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Access to Care Ranking 2022



 

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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 Sort descending State
01 Vermont
02 Massachusetts
03 Maine
04 Wisconsin
05 Minnesota
06 New Hampshire
07 Rhode Island
08 Pennsylvania
09 Connecticut
10 District of Columbia
11 Washington
12 Montana
13 Illinois
14 Maryland
15 New York
16 Kentucky
17 Delaware
18 Iowa
19 Oregon
20 New Mexico
21 Colorado
22 Ohio
23 South Dakota
24 New Jersey
25 Michigan
26 Utah
27 North Dakota
28 Oklahoma
29 West Virginia
30 California
31 Hawaii
32 Indiana
33 Nebraska
34 Alaska
35 Louisiana
36 Wyoming
37 Virginia
38 North Carolina
39 Nevada
40 Arkansas
41 Missouri
42 Idaho
43 South Carolina
44 Kansas
45 Tennessee
46 Arizona
47 Mississippi
48 Georgia
49 Florida
50 Alabama
51 Texas

Adults with Ami Who Are Uninsured 2022


 

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11.1% (over 5.5 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 3.8% in Massachusetts to 21.5% in Texas.

Rank Sort descending State Percentage Number
01 Massachusetts 3.80% 45,000
02 Kentucky 4.20% 33,000
03 Rhode Island 4.40% 9,000
04 District of Columbia 4.70% 6,000
05 Hawaii 4.70% 9,000
06 Vermont 5.10% 6,000
07 New York 5.20% 151,000
08 Connecticut 5.40% 28,000
09 Maryland 5.60% 43,000
10 Pennsylvania 5.90% 115,000
11 Wisconsin 6.30% 56,000
12 Michigan 6.90% 108,000
13 Ohio 6.90% 150,000
14 Illinois 7.10% 130,000
15 Delaware 7.30% 12,000
16 California 7.40% 434,000
17 Minnesota 8.00% 69,000
18 New Mexico 8.10% 28,000
19 New Hampshire 8.80% 22,000
20 Alaska 9.70% 11,000
21 North Dakota 9.80% 11,000
22 South Dakota 9.80% 10,000
23 Montana 10.00% 17,000
24 West Virginia 10.10% 37,000
25 New Jersey 10.60% 116,000
26 Colorado 10.80% 113,000
27 Arkansas 11.30% 52,000
28 Iowa 11.30% 46,000
29 Utah 11.30% 70,000
30 Nevada 11.50% 61,000
31 Arizona 11.60% 127,000
32 Nebraska 11.60% 32,000
33 Washington 11.60% 165,000
34 Oregon 11.80% 95,000
35 Louisiana 12.40% 95,000
36 Virginia 12.40% 147,000
37 Maine 12.60% 31,000
38 Indiana 13.40% 153,000
39 Idaho 14.00% 42,000
40 Kansas 14.00% 63,000
41 Georgia 15.20% 207,000
42 Tennessee 15.30% 148,000
43 North Carolina 15.40% 240,000
44 South Carolina 15.60% 119,000
45 Oklahoma 17.60% 117,000
46 Florida 17.80% 512,000
47 Wyoming 18.00% 19,000
48 Mississippi 18.20% 81,000
49 Alabama 19.30% 154,000
50 Missouri 19.30% 209,000
51 Texas 21.50% 759,000
52 National 11.1 5,514,000

Adults with Ami Who Did Not Receive Treatment 2022


 

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Over half (56%) of adults with a mental illness receive no treatment. 

Over 27 million individuals experiencing a mental illness are going untreated.

The state prevalence of untreated adults with mental illness ranges from 42.6% in Vermont to 67.1% in Hawaii.

