The percentage of Georgia children who are uninsured has declined, but the state still has the fourth-highest number of kids without coverage, according to a report released Wednesday.

In raw numbers, Georgia has nearly 220,000 children who are uninsured, trailing only Texas, California and Florida, said the report from Georgetown University’s Center for Children and Families. All three of those states have much higher populations than Georgia.

Just six states — the four previously mentioned plus Arizona and North Carolina — are home to half of the 5.3 million uninsured children in the United States.

The report, “Children’s Health Coverage on the Eve of the Affordable Care Act,” found the number of uninsured kids nationally has continued to decline. Joan Alker of Georgetown told reporters Wednesday that the decrease is largely due to Medicaid and the Children’s Health Insurance Program (CHIP).

Nationally, the uninsured rate of adults — 20.6 percent — far exceeds that of kids, at 7.2 percent.

The Georgetown center also released the results of a survey showing that most Americans believe the number of uninsured children in their state has increased in the last five years.

The report said 15 states, including Georgia, have significantly higher rates of kids without coverage than the national average. Georgia, at 8.8 percent, trails several other states. Nevada’s 16.6 percent is the highest, followed by Alaska, Arizona, Texas and Montana.

Children are more likely to be uninsured if they live in the South or the West, the report found. Latino children have disproportionately higher uninsured rates. Kids in rural areas also have high rates.

Pat Willis, executive director of Voices for Georgia’s Children, an advocacy group, noted that the state is among the most populous in the nation (currently No. 8 by federal estimates). For Georgia to have more uninsured children than most other states is not surprising in itself, she said.

“But having 4 percent of all uninsured children in the U.S. certainly points to a failure on our part to totally commit to the health interests of our kids,’’ Willis added.

“We are glad to see that the percentage of uninsured children in Georgia continues to decline, down from 10 percent to 9 percent since 2010, and down from about 13 percent in 2005, but the reduction isn’t fast enough,’’ Willis said. “Since 2005 we’ve known that approximately 200,000 children qualified for Medicaid or PeachCare but were not on the rolls.”

The Affordable Care Act’s expansions of coverage, though, may help drop the uninsured number.

Federal officials last week reported that through healthcare.gov, an additional 396,000 people — including 7,709 in Georgia — have been deemed eligible either for Medicaid or CHIP (known as PeachCare in Georgia) under the health care law.

Presumably many of those newly eligible are children, who currently comprise the majority of Medicaid members in Georgia.

The number of people deemed eligible for Medicaid is likely to continue to grow despite Georgia’s decision not to expand its Medicaid program.

That’s because of the so-called “woodwork” or “welcome mat” effect. Experts forecast that the ACA will lead many people who were already eligible for Medicaid and CHIP but had never enrolled to “come out of the woodwork” and finally sign up.

Georgia expects the woodwork effect will lead 46,000 Georgians to join Medicaid and PeachCare this fiscal year, with an additional 19,000 joining in fiscal 2015.

Dr. Bob Wiskind, an Atlanta pediatrician, said many kids eligible for Medicaid and PeachCare are not enrolled in either program “‘due to parents not understanding that their children qualify or being unable to navigate the system to get their children covered.”

Wiskind,  president of the Georgia chapter of the American Academy of Pediatrics (AAP), said the organization  supports expanding Medicaid under the Affordable Care Act “since research shows that once parents are covered, they are more likely to cover their children.”

“The Georgia AAP looks forward to continuing to work with state agencies to reduce the number of uninsured children in Georgia and ensure that every child gets the care they need to remain healthy,” he said.