CHARLESTON, W.Va. (AP) -- West Virginia isn't doing a good job of delivering health care services for low-income residents, according to a private foundation's report released Wednesday.

The Commonwealth Fund report ranked West Virginia tied with Nevada for 41st among the states and the District of Columbia.

The New York and Washington, D.C.-based organization that supports independent research on health policy looked at 30 different indicators in four categories.

While West Virginia ranked 20th in providing appropriate preventive care screenings and treatment for low-income residents, it ranked 28th in health-care access and affordability, 46th in potentially avoidable hospital use and 50th in promoting healthy lifestyles.

The report, titled "Health Care in the Two Americas," found big gaps between the lowest- and highest-performing states. For instance, low-income adults in West Virginia are far more likely to lose six or more teeth to decay or disease compared to Connecticut, Hawaii and Utah.

The report also ranked West Virginia at the bottom for the number of hospital admissions and return trips and potentially avoidable emergency room visits among Medicare patients.

"We found repeated evidence that we are often two Americas, divided by income and geography when it comes to opportunities to lead long and healthy lives," said Cathy Schoen, a Commonwealth Fund senior vice president and the report's lead author. "These are more than numbers. We are talking about people's lives, health, and well-being."

Nine of the bottom 10 states were in the South.

The report used the most current data available, generally from 2010-2011. The goal is to prompt state policymakers and health care leaders to use the data to target resources for improvements for low-income residents.

West Virginia is already taking steps to do that.

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Report: W.Va. lagging on health care for poor