Rank Sort descending State Percentage Number
01 Vermont 42.60% 49,000
02 Iowa 44.20% 181,000
03 Massachusetts 44.70% 526,000
04 Wisconsin 44.80% 400,000
05 Minnesota 46.10% 401,000
06 Maine 47.70% 117,000
07 Nebraska 48.80% 134,000
08 Arkansas 49.60% 228,000
09 Utah 49.70% 307,000
10 North Dakota 50.10% 56,000
11 Ohio 50.30% 1,088,000
12 Rhode Island 51.00% 99,000
13 Montana 51.10% 89,000
14 Kansas 51.20% 229,000
15 North Carolina 51.60% 801,000
16 West Virginia 51.70% 191,000
17 Pennsylvania 51.90% 1,012,000
18 New Hampshire 52.30% 131,000
19 South Dakota 52.30% 56,000
20 Illinois 52.60% 958,000
21 Missouri 53.30% 575,000
22 Idaho 53.40% 161,000
23 Kentucky 53.50% 420,000
24 Tennessee 53.50% 514,000
25 Colorado 53.60% 558,000
26 Connecticut 54.00% 276,000
27 Delaware 54.20% 86,000
28 New Mexico 54.20% 185,000
29 Washington 54.30% 778,000
30 Oregon 54.50% 439,000
31 Virginia 54.70% 645,000
32 District of Columbia 55.20% 74,000
33 Michigan 55.40% 866,000
34 South Carolina 56.10% 427,000
35 Oklahoma 56.60% 376,000
36 Indiana 56.70% 643,000
37 Arizona 57.00% 619,000
38 New Jersey 57.10% 627,000
39 Alabama 57.30% 454,000
40 Maryland 58.00% 452,000
41 Nevada 58.00% 305,000
42 New York 58.30% 1,690,000
43 Alaska 58.70% 66,000
44 Mississippi 59.30% 265,000
45 Louisiana 59.60% 453,000
46 Texas 60.70% 2,148,000
47 Wyoming 61.70% 64,000
48 California 61.80% 3,617,000
49 Florida 63.50% 1,823,000
50 Georgia 63.50% 860,000
51 Hawaii 67.10% 127,000
52 National 55.90% 27,646,000

Adults with Ami Reporting Unmet Need 2022


 

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Almost a quarter (24.7%) 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 14.9% in Hawaii to 37.1% in the District of Columbia.

Rank Sort descending State Percentage Number
01 Hawaii 14.90% 28,000
02 Louisiana 18.40% 139,000
03 South Carolina 19.70% 150,000
04 Montana 21.50% 37,000
05 Minnesota 21.60% 187,000
06 New Jersey 21.60% 238,000
07 Massachusetts 21.70% 255,000
08 New York 21.70% 628,000
09 West Virginia 22.20% 82,000
10 Florida 22.40% 643,000
11 New Hampshire 22.40% 56,000
12 New Mexico 22.70% 78,000
13 Kentucky 22.90% 181,000
14 Oklahoma 22.90% 152,000
15 Wisconsin 22.90% 204,000
16 Illinois 23.20% 422,000
17 California 23.50% 1,379,000
18 Connecticut 23.50% 120,000
19 Texas 24.00% 845,000
20 Washington 24.00% 341,000
21 Georgia 24.10% 326,000
22 Alaska 24.40% 28,000
23 Wyoming 24.50% 25,000
24 Arkansas 24.70% 114,000
25 Ohio 24.80% 540,000
26 Vermont 25.20% 29,000
27 Mississippi 25.30% 113,000
28 South Dakota 25.30% 27,000
29 Rhode Island 25.40% 50,000
30 North Dakota 25.60% 29,000
31 Pennsylvania 25.70% 499,000
32 Tennessee 25.70% 249,000
33 Maine 25.90% 63,000
34 Alabama 26.70% 212,000
35 Indiana 26.80% 306,000
36 Michigan 26.80% 419,000
37 North Carolina 27.20% 423,000
38 Nebraska 27.60% 76,000
39 Virginia 27.70% 326,000
40 Utah 27.90% 172,000
41 Delaware 28.10% 45,000
42 Arizona 28.40% 306,000
43 Oregon 28.80% 231,000
44 Idaho 29.10% 88,000
45 Nevada 29.30% 154,000
46 Missouri 30.10% 325,000
47 Maryland 30.20% 236,000
48 Colorado 31.80% 331,000
49 Kansas 32.60% 145,000
50 Iowa 32.90% 134,000
51 District of Columbia 37.10% 50,000
52 National 24.70% 12,236,000

Adults with Disability Who Could Not See a Doctor Due to Costs 2022


 

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29.67% of adults with a cognitive disability were not able to see a doctor due to costs.

According to the Centers for Disease Control (CDC), 12% of people in the U.S. had a cognitive disability, even when adjusted for age. The percentage of people with cognitive disability ranged from 8.9% in some states to 19.6%.

The prevalence of adults with cognitive disability who couldnít see a MD due to cost ranges from 18.48% in Rhode Island to 40.65% in Texas.

