If you need health care in the U.S., the quality will vary depending on where you are.

A study from WalletHub ranked the best and worst states for health care by analyzing cost, access, and health outcomes in addition to some ancillary factors.

An overwhelming majority of the top 15 states are located within the Northeast, while every state at the bottom of the rankings is in the South.

“The geography of the states varies where oceans or mountains can limit access to health care,” Dr. Andrew Boyd, associate vice chancellor for research in computing and data initiatives at the University of Illinois-Chicago, told Yahoo Finance when asked about the analysis. “What the ranking does not show is the baseline disease prevalence and the environment which all impact health outcomes.”

WalletHub's top states for health care are Massachusetts, Rhode Island, Minnesota, Hawaii, Maryland, Vermont, Colorado, Iowa, Connecticut, South Dakota, New Hampshire, Pennsylvania, the District of Columbia, New Jersey, and Maine.

At the bottom of the list are Alabama, Louisiana, Arkansas, Mississippi, North Carolina, Oklahoma, Wyoming, West Virginia, Nevada, Missouri, South Carolina, Georgia, Texas, Florida, and Arizona.

The importance of Medicaid

Massachusetts, which ranked first overall, ranked first in access and outcomes and has the highest percentage of insured children and insured adults while also ranking in the top five for lowest infant mortality rate and lowest percentage of adults with no dental visit in the past year.

Interestingly, though, the The Bay State ranked 24th in cost.

“Ranking health care systems is complex,” Boyd said. “The state with the highest ranking overall is first in access and outcomes but is ranked 24th in cost. Having access to health care is a necessary but not sufficient step in achieving good health care.”

There also seems to be a notable impact by the Medicaid expansion. Out of the 12 states that have not adopted the expansion, nine are ranked at the bottom in terms of overall health care.

And, out of the states with the highest uninsured rates for both children and adults, an overwhelming majority are not Medicaid expansion states.

“Medicaid expansion helps to provide patients additional insurance to access health care,” Boyd said. “However, a number of other variables also impact the expansion impact, such as: Do new Medicaid patients have access to clinicians and hospitals with the new insurance coverage, for example? Without growth in clinical services that accept Medicaid, just the expansion of Medicaid by itself will not lead to better overall health systems.”