The LBJ Hospital in American Samoa is seeking a budget of just over 50 million US dollars in the new fiscal year, an increase of 13 million dollars on its current budget.
The budget request includes 10 million dollar to fund the off island medical referral programme.
The hospital stopped paying for off island referrals in 2008 because of the lack of funding.
Since then patients have had to pay for their own travel and medical expenses while the hospital arranged their treatment with hospitals in Hawaii, the Philippines and New Zealand.
The chairman of the Hospital Authority Board, Moananu Va, points to the law requiring the government to pay for necessary off island care for local patients.
He says ten million is their best estimate of the cost of the programme.
The LBJ chairman says some expenses which were deferred for more than two years, such as education and capital equipment, cannot be put off any longer.