In the report accompanying the 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 and March 2019 meetings. This presentation reviews the draft report chapter, which responds to the congressional request and will be included in MACPAC’s June report to Congress.