Rank Sort descending State Percentage Number
01 Rhode Island 18.48 18,204
02 Vermont 20.33 9,346
03 Connecticut 20.59 52,774
04 Iowa 21.22 47,967
05 Massachusetts 21.68 122,701
06 North Dakota 22.25 12,879
07 Wisconsin 22.28 94,587
08 Hawaii 22.90 24,832
09 Kentucky 23.34 132,541
10 West Virginia 23.35 63,123
11 Washington 23.45 129,850
12 Montana 23.68 24,375
13 Pennsylvania 23.77 269,121
14 Maryland 23.87 102,734
15 Nevada 24.31 72,956
16 New York 24.53 351,676
17 District of Columbia 24.59 13,849
18 New Jersey 25.19 *
19 California 25.54 798,630
20 South Dakota 26.14 17,659
21 New Mexico 26.15 54,176
22 Minnesota 26.19 102,491
23 Ohio 26.99 290,259
24 Maine 27.34 39,967
25 Michigan 27.50 281,553
26 Delaware 27.59 21,424
27 Louisiana 27.79 155,929
28 Idaho 28.05 43,386
29 Colorado 28.69 111,500
30 Nebraska 29.48 37,445
31 Alaska 29.49 17,492
32 Tennessee 29.93 224,845
33 New Hampshire 30.40 35,528
34 Arkansas 30.53 117,147
35 Indiana 30.53 191,026
36 Oregon 30.67 118,469
37 Virginia 30.71 198,169
38 Missouri 30.88 192,461
39 Arizona 31.35 203,838
40 Oklahoma 31.52 138,679
41 South Carolina 31.70 161,528
42 Illinois 32.25 306,123
43 North Carolina 32.94 356,776
44 Wyoming 32.94 14,280
45 Utah 33.31 81,119
46 Mississippi 33.37 121,330
47 Florida 34.90 733,738
48 Alabama 38.35 233,440
49 Kansas 38.74 97,643
50 Georgia 39.18 370,081
51 Texas 40.65 954,935
52 National 29.67 8,496,389

Youth with MDE Who Did Not Receive Mental Health Services 2022



 

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60.3% 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, 1 in 3 youth are still not receiving the mental health services they need.

The state prevalence of untreated youth with depression ranges from 30.0% in Maine to 73.1% in Texas.

Rank Sort descending State Percentage Number
01 Maine 30.00% 4,000
02 Colorado 39.30% 20,000
03 District of Columbia 41.00% 1,000
04 Vermont 42.60% 3,000
05 Maryland 44.70% 32,000
06 Wyoming 44.90% 4,000
07 Utah 45.40% 25,000
08 New Hampshire 46.60% 7,000
09 Iowa 49.30% 21,000
10 Oregon 49.70% 29,000
11 Washington 49.80% 50,000
12 Indiana 51.50% 50,000
13 North Carolina 51.90% 74,000
14 Delaware 52.30% 6,000
15 Nebraska 52.60% 12,000
16 Montana 53.50% 6,000
17 Kansas 54.50% 21,000
18 North Dakota 54.60% 4,000
19 Wisconsin 55.10% 36,000
20 Illinois 55.20% 77,000
21 Pennsylvania 55.20% 57,000
22 Virginia 55.20% 58,000
23 New Mexico 55.90% 18,000
24 Oklahoma 56.00% 30,000
25 Massachusetts 56.80% 44,000
26 Missouri 57.30% 37,000
27 Minnesota 58.30% 42,000
28 Arkansas 58.90% 23,000
29 New Jersey 58.90% 42,000
30 Kentucky 59.30% 27,000
31 South Dakota 59.60% 6,000
32 Michigan 59.70% 74,000
33 New York 60.90% 103,000
34 Louisiana 62.50% 32,000
35 Ohio 63.30% 76,000
36 Alaska 63.40% 6,000
37 West Virginia 63.90% 13,000
38 California 64.50% 278,000
39 Rhode Island 64.90% 6,000
40 Nevada 65.20% 28,000
41 Connecticut 65.60% 24,000
42 Tennessee 66.50% 40,000
43 Alabama 66.80% 34,000
44 Idaho 67.10% 19,000
45 Florida 67.30% 117,000
46 South Carolina 67.60% 34,000
47 Georgia 67.80% 75,000
48 Arizona 70.10% 67,000
49 Hawaii 71.00% 7,000
50 Mississippi 71.70% 20,000
51 Texas 73.10% 255,000
52 National 60.30% 2,173,000

Youth with Severe MDE Who Received Some Consistent Treatment 2022



 

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Nationally, only 27.2% of youth with severe depression receive some consistent treatment (7-25+ visits in a year). 

Even when simply measuring the number of visits, fewer than 1 in 3 youth with severe depression meet this determination of consistent care.

