PORTLAND, Maine (AP) — The number of children without health care coverage grew in Maine during a five-year period that coincided with tightened Medicaid eligibility guidelines and the governor's decision not to expand Medicaid under the Affordable Care Act, according to a report released Tuesday.

Maine and North Dakota were the only states to see increasing numbers of children without insurance from 2010 to 2015 as other states were adding more children to health care insurance through Medicaid, marketplaces set up under the health care reform or through private insurance, according to the Annie E. Casey Foundation report.

All told, the percentage of uninsured children grew 50 percent, from 4 percent to 6 percent in Maine, while the national rate dropped from 8 percent to 5 percent. The total number of uninsured Maine children grew from 11,000 to 14,000, the report said.

Republican Gov. Paul LePage's administration's actions surrounding Medicaid didn't change health care coverage for children. But child welfare advocates believe Maine children eligible for coverage under Medicaid nonetheless went off the rolls when their parents lost coverage.

"There's a lot of research that says when parents are covered, children are more likely to be covered," said Claire Berkowitz of the Maine Children's Alliance.

The governor's office contends parents must take responsibility for ensuring their children are receiving health care benefits for which they're eligible.

"If parents lose coverage and do not allow their kids to receive the services they are eligible for, that is the responsibility of the parents, not the state," said Peter Steele, his chief of communications.

Two things happened in the period covered by the report from the nonpartisan Annie E. Casey Foundation, which was established in 1948 by the founder of the United Parcel Service to honor his widowed mother by helping children, families and communities.

First, the state rejected a proposal to expand Medicaid to offer coverage to thousands more adults under the Affordable Care Act; the governor said the federal money for the expansion would eventually run out, leaving Maine with a big expense. Second, the state tightened the income eligibility for Medicaid from 200 percent of the federal poverty level to 100 percent of the poverty level.

The Maine Children's Alliance is working with schools, food banks and child care providers to let parents know their children may be eligible even if the adults aren't, Berkowitz said.

The report found other troubling trends for children in Maine, the poorest state in New England.

Seventeen percent of Maine children were living in poverty, and 1 in 3 children lived in a home where no parent had full-time employment in 2015, according to the report.

But it wasn't all bad news for Maine.

The number of Maine kids living in poverty dropped 2 percentage points; Maine's teen birth rate fell; and Maine received the nation's top ranking for families where the head of the household attained at least a high school education.