As in many areas of the country, low-income people in Washington, D.C., face a number of challenges in obtaining health services delivered in a timely manner, in an appropriate setting, and with attention to continuity and quality of care. One barrier is financial; nearly 30 percent of nonelderly DC residents below 200 percent of the federal poverty level (FPL) are uninsured. Another barrier is availability; many economically depressed sections of the city are underserved by health care providers. Hospitals and clinics that serve the poor are experiencing some financial strain as competition among hospitals for paying patients continues to increase and Medicaid payments are held in check. The District's Medicaid program has for many years paid facilities relatively generous rates.