The US Department of Homeland Security (DHS) has proposed a new fee of $103,265 on H-1B visa petitions that are subject to the annual cap, and the American Hospital Association (AHA) has formally asked for health care professionals to be exempted, warning that the cost could force hospitals, especially rural and safety-net hospitals, to stop recruiting overseas.
For many international nurses watching US immigration news, the headline number is alarming. But the details matter: most foreign-educated nurses enter the US on immigrant visas (green cards), not H-1B. Here’s what we know.
The proposed rule
- The proposal (docket USCIS-2026-0298, dated 25 August 2026) would add a standalone fee of $103,265 to cap-subject H-1B petitions, on top of existing filing fees and any separate payment required under a presidential proclamation.
- It would apply both to people changing status inside the US and to petitions processed through consulates abroad.
- Cap-exempt petitions are not covered. Cap-exempt employers include institutions of higher education, their affiliated nonprofit entities (which can include some academic hospitals), and nonprofit or government research organisations.
- The rule is a proposal; DHS must review public comments before finalising it, and the final version could change.
What the AHA is asking for
In a comment letter dated 24 September 2026, signed by Stacey Hughes, AHA executive vice president for government relations and public policy, the hospital association:
- Welcomed the exclusion of cap-exempt petitions.
- Asked DHS to exempt health care professionals from the fee for cap-subject petitions.
- Asked, if the fee goes ahead, for an exemption for physicians in the Conrad 30 programme, which places foreign-trained doctors in underserved areas.
- Warned the fee could lead many providers to stop recruiting from abroad, reducing services, especially in rural and safety-net hospitals.
The AHA cited federal projections of a shortage of more than 108,000 registered nurses by 2038, with an 11% shortage in non-metropolitan areas, and noted that health care professionals make up less than 5% of H-1B holders. Members of Congress have also written to DHS this year urging an exemption for health workers.
Do nurses use H-1B visas?
Mostly, no. Registered nurses usually don’t qualify for H-1B because the visa requires a “specialty occupation” needing at least a bachelor’s degree, and a bachelor’s is not the minimum requirement for most staff RN jobs in the US. Some specialised or advanced practice roles, such as nurse practitioners, nurse anaesthetists, nurse educators or some nurse managers, may qualify.
Data from CGFNS International, which screens credentials of foreign-educated health professionals for US visas, illustrate this. In fiscal year 2024, around 76% of its VisaScreen certificates were for permanent (green card) routes such as EB-3, about 12% for TN (for Canadians and Mexicans under the USMCA) and about 11% for H-1B. Most were for registered nurses.
Who could be affected?
- Advanced practice nurses (NPs, CRNAs) and other nurses in specialty roles sponsored on cap-subject H-1B petitions by for-profit or non-university employers.
- International students who planned to move from student status to H-1B after graduating from US nursing programmes.
- Physicians, particularly those moving from J-1 training visas to H-1B.
- Hospitals that rely on H-1B for other roles such as physical therapists and medical laboratory scientists.
What about the green card route?
The EB-3 route, used by most international nurses, is not affected by this fee proposal. However, it has its own challenge: long waits because of annual green card limits and per-country caps, with periods of “visa retrogression” when the queue stops moving. Nurses should check the State Department’s monthly Visa Bulletin for current dates.
Practical advice
- Don’t panic about headlines. Confirm which visa route your employer or recruiter is using.
- Be wary of agencies demanding large fees from nurses “because of new visa costs”. Under US rules, many employer costs for H-1B cannot lawfully be passed to the worker.
- Get information from official sources (USCIS, the State Department) or a qualified immigration attorney.
- Keep your NCLEX, licensure and VisaScreen documents up to date while waiting.
Related: US licensure for international nurses · Trump administration nursing policies explained · NCLEX study plan
Sources: American Hospital Association comment letter to DHS (24 September 2026); CGFNS International data for FY2024. General information, not legal advice.