The state prevalence of youth with severe depression who received some outpatient treatment ranges from 65.6% in Maine to 12.2% in Tennessee.

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

Rank Sort descending State Percentage Number
01 Maine 65.60% 7,000
02 Vermont 49.70% 3,000
03 New Hampshire 47.60% 4,000
04 Wyoming 45.60% 3,000
05 Colorado 43.10% 16,000
06 Massachusetts 42.20% 19,000
07 Pennsylvania 39.90% 28,000
08 Illinois 38.30% 38,000
09 Oregon 36.60% 14,000
10 Wisconsin 36.40% 19,000
11 Delaware 36.30% 3,000
12 Minnesota 35.90% 17,000
13 District of Columbia 35.80% 1,000
14 Washington 35.70% 24,000
15 Montana 35.50% 3,000
16 Maryland 34.50% 18,000
17 Oklahoma 33.60% 12,000
18 North Dakota 33.00% 2,000
19 Indiana 32.90% 23,000
20 Alabama 31.30% 8,000
21 Michigan 30.40% 26,000
22 Iowa 29.50% 9,000
23 South Dakota 29.30% 2,000
24 Kentucky 28.60% 9,000
25 New Jersey 28.40% 14,000
26 New York 28.30% 29,000
27 Nebraska 27.80% 5,000
28 Idaho 27.70% 6,000
29 Utah 27.30% 11,000
30 California 26.10% 72,000
31 Ohio 25.10% 19,000
32 Virginia 25.00% 19,000
33 North Carolina 24.90% 27,000
34 South Carolina 24.20% 8,000
35 Connecticut 23.60% 5,000
36 Arkansas 22.70% 7,000
37 Kansas 22.70% 6,000
38 New Mexico 22.50% 5,000
39 Louisiana 21.10% 7,000
40 West Virginia 20.90% 3,000
41 Rhode Island 20.40% 1,000
42 Alaska 20.20% 1,000
43 Georgia 20.10% 14,000
44 Texas 19.20% 44,000
45 Nevada 18.70% 5,000
46 Florida 17.00% 20,000
47 Arizona 16.10% 10,000
48 Mississippi 13.50% 2,000
49 Hawaii 13.30% 1,000
50 Missouri 12.60% 5,000
51 Tennessee 12.20% 6,000
52 National 27.20% 661,000

Children with Private Insurance that Did Not Cover Mental or Emotional Problems 2022



 

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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. However, the rate of children with private insurance that does not cover mental or emotional problems increased 0.3 percent from last year's dataset, and there are still 950,000 youth without coverage for their behavioral health.

The state prevalence of children lacking mental health coverage ranges from 1.9% in Massachusetts to 17.7% in Arkansas.

Rank Sort descending State Percentage Number
01 Massachusetts 1.90% 5,000
02 Vermont 2.10% 0
03 Connecticut 3.50% 5,000
04 Rhode Island 3.80% 1,000
05 Missouri 4.20% 9,000
06 New Hampshire 4.30% 2,000
07 Oklahoma 4.40% 6,000
08 District of Columbia 4.50% 1,000
09 West Virginia 4.50% 2,000
10 Wisconsin 4.50% 12,000
11 South Dakota 4.70% 2,000
12 Utah 4.70% 10,000
13 New Jersey 5.00% 18,000
14 Washington 5.20% 15,000
15 Maine 5.40% 3,000
16 Michigan 6.10% 27,000
17 Virginia 6.40% 22,000
18 Maryland 6.50% 15,000
19 Illinois 6.60% 33,000
20 Oregon 6.60% 10,000
21 Pennsylvania 6.80% 32,000
22 Delaware 7.00% 3,000
23 Georgia 7.00% 25,000
24 Nevada 7.10% 8,000
25 Indiana 7.40% 22,000
26 Iowa 7.40% 10,000
27 Ohio 7.40% 33,000
28 Alaska 7.50% 2,000
29 New York 7.70% 48,000
30 New Mexico 7.80% 5,000
31 Kansas 7.90% 8,000
32 Minnesota 8.00% 20,000
33 California 8.20% 111,000
34 Mississippi 8.20% 6,000
35 Hawaii 8.30% 3,000
36 Tennessee 8.80% 19,000
37 Louisiana 9.00% 11,000
38 Kentucky 9.30% 15,000
39 Montana 9.50% 3,000
40 Colorado 9.60% 22,000
41 North Carolina 10.00% 34,000
42 Arizona 10.20% 27,000
43 Florida 11.70% 65,000
44 Idaho 12.20% 11,000
45 South Carolina 12.40% 19,000
46 Alabama 12.50% 16,000
47 Wyoming 12.70% 3,000
48 Texas 13.80% 135,000
49 Nebraska 15.40% 13,000
50 North Dakota 15.60% 5,000
51 Arkansas 17.70% 17,000
52 National 8.10% 950,000

Students Identified with Emotional Disturbance for An Individualized Education Program 2022



 

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Only .759% of students are identified as having an Emotional Disturbance (ED) for an Individualized Education Program (IEP).

