Poverty

Publications

Listed by publication date. You can also view these publications alphabetically.

2006

Premium Assistance Programs for Low Income Families: How Well Does it Work in Rural Areas?
Date: 01 / 2006
Author(s): Pam Silberman, Laura Brogan, Charity Moore, Rebecca Slifkin
Research center: North Carolina Rural Health Research and Policy Analysis Center
Topics: Children, Health insurance and the uninsured, Medicaid and S-CHIP, Poverty
Report Number: Working Paper No. 85
Reports results of a study on the viability in rural areas of premium assistance programs use Medicaid or State Children's Health Insurance (SCHIP) funding to subsidize the premium costs of employer-sponsored insurance or private non-group policies for eligible individuals. Because of the characteristics of rural residents and their employment markets, many stand to benefit from premium assistance programs, but there are also reasons to believe that these programs may be less successful in rural communities. Findings form the telephone survey of Medicaid or SCHIP officials in 14 of the 16 states with at least one premium assistance program indicate that premium assistance programs have not lived up to their potential. Enrollment in most of the states' programs has been small, and while positive in concept, these programs have inherent limitations that may preclude more widespread enrollment. Of particular concern is that rural residents are more likely to work for small employers who do not offer health insurance or have higher premiums or less comprehensive benefits. However, with creative program design, premium assistance programs may be a useful tool for states to expand health insurance coverage to the rural uninsured.

2005

Impact of Welfare Reform on Health Insurance Coverage in Rural Areas
Date: 12 / 2005
Author(s): Timothy D. McBride, Courtney Andrews
Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
Topics: Health insurance and the uninsured, Poverty
Report Number: Rural Policy Brief Vol. 10, No. 6 (PB2005-6 )
Explores the impact of welfare reform on the health insurance coverage of welfare recipients and other low-income persons over the period when the reform was phased in. Key findings of this study showed that a substantial percentage of persons who left the Aid to Families with Dependent Children (AFDC) program after reform became uninsured, and former AFDC recipients in rural areas were more likely than urban counterparts to lose insurance coverage. Insurance loss was more likely for those who gained employment than for those who remained unemployed.
Trends in Uninsurance among Rural Minority Children
Date: 10 / 2005
Author(s): Amy Martin, Janice C. Probst, Charity G. Moore, Daniel Patterson, Keith Elder
Research center: South Carolina Rural Health Research Center
Topics: African Americans, Children, Health insurance and the uninsured, Hispanics, Minority health, Poverty
Disparities in health insurance coverage for both minority and rural children persist, with children who are simultaneously minority race/ethnicity and living in rural areas being particularly disadvantaged. Using twenty-one years of data from the National Health Interview Survey to explore trends in health insurance and health services utilization for children between 1980 and 2001, and focusing on non-Hispanic white, non-Hispanic African American, and Hispanic children, the authors found that rural children have been consistently less likely to have insurance than urban children, and minority status adds to the disparity. Several factors consistently influenced the odds that a child would lack health insurance, measured in 1980, 1986, 1994 and 2001. Compared to urban white children, rural white children and Hispanic children, both urban and rural, were more likely to lack insurance. Factors consistently associated with lack of health insurance, such as poverty, low education, and non-parental households, have been more prevalent among minority children since 1979, and remained so in 2001. Rural disadvantages for minority children are marked.
Impact of Medicaid Cuts on Rural Communities
Date: 08 / 2005
Author(s): Pam Silberman, Matt Rudolf, Laura Brogan, Stephanie Poley, Rebecca Slifkin, Charity Moore
Research center: North Carolina Rural Health Research and Policy Analysis Center
Topics: Medicaid and S-CHIP, Poverty
Report Number: Working Paper No. 82
Medicaid is a critical program in both urban and rural areas, but it is particularly important in rural areas because of high levels of poverty and less access to employer-sponsored insurance. This study assesses the perception of state Medicaid staff and individuals from State Offices of Rural Health (SORH) and Rural Health Associations (RHA) regarding the impact on rural areas of state Medicaid policy changes that occurred between 2002 and 2004. Despite the importance of this program to rural communities, our study suggests that few people are specifically concerned with the unique challenges Medicaid changes may pose to rural communities. This study presents insight to the potential rural impact of Medicaid policy changes, especially those that could adversely affect the ability of rural residents to access services or that might potentially affect the overall rural health infrastructure.
Poverty, Stress, and Violent Disagreements in the Home Among Rural Families
Date: 08 / 2005
Author(s): Charity G. Moore, Janice C. Probst, Mark Tompkins, Steven Cuffe, Amy B. Martin
Research center: South Carolina Rural Health Research Center
Topics: Children, Physical abuse and domestic violence, Poverty
This study used information from a large, nationally representative telephone survey of households with children, carried out by the National Center for Health Statistics, to explore the prevalence of violent disagreements in the home. "Violent" disagreements are those that involve hitting or throwing, as opposed to heated argument or calm discussion. Poverty and parenting stress also were examined as they are hypothesized to be associated with violent disagreement. Findings from the study showed that rural children, all things held equal, were less likely than urban children to live in households where disagreements are expressed violently. Similarly, rural children were less likely to live in households with high parenting stress or low reported neighborhood trust. Nonetheless, rural practitioners must still be sensitive to the possibility of exposure to violence. Key factors associated with parenting stress, and thus with violent disagreements, are more prevalent in rural areas. Poverty and low-income were more common among rural than urban children, and affected well over half of rural minority children, in particular.
Effects of Rural Residence and Other Social Vulnerabilities on Subjective Measures of Unmet Need
Date: 2005
Author(s): Michelle L. Mayer, Rebecca T. Slifkin, Asheley Cockrell Skinner
Research center: North Carolina Rural Health Research and Policy Analysis Center
Topics: Children, Disabilities, Health services, Poverty
Citation: Medical Care Research and Review, 62(5), 617-628
To determine whether self-reports of unmet need are biased measures of access to health care, the authors examined the relationship between rural residence and perceived need for physician services. Logistic regression analyses was performed to examine the likelihood of reporting a need for routine preventive care and/or specialty care using data from the National Survey of Children with Special Health Care Needs. Even after controlling for factors known to be associated with evaluated need, parents of rural children were less likely to report a need for routine or specialty services. Poor children, those whose mothers had less education, and those who were uninsured in the previous year were also less likely to perceive a need for physician services. Findings suggest that rural residence and other social vulnerabilities are associated with decreased perception of need, which may bias subjective measurements of unmet need for these populations.
Effects of Race and Poverty on Perceived Stress Among Rural Women
Date: 2005
Author(s): Janice C. Probst, Charity G. Moore, Elizabeth G. Baxley
Research center: South Carolina Rural Health Research Center
Topics: Mental health, Minority health, Poverty, Women
Citation: Coward RT, Davis LA et al, Eds., Rural women's health: Mental, behavioral and physical issues. p. 197-215. New York, NY: Springer Publishing Company

