Access to Care Ranking 2021



 

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The Access Ranking indicates how much access to mental health care exists within a state. The access measures include access to insurance, access to treatment, quality and cost of insurance, access to special education, and workforce availability. A high Access Ranking (1-13) indicates that a state provides relatively more access to insurance and mental health treatment.

The 9 measures that make up the Access Ranking include:

  1.  Adults with AMI who Did Not Receive Treatment
  2.  Adults with AMI Reporting Unmet Need
  3. Adults with AMI who are Uninsured
  4.  Adults with Cognitive Disability who Could Not See a Doctor Due to Costs
  5.  Youth with MDE who Did Not Receive Mental Health Services
  6.  Youth with Severe MDE who Received Some Consistent Treatment
  7.  Children with Private Insurance that Did Not Cover Mental or Emotional Problems
  8.  Students Identified with Emotional Disturbance for an Individualized Education Program
  9.  Mental Health Workforce Availability
Rank State
01 Vermont
02 Massachusetts
03 Maine
04 District of Columbia
05 Delaware
06 Minnesota
07 Wisconsin
08 Rhode Island
09 Ohio
10 New Hampshire
11 Maryland
12 Pennsylvania
13 Connecticut
14 Hawaii
15 Iowa
16 Washington
17 Michigan
18 Kentucky
19 Montana
20 New York
21 Oregon
22 South Dakota
23 New Jersey
24 North Dakota
25 New Mexico
26 Indiana
27 Louisiana
28 Illinois
29 Nebraska
30 West Virginia
31 Colorado
32 Utah
33 Oklahoma
34 California
35 Idaho
36 Kansas
37 Alaska
38 Wyoming
39 Virginia
40 Arizona
41 Missouri
42 Arkansas
43 Tennessee
44 North Carolina
45 South Carolina
46 Nevada
47 Alabama
48 Florida
49 Mississippi
50 Texas
51 Georgia

Adults with AMI who are Uninsured 2021

 

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10.8% (over 5.1 million) of adults with a mental illness remain uninsured.

The rankings for this indicator used data from the 2017-2018 NSDUH. In December 2017, Congress passed the Tax Cuts and Jobs Act, which eliminated the individual mandate penalty from the ACA.

There was a 0.5% increase from last year's dataset, the first time this indicator has increased since the passage of the ACA.

The increase in this indicator is consistent with data from the U.S. Census Bureau, which found that in 2018, the rate of uninsured Americans rose for the first time since the ACA took effect. 

Only twenty states saw a reduction in Adults with AMI who are uninsured in this year's dataset. The largest reductions were seen in Louisiana (5.0%), South Dakota (3.3%), Kentucky (2.4%) and Kansas (2.2%). The largest increases were seen in Iowa (5.1%), Mississippi (3.9%), Arkansas (3.7%) and Missouri (3.2%).

The state prevalence of uninsured adults with mental illness ranges from 2.5% in the District of Columbia to 23.0% in Wyoming.

Rank State Percentage Number
01 District of Columbia 2.5 3000
02 Vermont 3.9 4000
03 Massachusetts 4.2 51000
04 Connecticut 4.6 25000
05 Kentucky 4.8 37000
06 New York 5.1 139000
07 Rhode Island 5.8 11000
08 Pennsylvania 6 108000
09 Michigan 6.4 93000
10 New Mexico 6.4 19000
11 Hawaii 6.4 12000
12 Delaware 6.8 10000
13 Maryland 7 55000
14 Ohio 7.1 138000
15 Minnesota 7.3 58000
16 Wisconsin 7.4 62000
17 New Hampshire 7.5 17000
18 California 7.8 434000
19 South Dakota 8.2 9000
20 West Virginia 8.3 31000
21 Iowa 8.4 39000
22 New Jersey 8.8 94000
23 North Dakota 8.8 9000
24 Illinois 8.9 151000
25 Colorado 9 84000
26 Oregon 9 67000
27 Arizona 9.6 97000
28 Louisiana 9.7 72000
29 Nebraska 10.3 25000
30 Montana 10.3 17000
31 Nevada 10.5 51000
32 Washington 10.6 140000
33 Arkansas 10.9 51000
34 Indiana 11.4 134000
35 Alaska 11.6 12000
36 Utah 11.7 67000
37 Kansas 12.4 52000
38 South Carolina 12.5 85000
39 Maine 12.7 29000
40 Virginia 13.5 147000
41 Idaho 13.7 46000
42 North Carolina 13.8 204000
43 Oklahoma 15.9 92000
44 Missouri 16.2 169000
45 Florida 17.4 503000
46 Georgia 18.5 255000
47 Alabama 18.8 154000
48 Tennessee 19 171000
49 Texas 20.1 664000
50 Mississippi 22.2 95000
51 Wyoming 23 21000
52 National 10.8 511,400

