The U.S. Census Bureau released a report Thursday showing that 48 million Americans are living in poverty.

The report says that despite government programs that help the poor, even 16% of children are still living in poverty.

The report from the Census Bureau is different than the standard report because it takes into account living conditions when considering who is in poverty.  So while the official national poverty line is $23,283 for a family of four, in major cities the measure could be $30,000 or more.

California’s poverty rate under the new stat review is 23.4%, meaning almost 1 in 4 Californians can’t afford to live in that state’s high costs of living.  New York, Florida and 10 other states had increases in their poverty numbers with the new measure.

The biggest factor putting people into poverty is medical bills according to the report.