For purposes of an IEP, the term ìEmotional Disturbance 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.

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 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 32.23 per 1,000 students in Vermont to 2.13 per 1,000 students in Alabama.

 

Rank Sort descending State Percentage Number
01 Vermont 32.23 2,326
02 Minnesota 21.20 17,016
03 Massachusetts 20.22 17,455
04 Pennsylvania 16.33 26,105
05 Wisconsin 16.18 *
06 Maine 15.32 2,468
07 Indiana 13.36 12,712
08 Iowa 13.31 *
09 New Hampshire 13.24 2,132
10 Connecticut 12.43 5,824
11 Rhode Island 12.34 1,610
12 North Dakota 11.99 1,240
13 District of Columbia 11.54 802
14 Illinois 10.59 18,381
15 Oregon 10.30 5,568
16 South Dakota 10.04 1,251
17 Ohio 10.03 15,281
18 Nebraska 9.98 2,861
19 Delaware 9.47 1,211
20 New York 9.10 22,063
21 Missouri 8.87 7,188
22 Michigan 8.52 11,314
23 Virginia 8.47 9,913
24 Maryland 7.61 6,180
25 Mississippi 7.53 3,193
26 Texas 7.41 35,851
27 Arizona 7.39 7,756
28 Kentucky 7.39 4,501
29 Colorado 6.98 5,687
30 Wyoming 6.80 589
31 Montana 6.68 906
32 Oklahoma 6.66 4,057
33 Alaska 6.48 765
34 Georgia 6.35 10,124
35 New Mexico 6.15 1,830
36 New Jersey 5.84 7,313
37 Hawaii 5.80 959
38 Kansas 5.60 2,459
39 Washington 5.49 5,633
40 Florida 5.43 14,062
41 Idaho 4.95 1,412
42 Nevada 4.64 2,085
43 California 4.51 25,424
44 West Virginia 4.45 1,025
45 Tennessee 3.84 3,470
46 North Carolina 3.65 5,187
47 Utah 3.12 1,933
48 South Carolina 3.05 2,143
49 Louisiana 2.74 1,727
50 Arkansas 2.54 1,123
51 Alabama 2.13 1,420
52 National 7.59 345,160

Mental Health Workforce Availability 2022



 

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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.

The rate of mental health providers has improved in nearly every state since last yearís report.

The state rate of mental health workforce ranges from 150:1 in Massachusetts to 920:1 in Alabama.

Rank Sort descending State Number
01 Massachusetts 150:1
02 Oregon 180:1
03 District of Columbia 190:1
04 Alaska 200:1
05 Maine 200:1
06 Vermont 210:1
07 Connecticut 240:1
08 Oklahoma 240:1
09 Rhode Island 240:1
10 New Mexico 250:1
11 Washington 250:1
12 California 270:1
13 Colorado 270:1
14 Utah 290:1
15 Wyoming 290:1
16 New Hampshire 310:1
17 Montana 320:1
18 Louisiana 330:1
19 New York 330:1
20 Delaware 350:1
21 Maryland 360:1
22 Michigan 360:1
23 Nebraska 360:1
24 Minnesota 370:1
25 Hawaii 380:1
26 Ohio 380:1
27 North Carolina 390:1
28 Illinois 410:1
29 Arkansas 420:1
30 Kentucky 420:1
31 New Jersey 420:1
32 Pennsylvania 450:1
33 Idaho 460:1
34 Nevada 460:1
35 Wisconsin 470:1
36 Kansas 490:1
37 Missouri 490:1
38 North Dakota 510:1
39 South Dakota 530:1
40 Virginia 530:1
41 South Carolina 550:1
42 Florida 590:1
43 Indiana 590:1
44 Mississippi 590:1
45 Iowa 610:1
46 Tennessee 630:1
47 Georgia 690:1
48 Arizona 710:1
49 West Virginia 730:1
50 Texas 830:1
51 Alabama 920:1