The federal poverty level is an annual income figure, set each January by the federal government, that almost every New York health program uses to decide eligibility. The U.S. Department of Health and Human Services publishes it, and programs are written as percentages of it. For 2026 in the 48 contiguous states, 100% of the federal poverty level is $15,960 for a household of one, plus $5,680 for each additional person. A household of four is $33,000. In 2025 the figures were $15,650 and $5,500.

Nothing is set at exactly 100%. Each program’s line is a multiple, compared against a year of household income before taxes. The household is your tax household: you, a spouse you file jointly with, and the dependents you claim. Not roommates, and not an adult child who files their own return, even in the same apartment. Each person added raises the 100% line by $5,680, so the count matters as much as the pay. For coverage programs the income is MAGI, which pre-tax retirement and HSA contributions reduce.

The part people get wrong is time. The guideline is annual, and the NY State of Health application asks what you expect to earn this year: not last year’s return if this year looks different, and not one good month multiplied by twelve, the most common way people talk themselves out of coverage. Medicaid for people 65 and over, or applying on disability grounds, works differently. Its separate non-MAGI rules compare countable monthly income with the Medicaid income level.

You meet it as a percentage in a program’s rules, “up to 200% FPL”, and as the two questions that feed it on the NY State of Health application and a hospital’s financial assistance form: how many people are in your household, and what the household earns. Check the household count first: a wrong count shifts every threshold.

In New York: the guideline is federal, the same figure in Manhattan as anywhere else in the 48 contiguous states, and nothing adjusts it for the cost of living here. A salary that looks comfortable against it can still be tight in this city, and no program makes up the difference. The state sets the percentages, and its thresholds are higher than most states’. Eligibility is decided per person, so one household can come back with a child on Child Health Plus, which covers children regardless of immigration status, a parent on the Essential Plan and a grandparent measured under the separate rules for people 65 and over. The 200% line does two unrelated jobs under two different laws: the Essential Plan ceiling, and the point at or below which a hospital may not charge an uninsured patient anything out of pocket. That hospital law counts gross household income, not MAGI. The lines you will deal with:

Program or ruleThreshold
Medicaid, most working-age adultsabout 138% FPL
Essential Plan (ages 19 to 64)200% FPL
Hospital financial assistance: no out-of-pocket chargeat or below 200% FPL
Hospital charges capped at 10% of the Medicaid rate201% to 300% FPL
Hospital charges capped at 20% of the Medicaid rate; no hospital lawsuits301% to 400% FPL
Child Health Plus: free, then $15 to $60 per child per monthfree to 222% FPL; premiums to 400%
NYC Care sliding scale201% to 400% FPL
Marketplace premium tax credit (2027 plans)generally ends at 400% FPL

Dollar figures for each line, by household size: 2026 income limits.

  • Find your percentage. Divide a year of household income by the 100% figure for your household size: $15,960 plus $5,680 for each person after the first. The estimator does it in your browser, stores nothing, and shows your hospital tier.
  • Apply even if you sit right at a threshold. Programs verify with documents and use their own calculation; a table is a guide, not a decision. Medicaid, the Essential Plan and Child Health Plus take applications in any month.
  • Report a change within 30 days once you are enrolled through NY State of Health. What reporting triggers.

Also called: FPL, poverty guidelines, poverty line, federal poverty guidelines. Full guide: 2026 income limits for every New York health program. Reference: Federal poverty level (FPL) on Wikipedia — general definition, not New York specifics.

More in Glossary of health coverage and billing terms

  • CDPAP (Consumer Directed Personal Assistance Program) — The New York Medicaid program that lets a person hire, train and supervise their own home care aide, including a relative.
  • Spend-down (excess income) — The monthly amount of medical expense you must incur before Medicaid covers the rest of the month, when your income is over the limit.
  • Pooled income trust — A trust run by a nonprofit that holds your excess monthly income so Medicaid disregards it, while still paying your rent and bills.
  • 2026 Income Limits for Every New York Health Program, by Household Size — New York's 2026 income limits for Medicaid, the Essential Plan, Child Health Plus, NYC Care and hospital financial assistance, in one table by household size.
  • MAGI (modified adjusted gross income) — MAGI, modified adjusted gross income, decides Medicaid, Essential Plan and marketplace eligibility and adjusts Medicare premiums. What counts, which year.
  • Charity care — Charity care is the everyday name for hospital financial assistance in New York. Who qualifies, the income tiers to 400% of poverty, and how to apply.
  • Tax household — The group whose income is counted together for coverage eligibility, decided by who files a tax return with whom rather than by who lives in the apartment.
  • Do You Qualify for Free Hospital Care in New York? — Enter your household size and income to see where you fall against New York's hospital financial assistance thresholds. Runs in your browser; nothing is stored.

This page explains how the system works. It is not medical advice. More.