American Hospital Association Urges Trump to Exempt Health Care Personnel from $100,000 H 1B Fee

Recently, the American Hospital Association (“AHA”) voiced its support for an exemption from the $100,000 H-1B fee for health care workers.

 

In its letter, AHA urges the federal government to exempt health care personnel from the $100,000 H‑1B visa fee established by President Trump’s September 2025 proclamation, “Restriction on Entry of Certain Nonimmigrant Workers,” (MU’s blog on the fee is available here) arguing that the fee threatens hospitals’ ability to recruit and retain qualified foreign‑trained professionals.

 

Health care systems across the United States continue to grapple with profound clinician and nurse shortages that are projected to deepen significantly in the years ahead. 

 

The H-1B visa is essential to meeting shortages in health care occupations in the US. In fiscal year 2024 alone, of nearly 400,000 H‑1B petitions approved, 16,937 (4.2 %) were for medical and health occupations, including physicians, surgeons, and registered nurses.

 

AHA also articulated its strong support for the bipartisan Healthcare Workforce Resilience Act (discussed by MU here). These combined measures represent a coherent strategy to preserve and expand the U.S. health care workforce. Ensuring exemption from the fee is not only a regulatory measure—it is a critical component of maintaining continuous and equitable access to health services across communities nationwide.

December 2025 Visa Bulletin: Movement Forward in All Categories

The Department of State has just issued the December 2025 Visa Bulletin. This blog post analyzes this month's Visa Bulletin.

Visa Bulletin

Table A: Final Action Dates -- Applications with these priority dates or earlier may be approved for their Green Card (Permanent Residency card) or Immigrant Visa appointment:

Table B: Dates for Filing

USCIS will use the Table B Dates for Filing chart for I-485 employment-based filings in December 2025. See: USCIS Visa Bulletin Dates

The Dates for Filing chart did not change from November 2025 to December 2025.

MU Law Analysis

EB-1: EB-1 China and EB-1 India each moved forward one month. All other EB-1 categories remain current.

EB-2: EB-2 categories made the following progress forward in the December 2025 visa bulletin:

• EB-2 All Chargeability, EB-2 China, EB-2 Mexico, and EB-2 Philippines: 2 months
• EB-2 India: 6 weeks

EB-3: EB-3 categories made the following progress forward in the December 2025 visa bulletin:

• EB-3 All Chargeability, EB-3 Mexico, and EB-3 Philippines: 2 weeks
• EB-3 China and EB-3 India: 1 month

CALL FOR CONGRESSIONAL SUPPORT OF HEALTHCARE WORKFORCE RESILIENCE ACT

As discussed in a previous blog post, Musillo Unkenholt is pleased to report that the Healthcare Workforce Resilience Act (HWRA) has been reintroduced into Congress. The HWRA has bipartisan sponsorship of Senators Durbin and Cramer in the Senate and Representatives Brad Schneider and Don Bacon in the House.

The HWRA offers an immediate response to the U.S.’s nursing shortage crisis by recapturing 25,000 previously authorized but unused immigrant visas (Green Cards) for highly-qualified international nurses who meet strict professional requirements. The bill does not displace any U.S. nurses or increase the total number of available immigrant visas (Green Cards).

Musillo Unkenholt endorses the HWRA, an efficient and long-awaited step toward immigration reform that will work to meet the country’s growing need for a strong U.S. health care workforce.

The HWRA has the highest chance of passing in Congress with more co-sponsorship. If you or your employer would benefit from common-sense lawmaking to remedy the U.S. nursing shortage, contact your congressional representative about co-sponsorship of the HWRA.

DOL’s FLAG Resumes Wage Request Processing for Immigration Applications

The Department of Labor (DOL) announced on October 31, 2025 that it has resumed its processing of immigration-related requests for prevailing wages, labor certification determinations, and other wage applications via its online filing system, FLAG.

As discussed in an MU blog last month, the government shutdown has shuttered the DOL’s FLAG operations since October 1, 2025, when the website was made completely unavailable.

Although the government shutdown is ongoing, the DOL’s resumption of its processing is welcome news for employers and immigrants who have been ineligible to file certain cases without requisite DOL wage determinations.

DOL did not clarify whether FLAG will resume processing indefinitely throughout the remainder of the government shutdown. However, optimistically, in its announcement, DOL notes that it “is taking all steps necessary to resume application processing” and is “transition[ing] back to full operational status”.

