The Northern Marianas' healthcare provider is asking local government to invest $US90 million for the 2018 fiscal year.
Marianas Variety reported that the Commonwealth Healthcare Corporation (CHCC) asked for the money to hire more specialised physicians and apply for visas for its non-resident nurses.
During a Senate budget hearing Senator Justo Quitugua said the hospital should improve its services to reduce the number of patients referred to off-island hospitals.
An average of 800 patients are sent off-island each year.
However, CHCC chief executive Esther Muna said reducing off-island referrals was a part of her budget proposal.
She said the hospital wanted to provide more services but the government needed to invest in its health provider.