Adults with AMI who Did Not Receive Treatment

 

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57% of adults with a mental illness receive no treatment. 

Over 26 million individuals experiencing a mental illness are going untreated.

The state prevalence of untreated adults with mental illness ranges from 42.8% in Vermont to 65.8% in Hawaii.

Rank State Percentage Number
01 Vermont 42.8 45000
02 Arkansas 47.5 221000
03 Rhode Island 49 89000
04 Wisconsin 49.2 412000
05 Massachusetts 49.5 597000
06 Delaware 49.7 75000
07 Iowa 49.8 231000
08 Maine 49.9 114000
09 Ohio 50.7 978000
10 Kentucky 50.9 392000
11 Colorado 50.9 475000
12 Kansas 51.1 213000
13 Utah 51.2 294000
14 South Carolina 51.4 349000
15 Tennessee 51.7 463000
16 New Hampshire 51.9 116000
17 West Virginia 52.2 193000
18 District of Columbia 52.2 68000
19 Minnesota 52.6 416000
20 Arizona 52.7 535000
21 Pennsylvania 53 953000
22 Nebraska 53 128000
23 Washington 53.5 704000
24 Idaho 53.5 177000
25 Michigan 53.8 779000
26 Connecticut 53.9 287000
27 Montana 54.2 89000
28 Virginia 54.5 589000
29 North Dakota 54.5 56000
30 South Dakota 54.8 57000
31 Missouri 55.3 576000
32 Illinois 55.8 946000
33 Indiana 55.9 653000
34 North Carolina 56.5 833000
35 New Mexico 56.6 167000
36 Alabama 56.7 463000
37 Mississippi 57.7 247000
38 Oklahoma 58.9 340000
39 Maryland 59.1 459000
40 Oregon 59.3 442000
41 Texas 59.6 1960000
42 New Jersey 60 644000
43 New York 60.3 1655000
44 Nevada 60.3 282000
45 Louisiana 62 459000
46 Florida 63 1816000
47 Wyoming 64.8 60000
48 Georgia 64.9 888000
49 California 65 3620000
50 Alaska 65.5 70000
51 Hawaii 65.8 124000
52 National 57 267,970

Adults with AMI Reporting Unmet Need 2021

 

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Almost a quarter (23.6%) of all adults with a mental illness reported that they were not able to receive the treatment they needed.  This number has not declined since 2011.

Individuals seeking treatment but still not receiving needed services face the same barriers that contribute to the number of individuals not receiving treatment:

  1. No insurance or limited coverage of services.
  2. Shortfall in psychiatrists, and an overall undersized mental health workforce.
  3. Lack of available treatment types (inpatient treatment, individual therapy, intensive community services).
  4. Disconnect between primary care systems and behavioral health systems.
  5. Insufficient finances to cover costs ñ including copays, uncovered treatment types, or when providers do not take insurance.

The state prevalence of adults with AMI reporting unmet treatment needs ranges from 12% in Hawaii to 31.6% in Kansas.

