The Primary Care Shortage in the MidEast Region

As of September 30, 2020, more than 81 million Americans lived in over 7,200 areas or settings designated by the Health Resources and Services Administration (HRSA) as a primary care Health Professional Shortage Area (HPSA). An HPSA is a population group, geographic area, or facility that has substandard access to health services because it lacks a sufficient number of primary care, dental or mental health care practitioners. In terms of primary care, HRSA designation criteria is based upon the population within the HPSA relative to the number of primary care providers that service the area. For HRSA purposes, primary care providers include Doctors of Osteopathy (DO) or Doctors of Medicine (MD) who practice as general or family medicine practitioners, general internal medicine physicians, pediatricians, obstetricians or gynecologists. While the population-to-provider ratio needed to qualify for designation varies by HPSA type (population, geographic or facility), all HPSAs with a primary care shortage designation have a population-to-provider ratio that meets or exceeds certain thresholds stipulated by federal regulations. Areas designated as an HPSA are eligible to participate in federal programs aimed at attracting more primary care practitioners to work with these medically underserved populations. The HRSA estimates that, as of September 30, 2020, all primary care HPSAs in the U.S. would need nearly 15,000 more primary care providers to eliminate all shortage designations.

HPSAs in the MidEast region account for just over 8% of the U.S. population who live in primary care shortage areas. To eliminate the primary care shortage in the region, the HRSA estimates that MidEast region HPSAs would need over 1,550 more primary care providers. Here is a summary look at the primary care shortage in the MidEast region:

The Primary Care Shortage in the MidEast Region

State	(1) HPSAs	(2) Population	(3) Shortage
DC	15	240.5	58
DE	13	233.9	55
MD	45	801.5	112
NJ	36	28.7	22
NY	168	4,917.4	1,197
PA	139	511.0	114
Region	416	6,733.0	1,558
U.S.	7,203	81,516.3	14,945

(1) Designated Geographic, Population Group and Facility HPSAs with a primary care shortage

(2) Population of designated HPSAs, in thousands

(3) Primary Care practitioners needed to remove HPSA Designation

Source:  Designated HPSA Quarterly Summary, 9/30/20 (HRSA)

The Covid-19 Outbreak and Medicaid Enrollment in New England

In a previous commentary, we examined the impact of Covid-19 on enrollment in Medicaid, the joint federal-state health insurance program for eligible individuals with limited income and resources. Historically, Medicaid enrollment increases during economically difficult periods. Weak economic periods produce more unemployment, more people without job-related health insurance, more people in lower household incomes, and more people with eligibility for health insurance coverage through the Medicaid program. Conversely, during strong economic periods Medicaid enrollment tends to drop off or decline.

As in previous economic downturns, the Covid-19 induced recession has sparked an increase in Medicaid enrollment. Moreover, agencies that manage the Medicaid program in each state now forecast still more enrollment growth in the months ahead. Every region of the U.S. has experienced growth in its Medicaid enrollment numbers since the Covid-19 pandemic began. In the New England states, Covid-19's impact on Medicaid enrollment has been less severe than in other sections of the country. That said, after several years of stagnant enrollment numbers, in the first half of 2020 Medicaid enrollment in the region grew 5.6%, as compared to 6.5% nationally. Here's a summary look at the Covid-19 outbreak and Medicaid enrollment growth in New England during the first half of 2020:

The Covid-19 Outbreak and Medicaid Enrollment in New England

	Medicaid Enrollment (in 000s)
State	July 1, 2020	Jan 1, 2020		Growth
CT	865.5	826.7		4.7%
MA	1,440.1	1,370.6		5.1%
ME	222.5	209.7		6.1%
NH	181.7	166.4		9.2%
RI	279.2	259.9		7.4%
VT	158.3	146.2		8.3%
NE Only	3,147.4	2,979.5		5.6%
National	68,826.6	64,621.4		6.5%

Source: Medicaid.gov Enrollment Reports.