President Trump’s $100,000 H-1B Fee: Lawsuit and New Guidance

On Thursday, October 16, the U.S. Chamber of Commerce filed a lawsuit challenging President Trump’s $100,000 H-1B fee. MU posted its first blog on the $100,000 fee detailing the fee’s application last month.

The U.S. Chamber of Commerce, the nation’s largest business association and advocacy organization, brings this suit under claims that the fee exceeds the President’s authority and violates the Administrative Procedure Act (APA).

The lawsuit cites several studies and articles attesting that the H-1B program benefits the U.S. economy and is vital in addressing the U.S. labor shortage crisis. It also includes statements from businesses and investors regarding the devastating effects the proclamation will have on American businesses.

On Monday, October 20, USCIS updated its H-1B webpage with new guidance that the $100,000 fee is not required for petitions filed on behalf individuals who are already in the US on valid temporary status (such as an F-1, H-4, J-1, etc.).

The guidance also provided details on the type of case that may qualify for an exception from the fee and finally provided a mechanism for payment of the $100,000 fee.

MU will discuss these updates and more in detail during our free webinar on Tuesday, October 28, at 2PM Eastern. Register to attend!

WEBINAR: H-1B $100,000 Proclamation Updates

MU will be hosting a FREE webinar on Tuesday, October 28th at 2PM Eastern for our friends and clients.  Please join us! 

Join us for this FREE webinar to learn more about:

• Who is Subject to the $100,000 Payment
•  Exception Criteria
• Litigation Updates

Please join us!

November 2025 Visa Bulletin: No Movement for Employment-Based Categories

The Department of State has just issued the November 2025 Visa Bulletin. This blog post analyzes this month's Visa Bulletin.

Visa Bulletin

Table A: Final Action Dates -- Applications with these priority dates or earlier may be approved for their Green Card (Permanent Residency card) or Immigrant Visa appointment:

Table B: Dates for Filing

The USCIS will continue to use the Table B Dates for Filing chart for I-485 employment-based filings in November 2025. See: USCIS Visa Bulletin Dates

MU Law Analysis

EB-1, EB-2, EB-3: The Visa Bulletin for categories EB-1, EB-2, and EB-3 made no movement from October 2025 in either the Final Action Dates or Dates of Filing chart.

DOS Will Now Require Proof of Residence from Green Card Applicants

As discussed in an MU blog post last month, the U.S. Department of State (DOS) announced that, effective November 1, 2025, the National Visa Center (NVC) will only schedule immigrant visa (Green Card) interviews in an applicant’s country of residence or, if requested, country of nationality.

Related to the new policy, late last week, many Green Card applicants began receiving notices from DOS requesting proof of their residence.

The notices also explain that applicants may interview outside their country of residence and/or nationality only if experiencing special circumstances, which must be communicated to the NVC in specific terms before an interview can be scheduled. The DOS notices clarify that traveling to or residing temporarily in a third country in order to apply for a U.S. visa does not constitute a special circumstance.

Finally, although the notices request proof of residency, the notices indicate that applicants who interview outside their country of nationality may experience delayed visa processing.

MU is continuing to monitor DOS processes and trends related to its interview policy. If you have questions about your Green Card interview location or the evidence required by DOS, contact your MU legal team for assistance.

DHS Proposes Weighted Selection for the Highest Wages in H-1B Cap

On September 24, 2025, DHS published in the Federal Register a proposed new rule that would give priority to H-1B Cap candidates whose employer promises to pay the highest of the Occupational Employment Statistics (OES) wage levels.

The OES assigns wages from Levels I through IV for a particular position in a Metropolitan Statistical Area (MSA). An employer then chooses the appropriate wage level based on the experience and complexity of the position and files a Labor Condition Application (LCA) listing the appropriate OES wage.

According to DHS’s proposed rule, H-1B Cap registration candidates offered higher salaries would have a significantly greater chance of being selected in the H-1B cap than those offered lower wages. Specifically, higher wage levels would receive more entries in the selection pool: Wage Level IV (fully competent) would get four entries, Wage Level III (experienced) three entries, Wage Level II (qualified) two entries, and Wage Level I (entry-level) one entry.