Rank State Percentage Number
01 Hawaii 12 23000
02 Alabama 18.7 153000
03 Texas 19.9 655000
04 Wyoming 19.9 18000
05 Minnesota 20.7 163000
06 New Mexico 20.8 61000
07 Tennessee 20.9 188000
08 Louisiana 21 155000
09 New York 21.4 585000
10 Massachusetts 21.6 263000
11 Florida 21.9 633000
12 Ohio 22.1 427000
13 Idaho 22.1 73000
14 Vermont 22.5 24000
15 California 22.8 1272000
16 Illinois 22.9 388000
17 West Virginia 22.9 84000
18 Delaware 23 35000
19 Georgia 23.1 317000
20 North Dakota 23.3 24000
21 Oklahoma 23.5 136000
22 Washington 23.7 310000
23 Mississippi 23.8 102000
24 Indiana 23.9 281000
25 Michigan 24.4 353000
26 New Jersey 24.4 262000
27 Alaska 24.4 26000
28 Kentucky 24.5 189000
29 Montana 24.6 41000
30 Maine 24.8 57000
31 New Hampshire 24.8 55000
32 Wisconsin 24.9 209000
33 Maryland 25.2 196000
34 Connecticut 25.4 135000
35 Iowa 25.5 117000
36 Arizona 25.8 259000
37 Arkansas 26 122000
38 Missouri 26.1 272000
39 Nevada 26.1 122000
40 Nebraska 26.2 63000
41 South Dakota 26.4 28000
42 North Carolina 26.5 391000
43 South Carolina 26.6 181000
44 Pennsylvania 26.8 480000
45 Rhode Island 27.9 50000
46 Colorado 28.2 263000
47 Virginia 28.6 309000
48 District of Columbia 29.4 38000
49 Utah 30.1 172000
50 Oregon 30.2 225000
51 Kansas 31.6 132000
52 National 23.6 111,190

Adults with Disability Who Could Not See a Doctor Due to Costs

 

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28.69% of adults with a cognitive disability were not able to see a doctor due to costs.

According to the Centers for Disease Control (CDC), 11.5% of people in the U.S. had a cognitive disability in 2018, even when adjusted for age. The percentage of people with cognitive disability ranged from 7.9% in some states to 17.9%.

A 2017 study found that compared to working-age adults without disabilities, those with disabilities are more likely to live below the federal poverty level and to use public insurance. Their average health costs were also 3-7 times higher than those without disabilities.

The prevalence of adults with cognitive disability who couldn't see a MD due to cost ranges from 17.10% in the District of Columbia to 41.92% in Georgia.

Rank State Percentage Number
01 District of Columbia 17.10 8373
02 Iowa 17.54 37774
03 Hawaii 17.63 16639
04 Massachusetts 18.56 109857
05 Vermont 19.02 9542
06 New York 20.97 314383
07 Delaware 20.98 18284
08 Ohio 21.02 236528
09 Connecticut 21.61 53913
10 Pennsylvania 22.48 277857
11 Montana 22.85 20088
12 North Dakota 23.74 12428
13 Minnesota 24.20 91135
14 Maine 24.37 33492
15 Washington 24.84 141746
16 Michigan 25.18 252279
17 New Jersey 25.19 177138
18 Nevada 25.27 76372
19 Rhode Island 25.71 26383
20 Kentucky 25.85 137755
21 West Virginia 25.99 65433
22 Oregon 26.03 108294
23 New Hampshire 26.91 28858
24 California 27.05 796447
25 Indiana 27.10 157334
26 Arizona 27.17 153262
27 Wyoming 27.44 12362
28 Colorado 27.45 88135
29 Maryland 27.45 111740
30 Louisiana 28.08 160506
31 Oklahoma 28.18 115914
32 Wisconsin 28.20 119187
33 New Mexico 28.23 54533
34 South Dakota 28.36 17869
35 Illinois 29.66 249140
36 Kansas 30.27 70938
37 Alaska 30.90 17348
38 Idaho 31.04 43794
39 Nebraska 31.66 39724
40 Tennessee 31.86 245411
41 Utah 31.92 75977
42 Missouri 32.87 190827
43 South Carolina 33.75 179775
44 Arkansas 34.16 111986
45 Virginia 34.24 223528
46 Texas 34.57 690102
47 Mississippi 35.20 130909
48 North Carolina 35.23 343530
49 Florida 35.36 754413
50 Alabama 36.70 212868
51 Georgia 41.92 410646
52 National 28.69 815,377

Youth with MDE who Did Not Receive Mental Health Services 2021



 

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59.6% of youth with major depression do not receive any mental health treatment.

Youth experiencing MDE continue to go untreated. Even among the states with greatest access for youth, over 1 in 3 youth are still not receiving the mental health services they need.

The state prevalence of untreated youth with depression ranges from 38.6% in Maine to 71.0% in Nevada.

