The Puerto Rico government enters the fall 2027 Medicaid cliff with its largest request to Congress yet on paper and no contingency plan on the shelf. The federal agreement that lifted the federal share of Plan Vital funding to 76 percent expires on 1 October 2027, and absent new legislation the federal contribution falls back to 55 percent^[1] - an approximately 90 percent cut in federal funding that takes effect 30 September 2027.^[2] The González Colón administration has no contingency plan for coverage cuts or beneficiary exclusions if Congress fails to act; its entire strategy is to lobby federal lawmakers for a fix.^[3][4] Should Congress fail, between 860,000 and 1 million Plan Vital beneficiaries would lose coverage and the government would face a roughly $3,300 million deficit.^[5][6] The numbers put in context how different Puerto Rico's program is from state Medicaid. Plan Vital covers roughly 40 percent of the island's residents, more than double the share Medicaid covers in the states.^[7] The Multisector Advisory Board on Puerto Rico's Medicaid Program, created by Governor Jenniffer González Colón through Executive Order 2026-006^[8], released its final report urging Congress to fix the island's Medicaid financing before fiscal year 2028.^[9][10] The board's central recommendation is to remove the federal Medicaid funding cap so the island draws funds according to actual need, as states do; without congressional action, Medicaid funding to Puerto Rico could drop by $3.36 billion annually.^[11][12] The odds of Puerto Rico avoiding the full cliff improved following the 3 November 2026 congressional elections.^[13] If federal support is nonetheless reduced and the program had to be locally funded, the cost to the Puerto Rico treasury would run an estimated $4.85 billion in fiscal 2028.^[14] The request carries weight beyond the island's borders: Puerto Rico's Medicaid payment error rate of 2.51 percent^[15] runs at less than half the 5.09 percent national average^[16], an argument the administration intends to make as it lobbies for equal treatment under federal funding formulas.