Notice2026-09056
Notice of Criteria for Determining Maternity Care Health Professional Target Areas
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Published
May 7, 2026
Issuing agencies
Health and Human Services DepartmentHealth Resources and Services Administration
Abstract
HRSA published a 30-day public notice in the Federal Register on February 3, 2026, (Federal Register volume 91, number 22, pp. 4927- 4931) soliciting feedback on updated criteria for determining maternity care target areas (MCTA). In particular, HRSA requested feedback on proposed changes to the criteria and point scales for MCTAs by removing the criterion for Social Vulnerability Index (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 time/distance to the nearest source of accessible care outside of the MCTA. This notice responds to the comments received during this 30-day public notice period and sets forth updated MCTA scoring criteria.
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<title>Federal Register, Volume 91 Issue 88 (Thursday, May 7, 2026)</title>
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[Federal Register Volume 91, Number 88 (Thursday, May 7, 2026)]
[Notices]
[Pages 24882-24886]
From the Federal Register Online via the Government Publishing Office [<a href="http://www.gpo.gov">www.gpo.gov</a>]
[FR Doc No: 2026-09056]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Resources and Services Administration
Notice of Criteria for Determining Maternity Care Health
Professional Target Areas
AGENCY: Health Resources and Services Administration (HRSA), Department
of Health and Human Services (HHS).
ACTION: Notice of final response.
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SUMMARY: HRSA published a 30-day public notice in the Federal Register
on February 3, 2026, (Federal Register volume 91, number 22, pp. 4927-
4931) soliciting feedback on updated criteria for determining maternity
care target areas (MCTA). In particular, HRSA requested feedback on
proposed changes to the criteria and point scales for MCTAs by removing
the criterion for Social Vulnerability Index (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 time/distance to the nearest source of accessible care outside
of the MCTA. This notice responds to the comments received during this
30-day public notice period and sets forth updated MCTA scoring
criteria.
DATES: The proposed update to Maternity Care Health Professional Target
Areas will be implemented starting August 15, 2026.
FOR FURTHER INFORMATION CONTACT: Matthew Patterson, Senior Advisor,
Division of Policy and Shortage Designation, Bureau of Health
Workforce, HRSA, Mail Stop 15SWH03, 5600 Fishers Lane, Rockville,
Maryland 20857, phone number: (301) 594-5110, or <a href="/cdn-cgi/l/email-protection#12617670527a6061733c757d64"><span class="__cf_email__" data-cfemail="5e2d3a3c1e362c2d3f70393128">[email protected]</span></a>.
SUPPLEMENTARY INFORMATION:
Background
Section 332 of the Public Health Service (PHS) Act (42 U.S.C. 254e)
provides that the Secretary of HHS designate Health Professional
Shortage
[[Page 24883]]
Areas (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, Federal Register notice (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/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).
On February 3, 2026, through an FRN, HRSA announced a 30-day public
comment period to solicit input on updated criteria for determining
MCTAs (91 FR 4927). In particular, HRSA requested feedback on proposed
changes to 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 for travel time/distance to the
nearest source of accessible care outside of the MCTA. HRSA carefully
evaluated and analyzed the comments received and used them to guide the
final decision on how to update criteria used in MCTAs.
Comments on the Proposed Criteria for Identifying Maternity Care Target
Areas
HRSA received 14 responses to the request for comments. The
following is a breakdown of those 14 responses. Of those 14 responses,
six comments were from public interest/advocacy organizations, three
comments were from state government agencies, two comments were from
academic institutions/researchers, two comments were from health care
providers/institutions, and one comment was from an individual/private
citizen. Of the 14 comments received, one comment fell outside of the
scope of this request. The remaining 13 comments and HRSA's responses
are summarized below.
Summary of Comments
Social Vulnerability Index
HRSA received three comments that supported the February 3, 2026,
FRN proposal to remove the SVI and reallocate points to population-to-
full-time-equivalent maternity care health professional ratio and
travel time/distance to the nearest source of accessible care outside
of the MCTA. Ten comments did not support the proposal detailed in the
February 3, 2026, FRN.
The three commenters who supported the removal of SVI as a MCTA
criteria all mentioned that reallocation of the points to population-
to-full-time-equivalent maternity care health professional ratio and
travel time/distance to the nearest source of accessible care outside
of the MCTA would better measure access to maternity care providers,
and discussed that this will advantage rural communities in regards to
MCTA scoring and ultimately recruiting and retaining maternity care
providers to serve in those areas. Two specifically mentioned
transportation issues and road terrain conditions as additional
barriers to health care access facing rural communities. One commenter
specifically stated the removal of SVI and reallocation of points to
population-to-full-time-equivalent maternity care health professional
ratio and travel time/distance to the nearest source of accessible care
outside of the MCTA was equitable and will assist in National Health
Service Corps Loan Repayment Program recruitment.