Rank State Percentage Number
01 Maine 38.6 6000
02 District of Columbia 38.8 1000
03 Vermont 40.7 2000
04 Maryland 41.3 23000
05 Utah 45.2 22000
06 Washington 47 38000
07 Wisconsin 47.2 33000
08 Delaware 47.9 4000
09 Kentucky 49.3 19000
10 South Dakota 49.7 3000
11 Ohio 52.2 59000
12 Virginia 53 51000
13 Indiana 53 48000
14 Iowa 53 20000
15 North Dakota 53.4 3000
16 Rhode Island 53.4 5000
17 Oregon 53.9 30000
18 Kansas 54.7 19000
19 Louisiana 54.9 24000
20 Minnesota 55.4 32000
21 Nebraska 55.4 12000
22 Montana 55.6 5000
23 Michigan 55.7 66000
24 New Jersey 55.7 40000
25 Hawaii 56.2 5000
26 Wyoming 56.6 4000
27 New Hampshire 56.9 9000
28 Pennsylvania 57.5 56000
29 Alaska 57.8 5000
30 Missouri 58.8 40000
31 New York 59.1 85000
32 Connecticut 59.1 24000
33 West Virginia 59.3 11000
34 Arizona 59.6 52000
35 North Carolina 60.2 77000
36 Colorado 60.9 29000
37 Oklahoma 61.1 35000
38 Idaho 61.2 15000
39 Massachusetts 61.2 41000
40 Tennessee 61.5 35000
41 Illinois 62.1 90000
42 New Mexico 62.9 20000
43 Arkansas 63.9 23000
44 Florida 64.7 116000
45 California 66 259000
46 Mississippi 66.3 18000
47 Texas 67.1 209000
48 South Carolina 68 36000
49 Alabama 69.7 31000
50 Georgia 70.4 73000
51 Nevada 71 23000
52 National 59.60% 1988000

Youth with Severe MDE who Received Some Consistent Treatment 2021



 

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High percentages are associated with positive outcomes and low percentages are associated with poorer outcomes.

Nationally, only 27.3% of youth with severe depression receive some consistent treatment (7-25+ visits in a year). 

Late recognition in primary care settings and limited coverage of mental health services often prevent youth from receiving timely and effective treatment.

The state prevalence of youth with severe depression who received some outpatient treatment ranges from 50.0% in Maine to 11.2% in Nevada.

Rank State Percentage Number
01 Maine 50 5000
02 Maryland 49.2 21000
03 Vermont 45.4 2000
04 Delaware 41.5 2000
05 Rhode Island 41.2 3000
06 Wisconsin 40.4 23000
07 Oregon 37.9 14000
08 Massachusetts 37.7 15000
09 District of Columbia 37.3 1000
10 Pennsylvania 37.1 23000
11 Wyoming 36.3 2000
12 Ohio 36 28000
13 Nebraska 35.9 5000
14 Idaho 35.8 6000
15 New Hampshire 34.9 3000
16 Kentucky 34.2 10000
17 Minnesota 33.7 13000
18 North Dakota 33 1000
19 New Jersey 32.5 16000
20 Louisiana 32 9000
21 Kansas 31.1 7000
22 Arkansas 30 7000
23 Alaska 29.9 2000
24 Michigan 29.8 24000
25 Montana 29.3 2000
26 South Dakota 29.2 1000
27 Iowa 28.8 7000
28 South Carolina 28.3 9000
29 Hawaii 28.3 2000
30 West Virginia 27.8 4000
31 Tennessee 27.3 12000
32 Washington 26.7 13000
33 Indiana 26.1 16000
34 Virginia 26.1 16000
35 Alabama 25.9 6000
36 Texas 25 54000
37 Illinois 25 26000
38 Arizona 24.7 15000
39 California 24.6 59000
40 Utah 24.5 8000
41 Oklahoma 23.5 8000
42 New Mexico 22.6 5000
43 New York 21.9 22000
44 North Carolina 21.9 21000
45 Connecticut 21.6 5000
46 Colorado 21.5 8000
47 Florida 19.7 24000
48 Georgia 19.2 15000
49 Missouri 19 9000
50 Mississippi 14.9 2000
51 Nevada 11.2 3000
52 National 27.3 614000

Children with Private Insurance that Did Not Cover Mental or Emotional Problems 2021



 

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The Mental Health Parity and Addiction Equity law (MHPAE) was enacted in 2008, and promised the equal coverage of mental health and substance use services. The rate of children with private insurance that does not cover mental or emotional problems decreased 0.3% from last year's dataset. However, there are still 901,000 youth without coverage for their behavioral health. 

