Senate Republican leaders are in talks about a proposal to extend an increased Federal Medical Assistance Percentage (FMAP) matching rate to five states, including Alaska and Hawaii. This strategy aims to gain approval from the parliamentarian, which could be pivotal in securing Sen. Lisa Murkowski’s (R-Alaska) vote.

GOP negotiators are considering a plan to extend the enhanced FMAP rate to North Dakota, South Dakota, and Wyoming, alongside Hawaii and Alaska. They are also suggesting that the formula for increased federal assistance be recalculated based on the states’ population density, according to information from a Senate source familiar with the discussions.

Negotiators hope that by reworking the proposal it can pass muster with Senate Parliamentarian Elizabeth MacDonough.

If the proposal is accepted, it could provide as much as an additional $3 billion in Medicaid funds to Alaska. 

On Sunday, the parliamentarian dismissed a section of the bill that aimed to offer an enhanced federal matching rate specifically to the two states with the highest separate poverty guidelines: Alaska and Hawaii.

Sen. Dan Sullivan (R-Alaska), who has pushed to rework the FMAP formula for his state, says that current FMAP rates aren’t fair to Alaska.

“The way in which the FMAP is calculated doesn’t make any sense. It’s a pure per-capita-income formula. That’s it. So if your state has a high per-capita income, you have a very low FMAP, even if you have a super high costs of living, even if you have super duper high costs of health care delivery — which we have the highest in the country — none of that is reflected in the FMAP formulas,” Sullivan told The Hill. “I’ve been working this one for 10 years.”

The idea of further boosting federal Medicaid payments in some states may not sit well with conservatives such as Sens. Rick Scott (R-Fla.), Ron Johnson (R-Wis.) and Mike Lee (R-Utah), who are pushing an amendment to find more Medicaid savings.

Republican leaders have also presented arguments to the Senate parliamentarian to grant Alaska and Hawaii waivers for Supplemental Nutrition Assistance Program (SNAP) cost-sharing requirements if they show progress in reducing error rates in delivering food assistance.