There are three scenarios where a penetration rate (particularly for the low-income) can exceed 100%: 1. Health centers in the area serve a significant population over 200% of poverty (and the UDS doesn't distinguish). 2. Multiple health centers are serving the same individuals (particularly an issue where one health center provides a non-medical service, such as dental, for a broad area). 3. Health centers may serve large numbers of transient groups which may not be counted by Census (students, migrants, homeless, etc.) The first of these is the probably the most common. It is important to note that 90.62% of health centers patients of known income are below 200% of poverty nationally; we can't readily extrapolate from the awardee's overall poverty mix as many awardees report a significant number of users of unknown income (approximately 32.22% of users nationally). Conversely, it would not necessarily be true that every member of the low-income population would be expected to have a visit in the past year, so this may mean the denominator is higher than ideal as well. The issue is well understood and doesn't fundamentally change the basic utility of the calculation in assessing the role of health centers in serving the community. The data should be considered the starting point for considering this issue, not the final answer. Note: It is true that rural centers are more likely to be serving those over 200% of poverty (because the issue is overall access not financial access). Also, there is a penetration rate amongst the total population calculated which may be more reflective of the role of health centers in a rural or frontier area.