2004

Access To Dental Care For Rural Low Income And Minority Populations
Date: 09 / 2004
Author(s): Michelle M. Casey, Gestur Davidson, Ira Moscovice, David Born
Research center: Minnesota Rural Health Research Center
Topics: Dental health, Minority health, Poverty
Report Number: Working Paper No. 54
Using data from the 1999 National Health Interview Survey, this study examines the relationships between rural residence, income, race/ethnicity, and access to dental care. The study confirms that rural-urban disparities in access to dental care persist, and finds significant differences by race/ethnicity and income within rural populations in utilization of dental care, affording needed dental care, and dental insurance.
Assessing the Effect of a Lay Home Visitation Program for Rural High-Risk Women and Infants
Date: 2004
Research center: South Carolina Rural Health Research Center
Topics: African Americans, Children, Maternal and child health, Poverty, Women
This pilot study tested a retrospective data set approach for evaluating the effectiveness of a community health worker program at improving pregnancy and birth outcomes. The home visitation program uses lay health workers to provide health education, referral, and social support to rural, low income, Medicaid-insured pregnant African American women and their infants.

2003

Access to Care among Rural Minorities: Working Age Adults
Date: 01 / 2003
Author(s): Janice C. Probst, Michael E. Samuels, Charity G. Moore
Research center: South Carolina Rural Health Research Center
Topics: Health services, Minority health, Poverty
Examines the prevalence of health insurance and the use of physician services in rural areas. Findings include that rural minorities are handicapped by poverty and lack of education; low income and low education levels in non-metro areas translate into jobs that do not offer health insurance; and although non-metro adults were less likely to have insurance than metropolitan residents, they were not less likely to see a physician, with some exceptions.