The remaining 10 relevant comments were opposed to the HRSA
proposal to remove SVI. Nine commenters believe the system should
continue to look at multiple factors, including clinical and social
challenges, to better understand where care is needed. Five of the 10
commenters recommended retaining SVI or replacing it with a similar
metric, however, not all commenters had suggestions on what metric
could replace SVI. Two commenters recommended using the Social
Deprivation Index as a direct replacement, and one specifically
mentioned using the Centers for Disease Control and Prevention National
Vital Statistics System. Five commenters requested HRSA monitor how
scoring changes affect provider placement and recruitment. Four
commenters stated that removal of SVI may adversely affect rural areas
via reduced workforce placement, and four also recommended that HRSA
should conduct an impact analysis prior to implementation of any policy
change.
Response
HRSA thanks all commenters for their input on the proposed change
to MCTA criteria and recognizes that there are many factors that should
be considered when making changes to the way shortage areas are scored.
Many commenters indicated that SVI should be maintained; however,
HRSA's position is that SVI is used to help public health officials and
local planners better prepare for and respond to emergency events, not
necessarily to determine access to care. Congress established MCTAs
through the Improving Access to Maternity Care Act of 2018 (Pub. L.
115-320) to ensure that shortage areas in need of maternity care health
services have access to maternity care. The proposed reallocation of
points from SVI to the nearest source of accessible care will work to
better quantify the distances some communities must travel to seek
maternity care, and reallocation of points from SVI to the population-
to-full-time-equivalent maternity care health professional ratio will
work to better quantify the availability of maternity care providers
versus the population in the area under consideration for designation.
These two values closely align with access to maternity care, and
therefore, the congressional intent in establishing MCTAs. HRSA
understands the sensitivity around workforce recruitment and retention,
especially in rural areas. HRSA may continue to evaluate the components
of these two values, including the definition of maternity care health
professional. HRSA conducted an impact analysis on currently designated
MCTAs, including those in rural areas, in the February 3, 2026, FRN,
showing that the anticipated effect of these changes will be an overall
increase of 6.6 percent to MCTA scores.
Conclusion
HRSA appreciates the comments and recommendations received from the
public. HRSA considers many of the comments received to be useful and
informative to future discussions on how to strengthen MTCAs moving
[[Page 24884]]
forward. After consideration of the public comments received, HRSA is
implementing the final MCTA criteria as proposed. Details on the final
approach are below. If you have any questions, please contact Matthew
Patterson at <a href="/cdn-cgi/l/email-protection#a3d0c7c1e3cbd1d0c28dc4ccd5"><span class="__cf_email__" data-cfemail="1162757351796362703f767e67">[email protected]</span></a>.
Final Approach for Determining Maternity Care Health Professional
Target Areas
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; (2) percentage of females 15-44 with income at or below
200 percent of the FPL; (3) travel time/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 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
Obstetricians-Gynecologists 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
------------------------------------------------------------------------
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 United States Census Bureau.
Population with income at or below 200 percent of the FPL point
values will be distributed as follows:
------------------------------------------------------------------------
Population with income at or below 200% FPL ratio Points
------------------------------------------------------------------------
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%...............................................
------------------------------------------------------------------------
Score for Travel Time/Distance to the 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/
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/distance to the nearest source of accessible care point
values will be distributed as follows:
------------------------------------------------------------------------
Travel time/distance Points
------------------------------------------------------------------------
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
------------------------------------------------------------------------
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 (i.e., ages 15-44) will be derived
from the American Community Survey and births
[[Page 24885]]
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
------------------------------------------------------------------------
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
(i.e., aged 15-44) 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
------------------------------------------------------------------------
<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
------------------------------------------------------------------------
<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.............................................
------------------------------------------------------------------------
<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.
Smoking before pregnancy will be defined as smoking one or more
cigarettes daily for the 3 months prior to pregnancy. Smoking 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.............................
------------------------------------------------------------------------
[[Page 24886]]
<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.............................................
------------------------------------------------------------------------
<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.......................
<bullet> Core Mental Health ONLY: 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................................
------------------------------------------------------------------------
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 clearance for proposed data collection
activities.
Thomas J. Engels,
Administrator.
[FR Doc. 2026-09056 Filed 5-6-26; 8:45 am]
BILLING CODE 4165-15-P
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