AUSTIN, Texas (AP) -- Texas ranks worst in the nation in health care services and delivery, according to an annual scorecard issued by the federal Agency for Health Care Research and Quality.

In nine out of 12 categories, Texas rated weak or very weak. The only area where Texas earned the above average ranking of "strong" was in maternal and child health care measures. Out of a possible 100 points, Texas earned 31.61, while Minnesota, the highest ranking state, scored 67.31.

The agency identified 155 areas where it could compare the quality of health services across the country, such as infant mortality and obesity rates. Researchers used that data to generate both national and regional averages for each area, and they then compared each state to the national and regional averages to generate a score.

The report is designed to help politicians, policy makers, private insurers and state and federal agencies identify strengths and weaknesses in state health care programs.

Stephanie Goodman, spokeswoman for the Texas Health and Human Services Commission, said Thursday that the report goes far beyond what state agencies control, but she said it demonstrates the need to improve access to preventive health care.

"Late last year Texas received approval for a new effort that will help fund innovative local projects," she said. "Hospitals and other health care providers have come together to form regional partnerships, and they'll soon be sending the state their plans for making better use of Medicaid funds to expand access to preventive services and reduce the need for expensive emergency room care."

Texas scored particularly poorly in the home health care category, with the study finding that the state provided little support to the elderly and disabled who chose to live at home. Texas also ranked weak or very weak in preventive, acute and chronic care delivery.

The state's scores slipped from last year in treating cancer and diabetes patients.

The Texas Medicaid law for the disabled and poor offers one of the most limited health care programs in the nation, and more than 25 percent of Texans do not have health insurance of any kind, which is the highest uninsured rate in the nation.

The poor state of the Texas health care system has particular relevance as state lawmakers begin to consider how to respond now that President Barack Obama's federal health care overhaul has been upheld by the U.S. Supreme Court.

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Fed agency ranks Texas at bottom for health care