Nationally the number of children without health insurance has been steadily declining, but not in Arizona.

Nearly 214,000 Arizona children have no health insurance, which amounts to about 13 percent of the state’s kids. Only Alaska and Nevada have worse rates, researchers with Georgetown University’s Center for Children and Families found in a study released last week.

The Georgetown report, “Children’s Health Coverage on the Eve of the Affordable Care Act,” says children are more likely to be uninsured if they live in the South or West. Latino, American Indian and Alaska native children are also disproportionately uninsured, the researchers found.

While insurance coverage for U.S. children improved in 40 states between 2010 and 2012, it got worse in Arizona.

Health experts say Arizona state policies are to blame for its poor showing. Any improvement in the state’s 2014 numbers will depend on whether families understand and take advantage of their insurance options, since nearly 70 percent of uninsured children are eligible for a government insurance plan but not enrolled, the study says.

“Much will depend on Arizona’s efforts to educate and reach out to populations and communities with historically low ‘uptake rates’ — that is, uninsured that are eligible that enroll in Medicaid,” said Dr. Dan Derksen, a physician who is section chairman of public-health policy and management at the University of Arizona’s Mel and Enid Zuckerman College of Public Health.

Medicaid is a government insurance program for lowincome people. In Arizona the program is called the Arizona Health Care Cost Containment System, or AHCCCS.

Experts forecast that the tax penalties for not having minimum health insurance coverage required by the Affordable Care Act will encourage eligible uninsured to enroll, Derksen said.

Arizona children comprise 4 percent of the 5.3 million uninsured U.S. children, the researchers found, using data from the U.S. Census Bureau’s American Community Survey. Half of the country’s uninsured children live in six states. Besides Arizona, those states are Texas, California, Florida, Georgia and North Carolina.

The Phoenix-based Children’s Action Alliance says Arizona’s state policies have put more children at risk. Most significant, Arizona is the only state that has abandoned a federal government insurance program for children, the group says.

Arizona froze enrollment in its federal children’s health program for kids from low-income working families four years ago. The national program known as CHIP, or the Children’s Health Insurance Program, is known in Arizona as KidsCare.

During the same period, 40 states saw improvements in children’s coverage due to the success of Medicaid and the Children’s Health Insurance Program (CHIP).

Arizona, meanwhile, is the only state to abandon its CHIP program.

“We reap what we sow. We froze enrollment and saw the uninsured number (of children) increase,” said Joe Fu, director of health policy for the Children’s Action Alliance.

Temporary coverage for Arizona kids was created with a combination of hospital funding and federal funds.

But that coverage is set to expire at the end of this year, and enrollment in original KidsCare, already at fewer than 7,000 kids, is supposed to remain frozen. That means enrollment will eventually dwindle to zero.

The federal health insurance marketplace, created through the Affordable Care Act, will offer numerous health insurance options to many Arizona children, including policies with federal subsidies for those who qualify.

“Our concern is that there will be gaps in the transition process from KidsCare to the marketplace,” Fu said.

He said the state does not do enough outreach to help families understand their options, including whether they are eligible for AHCCCS. KidsCare enables kids in families that earn too much to qualify for AHCCCS to have health insurance.

“The Affordable Care Act was written with the intention that states would continue coverage through CHIP until about 2019,” Fu said. “The ACA really pushed for a multitude of coverage sources.”

Also, something called the “family glitch” of the Affordable Care Act could leave some kids uninsured, Fu said. The law says that if a large employer offers health insurance that is “affordable” (9.5 percent of the employee’s household income or less), that person is not eligible for subsidized insurance through the exchanges. Where the glitch occurs, Georgetown researchers say, is that employers don’t have to offer coverage for dependents, but the dependents also are not eligible for federal subsidies on the exchange.

The expansion of Medicaid qualifications in Arizona means that, as of January, children and their parents in families earning up to 133 percent of the federal poverty level can be covered. And while the website has had problems enrolling people in federally subsidized insurance, Arizona’s website to enroll people in Medicaid has been running very well, Derksen said.

With those positive factors, Arizona has the potential to markedly improve its rate of uninsured children, he said. Nationally, the Affordable Care Act is expected to cut the number of uninsured children by 40 percent.