Over the past three decades, knowledge of the process of construction of the early modern state has increased, covering new geographical areas and developing new topics, including the ideological dimensions of court ceremonies and other cultural and symbolic elements. With a focus on Portugal, this paper aims to look at poverty relief and public health as important fields for political assertion, consolidation, and investment of royal power. Based on strong empirical evidence, it will demonstrate that the sixteenth century Portuguese Crown was able to establish and implement homogenous and centralized poverty relief and health care policies and regulations for social and political purposes. It will include the creation of two nationwide networks, in particular: one comprising royal confraternities, the Misericórdia confraternities, to which the Crown gave quasi-monopoly over formal poverty relief, including hospital administration, and the other, formed by doctors, apothecaries, and surgeons, appointed by the central government to serve the poor. Together, the Misericórdias and the “medical net” gave the Crown the opportunity to intervene in the daily life of communities, increasing its capacity to mobilize the local elite to participate in royal initiatives. The gradual structuring and implementation of the Portuguese poverty relief and health care “system” reflects not only a specific exercise of sovereign powers but also a deliberate use of this system as an instrument for state formation.