US Healthcare Industry Continues to Push for Exemptions to $100,000 H-1B Fee

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.

FY 2027 H-1B CAP Lottery

The fiscal year 2027 (March 2026) H-1B cap registration period will open at noon ET on Wednesday, March 4, 2026 and close at noon ET on Thursday, March 19, 2026.

H-1B cap registrations are submitted electronically via USCIS’s website. H-1B cap lottery winners are then eligible to submit an H-1B petition between April 1, 2026 – June 30, 2026.

The H-1B cap lottery is open to employees filling positions requiring Bachelor’s degrees, which may include healthcare occupations such as Medical Technologists, Occupational Therapists, Physical Therapists, and even Registered Nurses.

Notable changes to this year’s H-1B cap season are:

USCIS will require a $100,000 payment for new H-1B visa applicants who are outside the US at the time of their cap case filing.

USCIS has announced that lottery selection will be weighted, with more entries for selection given to H-1B candidates with high wages.

For the latest on USCIS’s H-1B changes and to ensure your own H-1B filing strategy, please reach out to your MU attorney.

USCIS Places Hold on Benefit Applications related to Travel Ban

On January 1, 2026, USCIS issued a Policy Memorandum announcing an adjudicative hold on all pending benefit applications filed by individuals from the “high-risk countries” listed in Presidential Proclamations 10949 and 10998 (Trump's Travel Ban).

Last month, USCIS abruptly enacted the adjudicative hold, as discussed by MU in December 2025, but that hold has now been made official USCIS policy.

 

USCIS’s adjudicative hold applies to cases filed by individuals who list a country from the Travel Ban as either their country of birth or country of citizenship. USCIS does not specifically list the form types affected by the hold, nor how long the hold will be in effect.

 

Furthermore, USCIS will re-review approved benefit requests such as Green Cards for individuals from Travel Ban countries. This may include interviews or re-interviews to reassess Green Card eligibility.

 

Are there any exceptions?

 

The following case types are exempt from USCIS’s adjudicative hold:

• Green card replacements (Form I-90);
• Replacement naturalization/citizenship documents (Forms N-565, N-600);
• Certain work permit categories (Form I-765);
• Benefit requests filed by professional athletes—including coaches and relatives—for the purpose of attending the World Cup, Olympics, or other major sporting event; and
• Case types that would serve a U.S. national interest.

If you have specific questions or concerns about this Policy Memorandum, do not hesitate to reach out to your MU attorney.

DOS Freezes Visa Issuance to Nationals of 75 Countries

On January 14, 2026, the Department of State announced a visa freeze for nationals of 75 countries.

The pause applies only to consular Green Card issuances. This means it does not affect temporary visas issued abroad or Changes of Status or Adjustments of Status filed within the US.

Dual nationals who have citizenship in at least one non-paused country are exempt from the pause.

 

Pursuant to its pause, effective January 21, 2026, DOS will not issue immigrant visas to applicants who are nationals of the following countries:

 

Afghanistan, Albania, Algeria, Antigua and Barbuda, Armenia, Azerbaijan, Bahamas, Bangladesh, Barbados, Belarus, Belize, Bhutan, Bosnia and Herzegovina, Brazil, Burma, Cambodia, Cameroon, Cape Verde, Colombia, Cote d’Ivoire, Cuba, Democratic Republic of the Congo, Dominica, Egypt, Eritrea, Ethiopia, Fiji, The Gambia, Georgia, Ghana, Grenada, Guatemala, Guinea, Haiti, Iran, Iraq, Jamaica, Jordan, Kazakhstan, Kosovo, Kuwait, Kyrgyz Republic, Laos, Lebanon, Liberia, Libya, Moldova, Mongolia, Montenegro, Morocco, Nepal, Nicaragua, Nigeria, North Macedonia, Pakistan, Republic of the Congo, Russia, Rwanda, Saint Kitts and Nevis, Saint Lucia, Saint Vincent and the Grenadines, Senegal, Sierra Leone, Somalia, South Sudan, Sudan, Syria, Tanzania, Thailand, Togo, Tunisia, Uganda, Uruguay, Uzbekistan, and Yemen

 

DOS asserts the pause is required to ensure that immigrants from the affected countries do not become public charges in the US.