In 2019, a Milliman research report found large disparities between behavioral health and medical/surgical services, including that patients saw out-of-network behavioral health providers at much higher rates than physical health providers. It also found that these disparities were worse for children. In 2017, a behavioral health visit for a child was over 10 times more likely to be out-of-network than a primary care office visit. This was over two times the disparity shown for adults. 

To improve the worsening mental health of children and adolescents in the U.S., insurance companies must not only achieve parity in coverage of services, but also in network adequacy, so people are able to access those services when they need them. 

The state prevalence of children lacking mental health coverage ranges from 0.6% in Vermont to 14.8% in South Carolina.

Rank State Percentage Number
01 Vermont 0.6 0
02 Massachusetts 1.2 4000
03 New Hampshire 2.5 1000
04 Connecticut 3.3 5000
05 Maine 3.4 2000
06 New Jersey 4 14000
07 District of Columbia 4.6 1000
08 Washington 5.2 16000
09 Rhode Island 5.3 2000
10 Montana 5.4 2000
11 South Dakota 5.4 2000
12 Michigan 5.5 23000
13 Wisconsin 5.5 16000
14 Ohio 5.9 26000
15 Missouri 5.9 14000
16 Alabama 5.9 7000
17 Pennsylvania 6.1 29000
18 Georgia 6.5 23000
19 Virginia 6.6 21000
20 Oregon 6.7 10000
21 Delaware 6.9 3000
22 Indiana 7.1 22000
23 Illinois 7.2 34000
24 Maryland 7.2 18000
25 West Virginia 7.2 4000
26 California 7.5 100000
27 Minnesota 7.5 20000
28 Mississippi 7.5 6000
29 Iowa 7.5 10000
30 Louisiana 7.6 10000
31 New Mexico 7.8 4000
32 Utah 7.8 16000
33 Oklahoma 7.9 11000
34 Kansas 7.9 9000
35 New York 8.3 49000
36 Colorado 8.3 17000
37 Hawaii 9.2 3000
38 Florida 9.4 52000
39 North Carolina 10 33000
40 Alaska 10.3 2000
41 Kentucky 11 17000
42 Texas 11.5 108000
43 Wyoming 12 3000
44 Arizona 12.1 32000
45 Nevada 12.6 13000
46 Nebraska 12.6 10000
47 Idaho 12.7 10000
48 North Dakota 13.5 5000
49 Tennessee 13.5 27000
50 Arkansas 14.4 13000
51 South Carolina 14.8 23000
52 National 7.8 901000

Students Identified with Emotional Disturbance for an Individualized Education Program 2021



 

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High percentages are associated with positive outcomes and low percentages are associated with poorer outcomes

Only .757% of students are identified as having an Emotional Disturbance (ED) for an Individualized Education Program (IEP).

For purposes of an IEP, the term ìEmotional Disturbanceî is used to define youth with a mental illness that is affecting their ability to succeed in school.

Early identification for IEPs is critical. IEPs provide the services, accommodations and support students with ED need to receive a quality education. Inadequate education leads to poor outcomes such as low academic achievement, social isolation, unemployment, and involvement in the juvenile system. Further, the federal eligibility criteria to identify students as having an emotional disturbance for an IEP have indicated extremely poor reliability among school psychologists,2 and therefore must be revised to adequately identify students in need of more supports.

The rate for this measure is shown as a rate per 1,000 students.

The calculation was made this way for ease of reading.Unfortunately, doing so hides the fact that the percentages are significantly lower. If states were doing a better job of identifying whether youth had emotional difficulties that could be better supported through an IEP ñ the rates would be closer to 8% instead of .8 percent.

The state rate of students identified as having an emotional disturbance for an IEP ranges from 30.41 per 1,000 students in Vermont to 2.09 per 1,000 students in Alabama.

Rank State Percentage Number
01 Vermont 30.41 2233
02 Minnesota 20.69 16510
03 Massachusetts 19.51 16935
04 Wisconsin 16.18 *
05 Pennsylvania 15.76 25166
06 Maine 14.35 2328
07 Indiana 13.41 12838
08 Iowa 13.31 5896
09 New Hampshire 12.77 2095
10 Rhode Island 12.38 1615
11 District of Columbia 12.32 827
12 Connecticut 11.94 5691
13 North Dakota 11.85 1183
14 Illinois 10.19 18237
15 Nebraska 10.06 2846
16 Ohio 9.97 15377
17 South Dakota 9.89 1213
18 Oregon 9.81 5286
19 Delaware 9.25 1152
20 New York 9.15 22553
21 Missouri 8.66 7072
22 Michigan 8.45 11458
23 Virginia 8.38 9782
24 Maryland 7.64 6107
25 Mississippi 7.62 3326
26 Arizona 7.61 7742
27 Kentucky 7.45 4524
28 Oklahoma 6.89 4142
29 Colorado 6.88 5596
30 Wyoming 6.72 579
31 Texas 6.60 31519
32 Montana 6.50 881
33 Georgia 6.45 10286
34 Alaska 6.26 745
35 New Mexico 6.16 1853
36 New Jersey 5.98 7485
37 Hawaii 5.74 947
38 Florida 5.68 14604
39 Kansas 5.53 2436
40 Washington 5.25 5324
41 Idaho 4.95 1372
42 West Virginia 4.80 1133
43 Nevada 4.43 1959
44 California 4.42 25118
45 Tennessee 3.76 3381
46 North Carolina 3.72 5275
47 Utah 3.17 1918
48 South Carolina 3.04 2112
49 Louisiana 2.70 1715
50 Arkansas 2.42 1070
51 Alabama 2.09 1406
52 National 7.57 344473

Mental Health Workforce Availability 2021



 

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The term ìmental health providerî includes psychiatrists, psychologists, licensed clinical social workers, counselors, marriage and family therapists, and advanced practice nurses specializing in mental health care, but not yet certified peer specialists (because peer specialists are primarily covered only by Medicaid, and qualifications for them vary state by state).

The rate of mental health providers has improved in nearly every state since last year's report. However, the need for mental health care will greatly outpace these additions to the workforce, especially as rates of depression, anxiety and other mental health concerns increase in response to the coronavirus pandemic and increased awareness of ongoing racial injustice in 2020.

However, the COVID-19 pandemic has also shown that these workforce shortages can be mitigated through different models of care delivery. The Center for Medicare and Medicaid Services (CMS) encouraged states to reduce barriers to tele-mental health under Medicaid, and Medicare allowed audio-only tele-mental health visits during the pandemic. If these changes to care delivery are made permanent and coverage for peer support specialists and other paraprofessionals is expanded, these could help mitigate some of the effects of provider shortages in the future. 

The state rate of mental health workforce ranges from 160:1 in Massachusetts to 990:1 in Alabama.

Rank State Number
01 Massachusetts 160:1
02 Oregon 190:1
03 District of Columbia 210:1
04 Maine 210:1
05 Vermont 220:1
06 Alaska 230:1
07 Rhode Island 240:1
08 Connecticut 250:1
09 Oklahoma 250:1
10 New Mexico 260:1
11 Washington 270:1
12 California 280:1
13 Colorado 280:1
14 Utah 300:1
15 Wyoming 300:1
16 Montana 330:1
17 New Hampshire 330:1
18 Louisiana 340:1
19 New York 350:1
20 Michigan 370:1
21 Delaware 380:1
22 Nebraska 380:1
23 Maryland 390:1
24 Hawaii 400:1
25 Minnesota 400:1
26 North Carolina 410:1
27 Ohio 410:1
28 Arkansas 440:1
29 Illinois 440:1
30 Kentucky 440:1
31 New Jersey 450:1
32 Nevada 470:1
33 Idaho 480:1
34 Pennsylvania 480:1
35 Wisconsin 490:1
36 Kansas 510:1
37 Missouri 510:1
38 North Dakota 530:1
39 South Dakota 550:1
40 South Carolina 570:1
41 Virginia 570:1
42 Florida 620:1
43 Indiana 620:1
44 Mississippi 630:1
45 Iowa 640:1
46 Tennessee 660:1
47 Georgia 730:1
48 Arizona 750:1
49 West Virginia 770:1
50 Texas 880:1
51 Alabama 990:1