2002

Access to Care among Rural Minorities: Children
Date: 11 / 2002
Author(s): Janice C. Probst, Charity Moore, Karin Willert Roof, Elizabeth G. Baxley, Michael E. Samuels
Research center: South Carolina Rural Health Research Center
Topics: Children, Minority health, Poverty
Profiles the characteristics of non-metro children, their health insurance coverage, and their health care visits. Recommends a multi-faceted approach to ensure that non-metro children obtain appropriate levels of health care. Facets including retaining and expanding provision of care to indigent and low-income families, expanding insurance coverage, and addressing rural poverty.
Rural Beneficiary Need for a Medicare Drug Benefit Delivered Through the Rural Delivery System
Date: 10 / 2002
Author(s): Keith Mueller
Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
Topics: Aging, Pharmacy and prescription drugs, Poverty
Elderly who live below the poverty level, seniors without prescription drug coverage, Medicare plans
Access to Care Among Rural Minorities: Older Adults (Appendix - Methods, Data, and Detailed Tables)
Date: 10 / 2002
Author(s): Janice C. Probst, Michael E. Samuels, Charity G. Moore, Joette Gdovin
Research center: South Carolina Rural Health Research Center
Topics: Aging, Health disparities, Minority health, Poverty
Appendix of report on health status and health services use among poor and minority older adults in non-metro areas.
Access to Care Among Rural Minorities: Older Adults
Date: 10 / 2002
Author(s): Janice C. Probst, Michael E. Samuels, Charity G. Moore, Joette Gdovin
Research center: South Carolina Rural Health Research Center
Topics: Aging, Health disparities, Minority health, Poverty
Profiles health status of, and use of physicians by, non-metro older adults. Programmatic recommendations based on the findings: maintain programs that encourage providers to practice in non-metro areas, pay particular attention to the problems of the near-poor African-American elderly, and foster coalitions linking providers with voluntary community-based organizations to increase support services to elderly non-metro populations.

1999

Implementation of the State Children's Health Insurance Program: Outreach, Enrollment, and Provider Participation in Rural Areas (Full Report)
Date: 11 / 1999
Author(s): Jennifer L. Dunbar, Harvey I. Sloane, Curt D. Mueller
Research center: Walsh Center for Rural Health Analysis
Topics: Children, Health insurance and the uninsured, Medicaid and S-CHIP, Poverty
The State Children's Health Insurance Program (CHIP) provides states with an important source of funding for helping low-income, uninsured children overcome financial barriers to medical care. There is considerable interest among federal policy makers and rural advocates that CHIP may be especially important in providing coverage to children living in rural areas. This study qualitatively assesses CHIP outreach, enrollment, and provider issues in Colorado, Kansas, Oklahoma, Pennsylvania, and West Virginia. For a print copy of publications prior to 2004, please contact the Walsh Center at 301-951-5070.
Implementation of the State Children's Health Insurance Program: Outreach, Enrollment, and Provider Participation in Rural Areas (Policy Brief)
Date: 11 / 1999
Author(s): Jennifer L. Dunbar, Harvey I. Sloane, Curt D. Mueller
Research center: Walsh Center for Rural Health Analysis
Topics: Children, Health insurance and the uninsured, Medicaid and S-CHIP, Poverty
The State Children's Health Insurance Program (CHIP) provides states with an important source of funding for helping low-income, uninsured children overcome financial barriers to medical care. This policy analysis brief assesses CHIP outreach, enrollment, and provider issues in Colorado, Kansas, Oklahoma, Pennsylvania, and West Virginia. For a print copy of publications prior to 2004, please contact the Walsh Center at 301-951-5070.

1998

Anticipating the 1997 State Children's Health Insurance Program: What's Current in Five Rural States?
Date: 01 / 1998
Author(s): Jennifer Dunbar, Curt Mueller
Research center: Walsh Center for Rural Health Analysis
Topics: Children, Health insurance and the uninsured, Medicaid and S-CHIP, Poverty
This study examines aspects of of existing children's health insurance or health services to low-income, uninsured children. For a print copy of publications prior to 2004, please contact the Walsh Center at 301-951-5070.