While DHS notes its intent is to incentivize employers to offer higher wages to H-1B workers, clients should remember that a position’s wage level is also determined by the DOL’s wage level guidance. Therefore, not all H-1B positions are eligible for Level III and Level IV wages.

The proposed rule is currently accepting comments from the public until October 24, 2025, to which DHS will then respond and may alter some elements of the rule.

MU has prepared a comment to the proposed rule expressing strong opposition to replacing the current random lottery system with a weighted lottery. The proposed rule would make it more difficult for hospitals and clinics—especially those in rural areas and nonprofits—to recruit and retain essential healthcare staff such as nurses and medical technologists. MU maintains that the H-1B program is critical to address workforce shortages in the U.S. healthcare system.

WEBINAR: Business Immigration Hot Topics

MU will be hosting a FREE webinar on Tuesday, October 7th at 2PM Eastern for our friends and clients.  Please join us! 

Join us for this FREE webinar to learn more about:

• H-1B $100k Visa Fee
• H-1B Cap Employees October 1 Start Considerations
• USCIS H-1B Site Visit Trends   
• Visa Bulletin Fiscal Year 2026 Projections
• Healthcare Workforce Resilience Act

Please join us!

Government Shutdown: How it Could Affect Your Immigration Case

The US government is facing an impending shutdown at midnight on Wednesday, October 1, 2025. However, even in a “shutdown”, not all immigration processes will halt immediately.

Immigration cases proceed through several different government agencies. A shutdown will affect certain agencies (and thus their processes) differently than others. 

What will Halt as of an October 1 Shutdown?

DOL

Most significant to employment-based immigration cases, the Department of Labor (DOL) will not operate during a government shutdown.

Labor Condition Applications (LCAs), required for H-1B and E-3 filings, and Permanent Labor Certifications (PERMs), required for I-140 filings, cannot be drafted or filed during a government shutdown, and pending LCAs and PERMs will not be issued during a shutdown.

Further, the full FLAG online filing system will be disabled during a government shutdown. LCA and PERM records cannot be accessed online or printed from the FLAG system during a shutdown.

Finally, DOL may allow flexibility for employers who miss filing deadlines due to the government shutdown; if such guidance is issued, MU will update its blog accordingly.

What May Proceed after an October 1 Shutdown?

USCIS

Cases that will be filed with or are currently pending with US Citizenship and Immigration Services (USCIS) will continue to be accepted and processed during a shutdown. In past shutdowns, USCIS has accepted late immigration filings that could not be timely-filed due to the government shutdown.

DOS

Embassy services, such as visa appointments, are run by the Department of State and are also unlikely to be affected during a shutdown.

CBP

Entries to the US, including Canadian TN appointments, are handled by Customs and Border Protection and are also unlikely to be affected by a shutdown.

Clients with questions or concerns are encouraged to contact their MU attorney for best strategies during the potential government shutdown.

H-1B PROCLAMATION COULD ADD $100,000 FEE TO PETITIONS

Late Friday, September 19, 2025, President Trump issued the Presidential Proclamation, Restriction on Entry of Certain Nonimmigrant Workers.  The Proclamation creates a $100,000 fee due on each H-1B petition at the time the case is filed, although some exemptions exist.  There was – and continues to be -- widespread confusion about the applicability of the Proclamation to various types of H-1B cases.

Please join our webinar on Tuesday, September 23, 2025 at 2PM.  We will spend much of the webinar addressing the new Proclamation.  We have been involved with some non-public conversations with Washington DC.  We will share what we are allowed to share during that webinar.

REGISTER FOR THE WEBINAR

Here’s what we currently know. We will share updates as soon as they are announced:

• The Proclamation is effective Sunday, September 21, 2025 at 12:01AM Eastern Time and is valid for a period of 12 months.
• A fee of $100,000 per H-1B petition will be charged.  Note some reporting said the $100,000 would be assessed annually (totaling $300,000 for a three-year H-1B); that reporting is incorrect, the fee is a one-time $100,000 per H-1B petition. 
• Who the Fee Applies To – New H-1B petitions (both cap-subject and cap-exempt) that are filed with the USCIS after September 20, 2025.  The plain language of the Proclamation indicates the fee applies to all H-1B entries after September 20, 2025, but the Administration issued subsequent guidance on Saturday clarifying the fee will be applied to new H-1B petition filings submitted to the USCIS after September 20, 2025.
• Who is Exempt from the Fee – The fees does not apply to H-1Bs filed before September 20, 2025, including:
• Current H-1B holders who are traveling abroad and re-entering the US;
• Foreign nationals with a current H-1B approval and/or H-1B visa stamp who are entering the US for the first time; and
• H-4 dependents.
• Waiver of the $100,000 fee (National Interest Exemptions) – The USCIS may waive the $100,000 fee if:
• The H-1B employee’s work is in the national interest, and
• Their admission would not pose a threat to U.S. security or welfare.

