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In February 2026, bipartisan members of Congress renewed calls for relief from the $100,000 H 1B visa filing fee for international healthcare workers. In an American Hospital Association (AHA)-supported letter sent to the U.S. Department of Homeland Security (DHS) on February 11, lawmakers urged the agency to exempt healthcare workers from the fee, warning that the policy threatens already‑strained hospital staffing nationwide.
The
letter, led by Representatives Yvette D. Clarke (D‑NY) and Michael Lawler (R‑NY),
was signed by 100 members of Congress and emphasized that hospitals and
health systems rely heavily on international professionals to maintain access
to care, particularly in rural and underserved communities.
Hospitals Warn of Worsening Workforce Shortages
Lawmakers
cautioned that imposing a $100,000 fee on new H‑1B visa petitions would further
exacerbate existing staffing shortages and push financially vulnerable
hospitals closer to the brink. According to the letter, if healthcare employers
are unable to petition for H‑1B workers without absorbing the additional cost,
critical clinical positions may remain unfilled, reducing patient access to
essential services.
AHA Continues Advocacy for a Healthcare Exemption
The
AHA’s support for the congressional letter aligns with broader, ongoing
advocacy efforts by hospitals, academic medical centers, and healthcare
associations seeking an exemption from the $100,000 H‑1B fee. These
organizations argue that restricting access to H‑1B visas will worsen workforce
shortages across multiple healthcare professions and undermine the financial
viability of care providers serving high‑need populations.
As DHS
continues to evaluate implementation of the fee, healthcare stakeholders remain
focused on securing targeted relief that recognizes the essential role
international professionals play in sustaining the U.S. healthcare system.
In September 2025, President Trump instituted a prohibitive $100,000 fee on new H-1B visas. While lawsuits against the fee have been ongoing, the fee currently remains in effect. Hospitals, medical schools, and other healthcare companies have continued their calls for an exemption from the fee for international healthcare professionals who are essential to the US healthcare system.
In a recent article, the American Association of Medical Colleges (AAMC) raised concerns about how the fee is already affecting major staffing decisions for US hospitals approaching national Match Day with graduating medical students on March 20, 2026.
AAMC reports that in a fall survey by the Greater New York Hospital Association (representing 260 hospitals across NY, NJ, CT, and RI), 25% of hospitals said they had paused, deferred, or limited recruitment of physicians requiring H‑1B visas. Those hospitals currently employ 1,100 H‑1B medical residents and 800 H‑1B attending physicians, highlighting the scale of potential disruption.
Importantly, AAMC emphasizes that visa‑holding physicians do not displace U.S. graduates; in fact, 97.8% of U.S. MD seniors matched into residency positions in 2025.
International medical graduates make up about 25% of all practicing U.S. physicians. In fiscal year 2024 alone, approximately 11,000 new H‑1B visas were approved for physicians, who disproportionately practice in rural and high‑poverty counties and are more likely to work in primary care.
AAMC has cosigned multiple letters, joining
medical organizations, institutions of higher education, and health professions
education groups, in requesting that the U.S. Department of Homeland Security
(DHS) exempt these groups from the fee. AAMC also sent a letter to DHS
Secretary Kristi Noem in December 2025, warning that the proclamation will
worsen the nation’s existing workforce shortage, further strain the health care
workforce, and ultimately jeopardize patient access to care.
On December 29, 2025, DHS published a Final Rule in the Federal Register, amending the way in which USCIS will select candidates in the H-1B Cap Lottery.
Instead of the existing random lottery system, USCIS will implement a weighted selection process that prioritizes allocating H-1B visas to higher-skilled and higher-paid workers according to their Occupational Employment and Wage Statistics (OEWS) wage levels.
Each worker’s OEWS wage level, which ranges from Levels I to IV, will determine how many registration entries that candidate will receive. Higher wage levels receive more entries—four for Level IV, three for Level III, two for Level II, and one for Level I—resulting in higher-paid positions having greater odds of selection while still allowing all wage levels to participate.
Although DHS received nearly 17,000 public comments on its Notice of Proposed Rulemaking (NPR), issued back in September 2025, DHS published this Final Rule without any modifications. DHS notes that some commenters suggested that DHS should consider an exemption for healthcare occupations, especially in rural or shortage areas. However, DHS declined to carve out exemptions for certain industries or give additional weight for registrations in “critical sectors.”
The Final
Rule is effective February 27, 2026, and will be in place for the H-1B Cap
Registration Season for the 2027 Fiscal Year.
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.
On June 20, 2025, the Department of Homeland Security (DHS) launched a new report to allow employers to identify E-Verify cases with Employment Authorization Documents (EADs) that have been revoked.
EADs allow employees to work in a broad range of occupations and
industries, including healthcare, IT, and engineering.
EAD Revocations by DHS
DHS may terminate parole and revoke aliens’ EADs at any time. Employees
with revoked EADs may still possess an EAD that appears valid, although their
employment authorization has been revoked.
In late May 2025, DHS was permitted to terminate parole for Cubans, Haitians, Nicaraguans, and Venezuelans
(CHNV).
What Employers Need to Know
E-Verify will no longer provide case alerts for EADs that have been revoked. Instead, employers should generate the Status Change Report upon logging in to E-Verify.
The new Status Change Report allows E-Verify employers to review cases for any employees who presented an EAD for employment verification which has now been revoked by DHS.
DHS has also
published EAD Revocation Guidance For E-Verify
Employers regarding these changes on E-Verify’s website.
In its recent update to H-1B program requirements, DHS revised its regulation on H-1B CAP-exemptions for beneficiaries who are staffed at universities and certain nonprofits.
H-1B CAP exemption allows an employer to file an H-1B CAP case on behalf of an employee at any time in the fiscal year, outside of the usual annual limits on H-1Bs imposed by the H-1B CAP. H-1B CAP exemption is particularly useful for employers seeking to employ beneficiaries in the healthcare industry, where staffing needs are particularly urgent.
DHS is revising its CAP-exempt regulation to note that beneficiaries qualify for H-1B cap exemption when they spend at least half of their time providing essential work to a qualifying institution.
Previously, the regulation required a beneficiary to spend the majority of their time performing duties at a qualifying institution.
First, the revision reduces the time requirement by noting that the employee need only spend 50% of their time providing work to a qualifying institution.
Second, the revision allows for remote work, including telehealth, to count toward an employee’s time requirement for CAP-exemption, while the previous regulation required an employee’s physical presence at a qualifying institution.
In DHS’s final rule, the
agency acknowledges that its CAP-exempt regulation revision may slightly expand
who is eligible for the cap exemption. DHS’s intention is that the revision will
increase flexibility for employers and beneficiaries, as well as better
represent modern employment situations.
The DHS has
proposed a new “fair and humane” Public Charge rule meant to clarify its existing policy. The proposed
rule is very similar to the current policy, but refines the forms of aid
considered under the test.
Unlike the DHS’s 2019 attempt to enact a Public Charge rule intended to restrict immigration, the new proposal should not create additional hurdles for immigrants. Under the new proposal, only four specific forms of public assistance would be considered in a Public Charge determination:
The DHS specifically excludes from the proposed rule:
Additionally, specific categories of noncitizens would be exempted from public charge ground inadmissibility under the proposed rule, including:
