An Introduction to the Medically Underserved Population Designation; Why It Matters

By Dr. Rick Rader

About the Author

Rick Rader, MD, FAAIDD, is the director of the Habilitation Center at the Orange Grove Center and serves as the editor in chief of Exceptional Parentmagazine. He is the vice president for Public Policy and Advocacy at the American Academy of Developmental Medicine and Dentistry. He is on the Board of the American Association on Health and Disability and serves as the senior global advisor for Inclusive Health Innovation at Special Olympics International.

Our hope is that this weekly blog will offer information you want to know, so if you have a question you want answered about employment for people with disabilities or other mysteries of the world of work, please email me at janet.shouse@vumc.org.

While most physicians are attracted to medicine for the ultimate reward of curing people; the discipline of “developmental medicine” (treating patients with intellectual and developmental disabilities) offers equally rewarding outcomes. We do not cure Down syndrome, autism, cerebral palsy, Fragile X syndrome or the multitude of other syndromes, disorders and conditions that constitute developmental disabilities. Instead we have the potential to impact  health policy, educate the next generation of clinicians, empower families, engage in shared decision making, conduct applied research and ease some of the stresses around transition to adult care.

I am fortunate to have been involved in developmental medicine for the past 25 years. In my capacity as the director of the Morton J. Kent Habilitation Center at the Orange Grove Center in Chattanooga, I have been engaged in the identification, initiation and implementation of novel innovative medical programs designed to address the many health concerns across the lifespan for this marginalized population. It is unfortunate that most medical students do not receive any formal training in treating patients with intellectual and developmental disabilities. While most medical students and graduates would like to treat them, research studies have revealed that most newly graduated physicians do not have the confidence in treating this population. There are only a handful of elective clinical rotations that provide the hands-on experience that give the needed exposure to the challenges and rewards of working with patients with IDD.

Many medical students who have been introduced to “developmental medicine” report they found the “patient stories” so compelling that they would like to continue to treat this population as they move forward in their careers.  One of the reasons those students with an expressed interest are unable to follow this as a career path is the low reimbursement that accompanies this population. Many medical students graduate with student loans (college and medical school) approaching $400,000 to $500,000. They are often forced to pursue higher income specialties.

A potential solution to this dilemma (follow your heart or follow your debt) is the designation of people with intellectual and developmental disabilities as a “medically underserved population” or MUP.

This is a federal government designation provided to certain populations that have been determined as being underserved by our health care system and thus being at risk for adverse health outcomes. Examples of these “medically underserved populations” include Native Americans, residents of public housing, and migrant and seasonal agricultural workers. Physicians who provide treatment to these populations are eligible to receive student loan reduction or forgiveness (depending on their commitment). The loan reduction, coupled with salaries, would level the playing field and provide an attractive and rewarding opportunity to pursue the practice of developmental medicine.

Other opportunities that are part of the MUP designation include access to research opportunities, visa programs for foreign-born and foreign-trained physicians and establish community health centers. The designation would also include special populations as medical research subjects. There has been an aggressive, concerted and long-standing effort to petition the appropriate federal  agency, the Health Resources Service Administration, to implement this designation. Unfortunately, due to a complex political infrastructure, the effort has been unsuccessful. For more than 15 years the American Academy of Developmental Medicine and Dentistry, www.aadmd.org,has advocated for this designation. The organization has been able to influence several major national health care organizations (including the American Medical Association, the American Dental Association, The American College of Physicians, the President’s Committee for People with Intellectual Disabilities, The American Public Health Association, The National Council on Disability, and The American Physical Therapy Association) to adopt resolutions recommending that the federal government should issue the MUP designation to this population.

Finally, after years of a diligent campaign to achieve this recognition, there is light at the end of the tunnel.

On July 26, Reps. Seth Moulton, D-MA, and Gregg Harper, R-MS, introduced the Healthcare Extension and Accessibility for Developmentally Disabled and Underserved Population (HEADs UP) Act of 2018. This bill would declare people with IDD a medically underserved population.

People with IDD face a shortage of primary care providers, as well as higher infant mortality rates, higher poverty rates, and shorter life expectancy than the general population.

The MUP designation comes with increased access to resources from 25 different government programs including Federally Qualified Health Centers, Community Health Centers, loan repayment and training programs under Health Resources and Services Administration Workforce Development and Training Programs, and preference in research within agencies such as the National Institutes of Health.

I would urge you to contact your federal lawmakers and urge them to familiarize themselves with the HEADS UP Act bill (H.R. 6611)and also support it. You have an opportunity to influence policy and to address the health disparities experienced by individuals with intellectual and developmental disabilities.


I want to thank Dr. Rader for taking the time to explain why this effort is so important, both for those with intellectual and developmental disabilities and for those medical professionals who want to provide health care to this population. Rick is one of those people who seems to be involved in about 14 different projects at one time and knowledgeable about all of them. Thank you, Rick, for the work you do! As always, if you have questions about the blog, please contact me, Janet Shouse, at janet.shouse@vumc.org.