No specific guidance has been issued yet on how to apply for a national interest exemption, or which industries or companies might qualify. Given the ongoing nursing shortage, RNs and other healthcare workers may have a strong case for this exemption.  IT professionals probably will not have a strong case for the exemption. We expect more details soon. 

• Legal Challenges Expected:
• Lawsuits challenging the Proclamation are likely and may request an emergency block of the Proclamation and the implementation of the fee.

MU will update our clients with additional information as this Proclamation is implemented and challenged in court.  Again, please join us on Tuesday’s webinar for the latest information.

October 2025 Visa Bulletin: Modest Movement Forward for Most Categories

The Department of State has just issued the October 2025 Visa Bulletin, the first of the new Fiscal Year. This blog post analyzes this month's Visa Bulletin. 

Visa Bulletin

Table A: Final Action Dates -- Applications with these priority dates or earlier may be approved for their Green Card (Permanent Residency card) or Immigrant Visa appointment:

Table B: Dates of Filing

The USCIS will use the Table B Dates of Filing chart for I-485 employment-based filings in October 2025. See: USCIS Visa Bulletin Dates

MU Law Analysis

EB-1: EB-1 Philippines, Mexico, and Rest of World remain current. Only EB-1 China moved forward by roughly 5 weeks.

EB-2: EB-2 India, Philippines, Mexico, and Rest of World all moved forward 3 months. EB-2 China moved forward nearly 4 months.

EB-3: EB-3 Rest of World and Mexico did not move forward. EB-3 Philippines moved forward nearly 2 months. EB-3 China and India moved forward 3 months.

WEBINAR: Business Immigration Hot Topics

MU will be hosting a FREE webinar on Tuesday, September 23rd at 2PM Eastern for our friends and clients.  Please join us!

Join us for this FREE webinar to learn more about:

• H-1B Cap Employees October 1 Start Considerations
• USCIS H-1B Site Visit Trends
• Visa Bulletin Fiscal Year 2026 Projections
• F-1 Student Visa Proposed Rule Changes
• Healthcare Workforce Resilience Act

Please join us!

HEALTHCARE WORKFORCE RESILIENCE ACT REINTRODUCED INTO CONGRESS

Musillo Unkenholt is pleased to report that the Healthcare Workforce Resilience Act (HWRA) has been reintroduced into Congress. The HWRA has bipartisan sponsorship of Senators Durbin and Cramer in the Senate and Representatives Brad Schneider and Don Bacon in the House.

As America grapples with a devastating nursing shortage that is directly undermining the quality, accessibility, and affordability of healthcare for millions of Americans in rural communities across the country, Musillo Unkenholt endorses policymakers taking immediate action.

The HWRA offers an immediate response to this crisis by recapturing 25,000 previously authorized but unused immigrant visas (Green Cards) for highly-qualified international nurses who meet strict professional requirements. The bill does not displace any U.S. nurses or increase the total number of available immigrant visas (Green Cards).

This bipartisan solution will help to ensure rural and elderly Americans receive the nursing care they need today while policymakers seek additional solutions to help America produce more nurses in the future and end this crisis once and for all.

Musillo Unkenholt endorses the HWRA, an efficient and long-awaited step toward immigration reform that will work to meet the country’s growing need for a strong US health care workforce.

Green Card Interviews to be Scheduled in Country of Residence

The U.S. Department of State has announced that, effective November 1, 2025, the National Visa Center (NVC) will only schedule immigrant visa (Green Card) interviews in an applicant’s country of residence or, if requested, country of nationality.

Existing immigrant visa appointments scheduled through the NVC will generally remain in place and will not be automatically canceled or rescheduled based on this new policy.

