A new report found that the number of uninsured children is at its highest level in a decade.

More than 153,000 children in the state lacked health insurance in 2024, up from 147,000 in 2023, according to the State of Children’s Health Insurance, released Tuesday by the Pennsylvania Partnerships for Children.

Advocates warn that the trend is only going to get worse.

The 2024 increase reflected the bump in uninsured children as families were kicked off Medicaid during the unwinding process after COVID-19 protections expired.

Federal changes to Medicaid made in the budget reconciliation bill signed into law by President Donald Trump will likely lead to another spike in the number of uninsured children in Pennsylvania.

“It is important to note that the report comes at a time when the state of health care is fraught with concerns about access and affordability,” the report’s authors said. “As federal changes begin to take effect, it is expected that these deep cuts to Medicaid and (the Supplemental Nutrition Assistance Program) will negatively impact children.”

The Department of Human Services has estimated that more than 300,000 households will likely lose access to Medicaid coverage due to the federal changes. However, it’s not immediately clear how many children will be impacted.

The full effect of the federal changes to Medicaid are not scheduled to kick in until after the midterm elections in 2026.

The report also shows that the number of children without health insurance is already higher than it should be. Almost 50,000 children live in families that would qualify for Medicaid if they had applied for coverage in the program.

“Census data shows that 8.1% of Pennsylvania children who qualify for Medicaid are uninsured. That percentage worsened, rising from 6.8% in 2023,” according to the Partnerships for Children report. “While some families may not be aware of their public health insurance options, other factors are more likely to drive disparities in coverage, including difficulty navigating the enrollment processes, confusion about eligibility policies, and language and literacy barrier.”

Only five states have more children and more uninsured children than Pennsylvania — Florida, Illinois, New York and Texas. Of those, only Florida and Texas have a higher rate of children without insurance. Five percent of children are uninsured in Pennsylvania, compared to 8% of children in Florida and 14% in Texas.