Topics Centers Researchers Other Resources Search		Poverty Publications Listed by publication date. You can also view these publications alphabetically. 2006 Premium Assistance Programs for Low Income Families: How Well Does it Work in Rural Areas? Date: 01 / 2006 Author(s): Pam Silberman, Laura Brogan, Charity Moore, Rebecca Slifkin Research center: North Carolina Rural Health Research and Policy Analysis Center Topics: Children, Health insurance and the uninsured, Medicaid and S-CHIP, Poverty Report Number: Working Paper No. 85 Reports results of a study on the viability in rural areas of premium assistance programs use Medicaid or State Children's Health Insurance (SCHIP) funding to subsidize the premium costs of employer-sponsored insurance or private non-group policies for eligible individuals. Because of the characteristics of rural residents and their employment markets, many stand to benefit from premium assistance programs, but there are also reasons to believe that these programs may be less successful in rural communities. Findings form the telephone survey of Medicaid or SCHIP officials in 14 of the 16 states with at least one premium assistance program indicate that premium assistance programs have not lived up to their potential. Enrollment in most of the states' programs has been small, and while positive in concept, these programs have inherent limitations that may preclude more widespread enrollment. Of particular concern is that rural residents are more likely to work for small employers who do not offer health insurance or have higher premiums or less comprehensive benefits. However, with creative program design, premium assistance programs may be a useful tool for states to expand health insurance coverage to the rural uninsured. 2005 Impact of Welfare Reform on Health Insurance Coverage in Rural Areas Date: 12 / 2005 Author(s): Timothy D. McBride, Courtney Andrews Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis Topics: Health insurance and the uninsured, Poverty Report Number: Rural Policy Brief Vol. 10, No. 6 (PB2005-6 ) Explores the impact of welfare reform on the health insurance coverage of welfare recipients and other low-income persons over the period when the reform was phased in. Key findings of this study showed that a substantial percentage of persons who left the Aid to Families with Dependent Children (AFDC) program after reform became uninsured, and former AFDC recipients in rural areas were more likely than urban counterparts to lose insurance coverage. Insurance loss was more likely for those who gained employment than for those who remained unemployed. Trends in Uninsurance among Rural Minority Children Date: 10 / 2005 Author(s): Amy Martin, Janice C. Probst, Charity G. Moore, Daniel Patterson, Keith Elder Research center: South Carolina Rural Health Research Center Topics: African Americans, Children, Health insurance and the uninsured, Hispanics, Minority health, Poverty Disparities in health insurance coverage for both minority and rural children persist, with children who are simultaneously minority race/ethnicity and living in rural areas being particularly disadvantaged. Using twenty-one years of data from the National Health Interview Survey to explore trends in health insurance and health services utilization for children between 1980 and 2001, and focusing on non-Hispanic white, non-Hispanic African American, and Hispanic children, the authors found that rural children have been consistently less likely to have insurance than urban children, and minority status adds to the disparity. Several factors consistently influenced the odds that a child would lack health insurance, measured in 1980, 1986, 1994 and 2001. Compared to urban white children, rural white children and Hispanic children, both urban and rural, were more likely to lack insurance. Factors consistently associated with lack of health insurance, such as poverty, low education, and non-parental households, have been more prevalent among minority children since 1979, and remained so in 2001. Rural disadvantages for minority children are marked. Impact of Medicaid Cuts on Rural Communities Date: 08 / 2005 Author(s): Pam Silberman, Matt Rudolf, Laura Brogan, Stephanie Poley, Rebecca Slifkin, Charity Moore Research center: North Carolina Rural Health Research and Policy Analysis Center Topics: Medicaid and S-CHIP, Poverty Report Number: Working Paper No. 82 Medicaid is a critical program in both urban and rural areas, but it is particularly important in rural areas because of high levels of poverty and less access to employer-sponsored insurance. This study assesses the perception of state Medicaid staff and individuals from State Offices of Rural Health (SORH) and Rural Health Associations (RHA) regarding the impact on rural areas of state Medicaid policy changes that occurred between 2002 and 2004. Despite the importance of this program to rural communities, our study suggests that few people are specifically concerned