If you have questions about your Green Card interview location, contact your MU legal team for assistance.

USCIS to Consider “Anti-Americanism” in Certain Immigration Decisions

On August 19, 2025, USCIS issued a policy alert that the agency will review “anti-Americanism” as a  discretionary factor when reviewing certain benefit requests.

“Anti-Americanism” will be reviewed in requests such as employment authorization applications, F visa extension applications and changes of status, requests for National Interest Waivers, and employment-based adjustments of status.

 

USCIS dictates that officers should give “overwhelmingly negative weight” to evidence of an applicant’s support for or promotion of terrorist ideologies, antisemitism, or other conduct USCIS may consider “anti-American”. The agency asserts that such conduct will likely lead to denial of the requested benefit.

 

The policy explicitly allows officers to consider public behavior, including social media activity, as part of this discretionary review, making it important for applicants to be mindful of their digital footprint when applying for immigration benefits.

September 2025 Visa Bulletin: No Movement and No Retrogression So Far

The Department of State has just issued the September 2025 Visa Bulletin. This blog post analyzes this month's Visa Bulletin.

Visa Bulletin

Table A: Final Action Dates -- Applications with these dates may be approved for their Green Card (Permanent Residency card) or Immigrant Visa appointment:

Table B: Adjustment of Status Filing Chart

USCIS will continue to use the Table A Final Action chart for I-485 employment-based filings in September 2025. See: USCIS Visa Bulletin Dates

MU Law Analysis

There was no movement forward for any employment-based category, and as of August 18, 2025, no category has retrogressed.

The Visa Bulletin notes that there has been a steady increase in visa demand throughout the fiscal year. If, at any time before September 30, 2025, the annual limit of any category is reached, the Department of State will immediately make the preference category “unavailable”, and no further requests for visas will be honored.

End of Fiscal Year FAQ

Q.  Why do visa categories often retrogress in September?

A. The Department of State has a limited number of immigrant visas it may issue each fiscal year, which runs from October 1 – September 30. The Department of State must avoid issuing excess immigrant visa numbers before the end of the fiscal year or else it violates federal law. 

The issuance totals in some categories are approaching the annual limit for FY-2025, which could require the Visa Bulletin’s retrogression in order to slow down issuance rates. 

Q. Does this mean that certain categories will permanently be retrogressed?

A.  No. This would be a temporary retrogression in effect for the remainder of the fiscal year (i.e. until September 30, 2025). The Department of State generally advances final action dates in October each year, when the new fiscal year begins.

Q.  If I have an interview, but my priority date retrogresses in September, will I still be able to get my green card?

A.  If you have an interview before your category retrogresses, you will be able to get your green card.  However, if the Department of State updates your category to “unavailable” prior to your interview date, the interview may be postponed until your priority date becomes current again, which could be as early as October 1, 2025.

If you have questions on this month’s Visa Bulletin, please reach out to your MU attorney directly or Contact Us.

Department of State to Require In-Person Interviews for Most Visa Applicants

On July 25, 2025, the Department of State (DOS) announced in an Interview Waiver Update  that it will reduce significantly the categories of visas eligible for a waiver of an in-person visa interview.

Effective September 2, 2025, DOS will require all nonimmigrant visa applicants (including E, F, H, J, K, L, M, O, P, and R visa applicants) to appear for in-person interviews with consular officers. In-person interviews will be required for both initial and renewal applications.

DOS will waive the in-person interview requirement for very limited visa types, including certain B visa applicants and some diplomatic, official, and NATO visa applicants.

Previously, the Biden administration allowed visa interview waivers for renewals of all nonimmigrant visas that had expired within the previous 48 months. In February 2025, the Trump administration restricted the rule to allow for waivers only within 12 months of previous visa expiry.

Employers should consider the additional time required for interview scheduling and completion based on this update.

Immigrant Caregivers are Crucial to Staff Direct Care Industry

President Trump’s “immigration crackdown” has elicited a warning from the direct care industry: immigrants are essential.

Although immigrants comprise 17% of the total American labor force, they make up 31% of the home care workforce and 21% of the residential care aide and nursing assistant workforce, according to a 2024 report from Leading Age, an organization representing nonprofit aging services providers.

 

A recent article by USA TODAY highlights the severity and scope of the direct care worker shortage, which is set to reach critical levels as the US faces even higher demand to care for aging Baby Boomers.