 

The DOS visa freeze is being enacted in addition to several other policies already in effect to restrict immigration, including the Travel Ban and USCIS's own Travel Ban restrictions.

 

If you are filing benefit requests as a national of one of the countries above, consult with your MU attorney to discuss your best strategies for filing.

February 2026 Visa Bulletin: Movement Forward for Most EB-3 Categories

The Department of State has just issued the February 2026 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 (Immigrant Visa):

Table B: Dates for Filing – Form I-485 Applications to Adjust Status with these priority dates or earlier may be filed with USCIS:

USCIS will continue to use Table B: Dates for Filing chart for I-485 employment-based filings in February 2026. See: USCIS Visa Bulletin Date

MU Law Analysis

EB-3 All Chargeability, EB-3 Mexico, and EB-3 Philippines are the only categories to progress forward in February 2026, with forward movement of 5.5 weeks.

All remaining categories stayed steady and made no progress.

WEBINAR: H-1B Visa Updates

MU will be hosting a FREE webinar on Tuesday, January 13th at 2PM Eastern for our friends and clients.  Please join us! 

Join us for this FREE webinar to learn more about:

• H-1B $100k Payment Litigation Updates
• H-1B Cap Weighted Lottery

Please join us!

DHS Issues Final Rule for Weighted Selection of the Highest Wages in H-1B Cap

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.

Trump Expands Travel Ban to 39 Countries

On December 16, 2025, President Trump announced an expansion of his Travel Ban under Proclamation 10998. Proclamation 10998 amends Proclamation 10949, issued in June 2025, which originally imposed a travel ban on 19 countries.

The December 2025 Travel Ban extends travel restrictions on foreign nationals from 20 additional countries.

The new Travel Ban takes effect on January 1, 2026.

Which countries are affected?

Individuals born in the following countries are prevented from obtaining new visas under the travel ban (countries added to the ban in December 2025 in bold):

• Full travel ban on both temporary visas and immigrant visas (Green Cards):

• Afghanistan, Burma, Chad, Republic of the Congo, Equatorial Guinea, Eritrea, Haiti, Iran, Libya, Somalia, Sudan, Yemen, Burkina Faso, Mali, Niger, South Sudan, Syria, nationals holding travel documents from the Palestinian Authority, Laos, and Sierra Leone.

• Partial travel ban on B, F, M, and J temporary visas and immigrant visas (Green Cards):

• Burundi, Cuba, Togo, and Venezuela, Turkmenistan (Turkmenistan’s ban includes immigrant visas only), Angola, Antigua and Barbuda, Benin, Cote d’Ivoire, Dominica, Gabon, The Gambia, Malawi, Mauritania, Nigeria, Senegal, Tanzania, Tonga, Zambia, and Zimbabwe.

Are there any exceptions?

Yes. The ban does not apply to:

• existing Green Card holders;
• dual nationals, as long as the individual travels on a passport issued by a country that is not included in the ban;
• athletes, coaches and immediate relatives traveling for the World Cup, Olympics, or other major sporting event determined by the Secretary of State;
• specific diplomatic visas and visas issued to certain Iranian minorities; and
• other case-by-case determinations that an individual’s visa issuance would serve the US national interest.

If you have specific questions or concerns about how this Proclamation may affect your situation, do not hesitate to reach out to your MU attorney.

