In the report accompanying fiscal year 2019 Labor, Health and Human Services, and Education appropriations (P.L. 115-245), the House Committee on Appropriations asked MACPAC to examine options for ensuring long-term sustainable access to health care for Medicaid beneficiaries in Puerto Rico. MACPAC discussed this issue at its October and December 2018 meetings, and in this presentation provides new analysis on enrollment and spending, and the financing, benefit, and coverage implications of Puerto Rico’s Medicaid fiscal cliff.