------
Prevalence of pre-pregnancy hypertension >=50th 1
percentile.............................................
Prevalence of pre-pregnancy hypertension <50th 0
percentile.............................................
------------------------------------------------------------------------
This scoring methodology was finalized in the May 19, 2022, FRN (87
FR 30501), and HRSA is not proposing any changes.
<bullet> Cigarette Smoking
One point will be awarded if the prevalence of cigarette smoking
before or during pregnancy among women in the area is greater than or
equal to the 50th percentile among all counties in the United States.
Before pregnancy will be defined as smoking one or more cigarettes
daily for the 3 months prior to pregnancy. During pregnancy will be
defined as smoking one or more cigarettes during any trimester of
pregnancy. If the prevalence of cigarette smoking before or during
pregnancy among women in the area is less than the 50th percentile
among all counties, zero points will be awarded.
------------------------------------------------------------------------
Cigarette smoking Points
------------------------------------------------------------------------
Prevalence of Cigarette Smoking Before or During 1
Pregnancy >=50th percentile............................
Prevalence of Cigarette Smoking Before or During 0
Pregnancy <50th percentile.............................
------------------------------------------------------------------------
This scoring methodology was finalized in the May 19, 2022, FRN (87
FR 30501), and HRSA is not proposing any changes.
<bullet> Prenatal Care Initiation in the 1st Trimester
One point will be awarded if the prevalence of women who did not
initiate prenatal care in the first trimester of their pregnancy is
greater than or equal to the 50th percentile among all counties in the
United States. Zero points will be awarded if the prevalence of women
who did not initiate prenatal care in the first trimester of their
pregnancy is less than the 50th percentile among all counties.
------------------------------------------------------------------------
Prenatal care in first trimester Points
------------------------------------------------------------------------
Prevalence of No Prenatal Care in First Trimester >=50th 1
percentile.............................................
Prevalence of No Prenatal Care in First Trimester <50th 0
percentile.............................................
------------------------------------------------------------------------
This scoring methodology was finalized in the May 19, 2022, FRN (87
FR 30501), and HRSA is not proposing any changes.
<bullet> Behavioral Health Factor
One point will be awarded if a portion or all of the MCTA service
area is designated as a mental health HPSA meeting the following
population-to-provider median ratio thresholds based on its mental
health provider type. Zero points will be awarded if a portion or all
of the MCTA service area is not designated as a mental health HPSA or
if the mental health designation does not meet the population to
provider ratio threshold.
------------------------------------------------------------------------
Behavioral health factor Points
------------------------------------------------------------------------
Portion or all of MCTA service area is designated as a 1
mental health HPSA meeting the following population-to-
provider ratio thresholds based on its mental health
provider type..........................................
<bullet> Psychiatrist ONLY: Psychiatrist population-
to-provider ratio >=45,000:1.......................
Core Mental Health: Core mental health population-to-
provider ratio >=18,000:1..........................
<bullet> Psychiatrist and Core Mental Health:
Psychiatrist population-to-provider ratio
>=35,000:1 and core mental health population-to-
provider ratio >=6,000:1...........................
<bullet> No Psychiatrists or Core Mental Health
Providers: >=7,500: 0..............................
Portion or all of MCTA service area is designated as a 0
mental health HPSA and does not meet the population-to-
provider ratio thresholds above, OR is not designated
as a mental health HPSA................................
------------------------------------------------------------------------
This scoring methodology was finalized in the May 19, 2022, FRN (87
FR 30501), and HRSA is not proposing any changes.
Paperwork Reduction Act
The criteria used to identify MCTAs under section 332(k) of the PHS
Act, as described in this announcement, will not involve data
collection activities that fall under the purview of the Paperwork
Reduction Act of 1995. If the methods for determining MCTAs fall under
the purview of the Paperwork Reduction Act, HRSA will seek the Office
of Management and Budget
[[Page 4931]]
clearance for proposed data collection activities.
Ann M. Sheehy,
Acting Principal Deputy Administrator.
[FR Doc. 2026-02130 Filed 2-2-26; 8:45 am]
BILLING CODE 4165-15-P
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