January 2026 Visa Bulletin: More Forward Movement in All Categories

The Department of State has just issued the January 2026 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:

Employment- based	All Chargeability  Areas Except Those Listed	CHINA- mainland  born	INDIA	MEXICO	PHILIPPINES
1st	C	01FEB23	01FEB23	C	C
2nd	01APR24	01SEP21	15JUL13	01APR24	01APR24
3rd	22APR23	01MAY21	15NOV13	22APR23	22APR23

Table B: Dates for Filing

Employment- based	All Chargeability Areas Except Those Listed	CHINA- mainland  born	INDIA	MEXICO	PHILIPPINES
1st	C	01AUG23	01AUG23	C	C
2nd	15OCT24	01JAN22	01DEC13	15OCT24	15OCT24
3rd	01JUL23	01JAN22	15AUG14	01JUL23	01JUL23

USCIS will use Table B: Dates for Filing chart for I-485 employment-based filings in January 2026. See: USCIS Visa Bulletin Dates

MU Law Analysis

EB-1: EB-1 China and EB-1 India each moved forward in the January 2026 Visa Bulletin. All other EB-1 categories remain current.

• EB-1 China: 1 week
• EB-1 India: 11 months

EB-2: EB-2 categories made the following progress forward in the January 2026 Visa Bulletin: 

• EB-2 All Chargeability, EB-2 India, EB-2 Mexico, and EB-2 Philippines: 2 months
• EB-2 China: 3 months 

EB-3: EB-3 categories made the following progress forward in the January 2026 Visa Bulletin:

• EB-3 All Chargeability, EB-3 Mexico, and EB-3 Philippines: 1 week
• EB-3 China: 1 month
• EB-3 India: 7 weeks

USCIS Issues New Travel Ban Restrictions

U.S. Citizenship and Immigration Services (USCIS) has issued several new policies to restrict immigration for individuals born in countries listed in President Trump’s June 2025 Travel Ban.

Currently, the countries listed in the Travel Ban are Afghanistan, Burma, Chad, Republic of the Congo, Equatorial Guinea, Eritrea, Haiti, Iran, Libya, Somalia, Sudan, Yemen, Burundi, Cuba, Laos, Sierra Leone, Togo, Turkmenistan, and Venezuela. However, the Trump administration has also indicated it intends to add more countries to its Travel Ban list soon.

USCIS has implemented the following policies:

• Pause on Benefit Requests

On December 2, 2025, USCIS issued a Policy Memorandum that pauses decisions on USCIS Benefit Applications filed on behalf of foreign nationals from Travel Ban countries.

USCIS specifically notes it is pausing decision-making on Adjustment of Status (I-485), Green Card Replacement (I-90), Removal of Conditions (I-751), Reentry Permits and Travel Documents (I-131), and Preservation of Residence for Naturalization (N-470), though the memorandum indicates that all form types may be affected.

• “Re-review” of Past Approvals

USCIS also plans to conduct “re-reviews” of approved benefit requests filed on behalf of individuals from the countries above, which could involve re-interviews from USCIS.

• “Negative Factor” Consideration

In adjudicating discretionary benefit requests, such as adjustment of status, change of status, or extension of stay requests, USCIS officers will now consider the fact that an individual is a national of one of these 19 Travel Ban countries as a “significant negative factor.” This is based on a separate Policy Alert issued by USCIS on November 27, 2025.

 

If you are filing benefit requests as a national of one of the 19 Travel Ban countries, consult with your MU attorney to discuss your best strategies for filing.

Department of State Will Review H-1B and H-4 Visa Applicants’ Social Media

The Department of State (DOS) has announced that effective December 15, 2025, it will review the online presence of all H-1B visa applicants and their dependents, H-4 visa applicants.

As this measure is being enacted by the DOS, it will apply to visa applicants applying for visas at embassies abroad and does not explicitly apply to H-1B or H-4 petitions filed within the US, such as amendments, extensions, transfers, and changes of status.

 

In June 2025, DOS announced it would begin to review social media of students applying for F, M and J visas. This December 2025 announcement expands that online vetting process to include H-1B and H-4 visa applicants.

 

If social media profile(s) exist for H-1B and H-4 visa applicants, DOS will instruct them to adjust the privacy settings to “public”.  

 

DOS’s stated purpose for social media review of applicants is national security and public safety.

 

DOS also notes that its social media review will include whether an applicant’s online information shows an intention “to engage in activities consistent with the terms for their admission”.

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.