with the unique challenges Medicaid changes may pose to rural communities. This study presents insight to the potential rural impact of Medicaid policy changes, especially those that could adversely affect the ability of rural residents to access services or that might potentially affect the overall rural health infrastructure. Poverty, Stress, and Violent Disagreements in the Home Among Rural Families Date: 08 / 2005 Author(s): Charity G. Moore, Janice C. Probst, Mark Tompkins, Steven Cuffe, Amy B. Martin Research center: South Carolina Rural Health Research Center Topics: Children, Physical abuse and domestic violence, Poverty This study used information from a large, nationally representative telephone survey of households with children, carried out by the National Center for Health Statistics, to explore the prevalence of violent disagreements in the home. "Violent" disagreements are those that involve hitting or throwing, as opposed to heated argument or calm discussion. Poverty and parenting stress also were examined as they are hypothesized to be associated with violent disagreement. Findings from the study showed that rural children, all things held equal, were less likely than urban children to live in households where disagreements are expressed violently. Similarly, rural children were less likely to live in households with high parenting stress or low reported neighborhood trust. Nonetheless, rural practitioners must still be sensitive to the possibility of exposure to violence. Key factors associated with parenting stress, and thus with violent disagreements, are more prevalent in rural areas. Poverty and low-income were more common among rural than urban children, and affected well over half of rural minority children, in particular. Effects of Rural Residence and Other Social Vulnerabilities on Subjective Measures of Unmet Need Date: 2005 Author(s): Michelle L. Mayer, Rebecca T. Slifkin, Asheley Cockrell Skinner Research center: North Carolina Rural Health Research and Policy Analysis Center Topics: Children, Disabilities, Health services, Poverty Citation: Medical Care Research and Review, 62(5), 617-628 To determine whether self-reports of unmet need are biased measures of access to health care, the authors examined the relationship between rural residence and perceived need for physician services. Logistic regression analyses was performed to examine the likelihood of reporting a need for routine preventive care and/or specialty care using data from the National Survey of Children with Special Health Care Needs. Even after controlling for factors known to be associated with evaluated need, parents of rural children were less likely to report a need for routine or specialty services. Poor children, those whose mothers had less education, and those who were uninsured in the previous year were also less likely to perceive a need for physician services. Findings suggest that rural residence and other social vulnerabilities are associated with decreased perception of need, which may bias subjective measurements of unmet need for these populations. Effects of Race and Poverty on Perceived Stress Among Rural Women Date: 2005 Author(s): Janice C. Probst, Charity G. Moore, Elizabeth G. Baxley Research center: South Carolina Rural Health Research Center Topics: Mental health, Minority health, Poverty, Women Citation: Coward RT, Davis LA et al, Eds., Rural women's health: Mental, behavioral and physical issues. p. 197-215. New York, NY: Springer Publishing Company 2004 Access To Dental Care For Rural Low Income And Minority Populations Date: 09 / 2004 Author(s): Michelle M. Casey, Gestur Davidson, Ira Moscovice, David Born Research center: Minnesota Rural Health Research Center Topics: Dental health, Minority health, Poverty Report Number: Working Paper No. 54 Using data from the 1999 National Health Interview Survey, this study examines the relationships between rural residence, income, race/ethnicity, and access to dental care. The study confirms that rural-urban disparities in access to dental care persist, and finds significant differences by race/ethnicity and income within rural populations in utilization of dental care, affording needed dental care, and dental insurance. Assessing the Effect of a Lay Home Visitation Program for Rural High-Risk Women and Infants Date: 2004 Research center: South Carolina Rural Health Research Center Topics: African Americans, Children, Maternal and child health, Poverty, Women This pilot study tested a retrospective data set approach for evaluating the effectiveness of a community health worker program at improving pregnancy and birth outcomes. The home visitation program uses lay health workers to provide health education, referral, and social support to rural, low income, Medicaid-insured pregnant African American women and their infants. 