FPL (Federal Poverty Level)
Federal Poverty Level
Annual income thresholds published by HHS used to determine eligibility for federal programs.
1 min read · Last reviewed May 23, 2026
At a glance
- Category
- Payer
- Acronym for
- Federal Poverty Level
- Primary sources
- 1
- Workspace handoff
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Where this comes up
Front-office and billing both hit this term — eligibility before the visit, prior auth before the procedure, contract terms during fee-schedule negotiation, and credentialing whenever a new provider joins or a payer roster lapses. Misses here become denials downstream.
Full definition
What it is in practice
HHS publishes the FPL annually in the Federal Register. Programs reference percentages of FPL for eligibility (e.g., Medicaid 138% for ACA expansion, sliding fee 200%).
How it shows up in your practice
FPL-based eligibility verification is part of registration for sliding fee, charity care, and ACA marketplace enrollment.
Sources
- CMS — Medicare Administrative Contractorshttps://www.cms.gov/medicare/coding-billing/medicare-administrative-contractors-macs
Look up current FPL in Ask D3
Open ask d3 →Related terms
- Compliance ProgramSliding Fee Discount ScaleA discount schedule based on family income and size, required of HRSA-funded health centers for patients at or below 200% of FPL.
- Compliance ProgramCharity Care PolicyWritten policy describing how a hospital or health system provides free or discounted care to patients meeting financial eligibility criteria; required for 501(c)(3) nonprofit hospitals under IRC 501(r).
- PayerMedicaidJoint federal-state program providing health coverage to certain low-income individuals, families, pregnant women, elderly, and people with disabilities.
D3rx is a healthcare-billing and compliance research aid maintained by D3rx Inc. Articles are drafted by an LLM (Anthropic Claude) against primary HHS, OCR, CMS, eCFR, NIST, and state-regulator publications, and reviewed for restraint and source fidelity by the D3rx team.
Reviewer status: a named credentialed reviewer (CHC, CHPC, or healthcare attorney) is being engaged. Until that engagement is finalized, this page does not claim credentialed review.
Related across the archive
- GlossaryMedicaidJoint federal-state program providing health coverage to certain low-income individuals, families, pregnant women, elderly, and people with disabilities.
- GlossaryCharity Care PolicyWritten policy describing how a hospital or health system provides free or discounted care to patients meeting financial eligibility criteria; required for 501(c)(3) nonprofit hospitals under IRC 501(r).
- GlossarySliding Fee Discount ScaleA discount schedule based on family income and size, required of HRSA-funded health centers for patients at or below 200% of FPL.
- GlossaryCHIP (Children's Health Insurance Program)State-administered federal program providing health coverage to children in families with incomes too high for Medicaid but too low for private coverage.
- GlossaryMAC LCD ArticleA Local Coverage Article published by a MAC to provide billing, coding, or coverage clarification that does not rise to the formal LCD.
- GlossaryMedicaid MCOA managed care organization contracted by a state to deliver Medicaid benefits.
- GlossaryMedicare Administrative Contractor (MAC)CMS-contracted regional entity that processes Medicare claims, makes coverage decisions, conducts provider education, and handles first-level appeals.
- ComplianceOIG LEIE Monthly Exclusion Screening: Process + Audit-Ready LogsMonthly OIG LEIE and SAM.gov exclusion screening for every workforce member and vendor: the workflow, the log fields auditors require, and the escalation path.
This glossary entry is a research aid for billing and compliance staff. It does not provide legal, medical, or financial advice and does not replace counsel. References cited link to primary sources at HHS, OCR, CMS, eCFR, NIST, and the relevant payer or industry body.