More than 67,000 Florida children gained health insurance coverage last year with the full implementation of the Affordable Care Act, according to a report released Wednesday by Georgetown University’s Health Policy Institute.

And yet Florida remained near the bottom of the states in covering kids, with nearly 378,000 children still uninsured. In sheer numbers, the report said, Florida ranked49th, behind only Texas and California.

Florida did show a bit of improvement in the rate of uninsured children, from 11.1 percent in 2013 to 9.3 percent last year. That enabled Florida to inch up the scale, from47thworst to46th.

LauraBrennaman, policy director for health advocacy group Florida CHAIN, said Florida “continues to lag on the nation.”

The rate of uninsured kids nationally reached 6 percent last year, down from 7.1 percent, causing authors of the report at the institute’s Center for Children and Families to call it an occasion for celebration.

“This was a very exciting year,” said JoanAlker, one of the authors. “Because the Affordable Care Act drew so much attention in 2014 (good and bad!), and there were so many outreach and enrollment activities, parents who came in for coverage often found out that their kids were eligible” for a public program.

Florida’s rate of uninsured of all ages remains far higher than the country as a whole, reflecting in part the disproportionate influence of jobs with low pay and no benefits.

But it also reflects the fact that Florida, unlike more than half of the states, turned down federal funds that would have expanded Medicaid to cover adults under the poverty level. Leaders of the Florida House said they didn’t want the Medicaid program to grow any larger.

That happened anyway though, when families tried to sign up for subsidized plans under theACAthrough the federal health insurance exchange. Those below the poverty level did not qualify to use the exchange, but in many cases, they discovered their children could enroll in Medicaid.

There is much more work to do, saidBrennamanof Florida CHAIN.

“Nearly one of every ten Florida children remains without coverage and without consistent access to quality health services,” she said.

The rate of uninsured children nationwide dropped to 6 percent in 2014, down from 7.1 percent. The rate has been declining each year for a decade because of expansions in Medicaid and passage of the Children’s Health Insurance Program (CHIP).  

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