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1/ Includes proposed reprogramming of $33,683,000 from the MCH Block Grant to Targeted Infant Mortality Initiative.
UNDERSERVED COUNTIES IN THE UNITED STATES
Senator HARKIN. This multicolored chart that I have put up there-perhaps you have seen it before, I am sure you have-the red areas are the designated underserved counties in the United States. The yellow ones are the ones that are fully served.
Evidently the green represents ones that we just do not have the paperwork on, we do not know what the designation is, we really do not understand what those counties are, yet.
Dr. HARMON. OK. To begin with, this chart shows approximately 3,200 counties or other areas including territories like Puerto Rico. The colors refer to whether or not they are designated or served as far as a health professional shortage area or a medically underserved area, served by either the National Health Service Corps or the community and migrant health center program.
Now the green are those that are not designated as a shortage or underserved area. About 36 percent of the jurisdictions_are green and are covered by the private sector, and not requiring Federal designation or assignment at this time. They are eligible to apply if they perceive the need. At this time they are not designated. They include 1,164 areas.
The remaining two-thirds or so are designated as having all or part of the county or the jurisdiction as underserved or shortage. The yellow 382, or 12 percent, are fully served with Federal activities such as a community and migrant health center or a National Health Service Corps assignee.
The orange 422, or 13 percent, are partly served through those kinds of programs. The red are the worst off; 1,232, or 39 percent, are designated but unserved by Federal program activities.
Another way of looking at this is that one-half of the country is either not designated or fully served, and the other one-half is designated and either partly or completely unserved, in these designated areas.
Senator HARKIN. Do you have any idea about the ones that are not designated? Do you have any kind of data on them at all?
Dr. HARMON. Well, we work with the entire United States through our regional offices and State cooperative agreements to provide technical assistance to facilitate designation. It goes through the States, and our primary care cooperative agreements, Governors' offices, private sector, are all able to seek assistance to obtain designation.
We think that many or most of those that are eligible are designated. There are new incentives, by the way, to pursue this, including better Medicare reimbursement. In the past there was some opposition to designation, historically, from organized medicine, for example, but that has given way now to support for designation, since there is a Medicare reimbursement incentive. We have seen an increased level of activity for that and other reasons.
Senator HARKIN. What can you tell me about how the area is divided between urban and rural? Can you tell me roughly what percentage of the shortage areas are rural and what percentage are urban?