United States citizens residing in Puerto Rico cannot vote in federal presidential or congressional elections, and hold only a non-voting resident commissioner in Congress. ^[1] United States midterm elections will be held on November 3, with all 435 House seats and one third of Senate seats up for election. ^[2] If passed, the CHW Access Act would permit primary care practices to receive Medicaid reimbursement for community health worker services. ^[3] This commentary analyzes the Community Health Worker Access Act introduced in the United States Congress. ^[4] Maternal mortality in the United States has risen over the past three decades. ^[5] Most existing US clinical guidelines and care models only cover the first 12 weeks postpartum. ^[6] Puerto Rico receives capped federal Medicaid funding unlike US states, requiring recurring congressional approval to maintain healthcare services. ^[7] The United States Congress holds constitutional authority over Puerto Rico's territorial political status. ^[8]