The odds of Puerto Rico avoiding the full Medicaid funding cliff improved following the November 3 2026 US congressional elections, Caribbean Business reported.^[1] Without new federal legislation, Plan Vital faces an approximately 90% cut in federal funding on September 30 2027.^[2] The program covers roughly 40% of Puerto Rico residents, and the local government would need an estimated $4.85 billion in fiscal 2028 to replace the lost federal support.^[3] Absent action, the annual federal allotment drops below $500 million and the federal match falls to 55%.^[4][5] The current terms, set by the December 2022 federal law, are a $3.825 billion annual cap with a 76% federal match.^[6] Health officials testified that a funding cut could leave 860,000 to 1,000,000 Plan Vital beneficiaries without coverage and create a $3.3 billion government deficit.^[7] The administration has no contingency plan built on coverage cuts or beneficiary exclusions.^[8] Medicaid legislation begins in the House Energy and Commerce Committee and the Senate Finance Committee, and both will be chaired by Democrats in January.^[9] Frank Pallone is expected to become House Energy and Commerce chairman.^[10] Democrats hold the Territories Health Equity Act, which would remove Puerto Rico's Medicaid cap.^[11] Resident Commissioner Pablo Jose Hernandez has proposed removing the Section 1108 cap so federal funding follows eligible spending, as it does in the states.^[12] The government's asks to Congress include eliminating the annual allotment cap so Puerto Rico receives funds according to real need, as the states do.^[13] Every scenario runs through the same date: without new legislation by September 30 2027, the $500 million floor takes over.^[4]