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Inadequate nurse staffing ratios and other shortcomings hamper Medicaid programs in many states, a new report finds.

Eligibility requirements and provider payments also tend to vary wildly from state to state, according to a largely unflattering assessment from the advocacy group Public Citizen.

No state reached two-thirds of the points available in the study’s scoring system. Massachusetts came closest, at 65%. Other high-scoring states included Nebraska, Vermont, Alaska, Wisconsin, Rhode Island, Minnesota, New York, Washington and New Hampshire. The lowest-scoring states were Mississippi, Idaho, Texas, Oklahoma, South Dakota, Indiana, South Carolina, Colorado, Alabama and Missouri.

The complete report “Unsettling Scores,” is available at http://www2.citizen.org/hrg/medicaid/.