2003 Access to Care among Rural Minorities: Working Age Adults Date: 01 / 2003 Author(s): Janice C. Probst, Michael E. Samuels, Charity G. Moore Research center: South Carolina Rural Health Research Center Topics: Health services, Minority health, Poverty Examines the prevalence of health insurance and the use of physician services in rural areas. Findings include that rural minorities are handicapped by poverty and lack of education; low income and low education levels in non-metro areas translate into jobs that do not offer health insurance; and although non-metro adults were less likely to have insurance than metropolitan residents, they were not less likely to see a physician, with some exceptions. 2002 Access to Care among Rural Minorities: Children Date: 11 / 2002 Author(s): Janice C. Probst, Charity Moore, Karin Willert Roof, Elizabeth G. Baxley, Michael E. Samuels Research center: South Carolina Rural Health Research Center Topics: Children, Minority health, Poverty Profiles the characteristics of non-metro children, their health insurance coverage, and their health care visits. Recommends a multi-faceted approach to ensure that non-metro children obtain appropriate levels of health care. Facets including retaining and expanding provision of care to indigent and low-income families, expanding insurance coverage, and addressing rural poverty. Rural Beneficiary Need for a Medicare Drug Benefit Delivered Through the Rural Delivery System Date: 10 / 2002 Author(s): Keith Mueller Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis Topics: Aging, Pharmacy and prescription drugs, Poverty Elderly who live below the poverty level, seniors without prescription drug coverage, Medicare plans Access to Care Among Rural Minorities: Older Adults (Appendix - Methods, Data, and Detailed Tables) Date: 10 / 2002 Author(s): Janice C. Probst, Michael E. Samuels, Charity G. Moore, Joette Gdovin Research center: South Carolina Rural Health Research Center Topics: Aging, Health disparities, Minority health, Poverty Appendix of report on health status and health services use among poor and minority older adults in non-metro areas. Access to Care Among Rural Minorities: Older Adults Date: 10 / 2002 Author(s): Janice C. Probst, Michael E. Samuels, Charity G. Moore, Joette Gdovin Research center: South Carolina Rural Health Research Center Topics: Aging, Health disparities, Minority health, Poverty Profiles health status of, and use of physicians by, non-metro older adults. Programmatic recommendations based on the findings: maintain programs that encourage providers to practice in non-metro areas, pay particular attention to the problems of the near-poor African-American elderly, and foster coalitions linking providers with voluntary community-based organizations to increase support services to elderly non-metro populations. 1999 Implementation of the State Children's Health Insurance Program: Outreach, Enrollment, and Provider Participation in Rural Areas (Full Report) Date: 11 / 1999 Author(s): Jennifer L. Dunbar, Harvey I. Sloane, Curt D. Mueller Research center: Walsh Center for Rural Health Analysis Topics: Children, Health insurance and the uninsured, Medicaid and S-CHIP, Poverty The State Children's Health Insurance Program (CHIP) provides states with an important source of funding for helping low-income, uninsured children overcome financial barriers to medical care. There is considerable interest among federal policy makers and rural advocates that CHIP may be especially important in providing coverage to children living in rural areas. This study qualitatively assesses CHIP outreach, enrollment, and provider issues in Colorado, Kansas, Oklahoma, Pennsylvania, and West Virginia. For a print copy of publications prior to 2004, please contact the Walsh Center at 301-951-5070. Implementation of the State Children's Health Insurance Program: Outreach, Enrollment, and Provider Participation in Rural Areas (Policy Brief) Date: 11 / 1999 Author(s): Jennifer L. Dunbar, Harvey I. Sloane, Curt D. Mueller Research center: Walsh Center for Rural Health Analysis Topics: Children, Health insurance and the uninsured, Medicaid and S-CHIP, Poverty The State Children's Health Insurance Program (CHIP) provides states with an important source of funding for helping low-income, uninsured children overcome financial barriers to medical care. This policy analysis brief assesses CHIP outreach, enrollment, and provider issues in Colorado, Kansas, Oklahoma, Pennsylvania, and West Virginia. For a print copy of publications prior to 2004, please contact the Walsh Center at 301-951-5070. 1998 Anticipating the 1997 State Children's Health Insurance Program: What's Current in Five Rural States? Date: 01 / 1998 Author(s): Jennifer Dunbar, Curt Mueller Research center: Walsh Center for Rural Health Analysis Topics: Children, Health insurance and the uninsured, Medicaid and S-CHIP, Poverty This study examines aspects of of existing children's health insurance or health services to low-income, uninsured children. For a print copy of publications prior to 2004, please contact the Walsh Center at 301-951-5070.