 

In 2020, 55.8 million people in the US were 65 and over, according to census data. A study in Health Services Research estimates that number will reach nearly 70 million by 2030.

 

From 2022 to 2037, a National Center for Health Workforce Analysis estimated the demand for home health aides will rise 35%, the demand for personal care aides will rise 38%, and the demand for nursing assistants will rise 41%.

 

Articles by Axios and AP News echo the essentiality of immigrant caregivers in US nursing homes, and warn of the effect President Trump’s immigration policies are already having on nursing home staffing in the US.

 

AP News reports:

 

“The aging of the massive Baby Boom generation is poised to fuel even more demand for caregivers, both in institutional settings and in individuals’ homes. BLS projects more growth among home health and personal care aides than any other job, with some 820,000 new positions added by 2032.”

 

Due to high demand and Department of State backlogs, immigrant nursing aides who qualify for a Green Card are currently waiting more than three years to enter the U.S. after their cases are approved.

 

Because of lengthy backlogs, staffing companies employing nursing assistants and nurse aides are best equipped to withstand immigration delays in their business models; however, meeting the demand for direct caregiving in the US in the coming years will require policies to extend temporary work authorization for direct care workers and policies to alleviate Department of State backlogs for permanent immigration solutions.

Department of State Shortens Validity of Temporary Visas for over 50 Countries

On July 17, 2025, NAFSA, a nonprofit policy advocate, released a report detailing the Department of State’s (DOS) recent actions to shorten temporary visa validity periods. DOS’s changes will affect multiple temporary visa types for nationals of over 50 countries.  

In most cases, DOS has shortened temporary visa validity to only 3 months and a single entry. In practice, this means applicants receiving a shortened visa must enter the US within 3 months of their visa issuance and will have to reapply for a visa before each entry to the US.

A full list of the more than 50 affected countries can be found in NAFSA’s report; the list includes Afghanistan, Cameroon, Ghana, Haiti, Iran, Nigeria, Sierra Leone, Uganda, Venezuela, and Zimbabwe.

With some variations, affected visa types include B, F, H, J, M, O, and P visas.

F visas are utilized by international students in the US. The H-1B visa is open to employees filling US positions that require Bachelor’s degrees, which include healthcare occupations such as Medical Technologists, Occupational Therapists, Physical Therapists, and even Registered Nurses.

Although DOS did not make an announcement of its sweeping temporary visa limitations, individual visa validity periods by country are updated on the DOS’s visa reciprocity website. Speak with an MU attorney if you have questions about your visa validity.

FY 2026 H-1B Cap is Reached: USCIS Will Not Conduct Second Round of Lottery

USCIS announced in a News Alert that the FY 2026 H-1B cap has been reached as of July 2025. Because the cap has been reached, USCIS will not conduct a second round of H-1B cap lottery selections in 2025.

The FY 2026 H-1B cap has been reached because USCIS received enough H-1B petitions between April 1, 2025 and June 30, 2025 to meet the 65,000 H-1B visa regular cap and 20,000 H-1B visa master’s cap. 

The case status for registrations that were not selected in the FY 2026 cap will be updated from “Submitted” to “Not Selected” in their https://my.uscis.gov/ account.

August 2025 Visa Bulletin: Slight Movement Forward for EB-3 India, Slight Retrogression for Others

The Department of State has just issued the August 2025 Visa Bulletin. This blog post analyzes this month's Visa Bulletin.

Visa Bulletin

Table A: Final Action Dates -- Applications with these priority dates or earlier may be approved for their Green Card (Permanent Residency card) or Immigrant Visa appointment:

Table B: Dates for Filing

USCIS will continue to use the Table A Final Action Dates chart for I-485 employment-based filings in August 2025. See: USCIS Visa Bulletin Dates

MU Law Analysis

EB-3 India was the only category to progress forward in August 2025, with forward movement of 1 month.  

EB-2 All Other, EB-2 Mexico, and EB-2 Philippines all retrogressed 6 weeks.  

All remaining categories stayed steady and made no progress.

As August is the penultimate month of the fiscal year, slight retrogression is typical and not a cause for concern. September 2025’s visa bulletin is unlikely to make progress forward and may slow or even retrogress again before the start of the fiscal year in October.