A major precipitating factor of the fiscal crisis in Puerto Rico is Medicaid. Federal law provides that the federal government supply block grants to its territories, including Puerto Rico. Each year the federal block grant funding produces a budget shortfall that Puerto Rico must fund. Puerto Rico's Medicaid budget shortfall has been as large as $1.8 billion. Medicaid underfunding is responsible for a structural budget deficit in Puerto Rico. The severe underfunding of Medicaid has had adverse consequences for Puerto Rico. During the last decade Puerto Rico has had various health crises: Hurricanes Maria and Fiona, the Zika virus, and COVID-19. To further exacerbate matters, during the last decade Puerto Rico has lost 50% of its physicians. As set forth herein, federal funding of Medicaid for Puerto Rico has to be reconstituted because it has created a fiscal and public health disaster.