WASHINGTON, 27 October 2026. A week before the US midterm elections, President Donald Trump announced a $275 million programme to recruit nurses for nursing homes. It is the latest in a long list of federal decisions that are reshaping nursing in the United States, and for nurses abroad who hope to work there.
Some of these policies put money into the nursing workforce. Others cut funding, tighten borrowing or restrict immigration. Several are being fought in court. This guide sets out what has actually happened, what each side argues, and what it means for you, whether you are a nurse in Ohio or a nurse in Lagos preparing for the NCLEX.
At a glance
| Policy | What happened | Status (October 2026) |
|---|---|---|
| Nurses for Nursing Homes | $275m in loan repayment and stipends for nurses in nursing homes | Applications opened 26 October |
| Nursing home staffing rule | 2024 minimum staffing and 24/7 RN rule repealed | Repeal effective 2 February 2026; enforcement barred until 2034 |
| Graduate student loans | Nursing excluded from “professional degree” list, lowering loan caps | Court stayed exclusion; MSN, DNP and DNAP treated as professional for now; lawsuits continue |
| Title VIII and NINR budget | FY2027 request: ~70% cut to Title VIII, 30% cut to nursing research | House committee bill rejects cuts; final budget pending |
| Medicaid (H.R. 1) | Close to $1 trillion in Medicaid reductions; $50bn rural fund | Being phased in; hospitals reporting service cuts |
| H-1B $100,000 fee | New fee on H-1B petitions, extended for 2026–27 | Enforcement blocked by a federal judge on 30 September |
| Travel ban and visa pauses | Nigeria under partial suspension; immigrant visa pauses | 75-country pause vacated in court; worldwide interview freeze from 25 August |
| VA nurses’ union contracts | Contracts terminated in August 2025 | A court ordered one agency-wide contract restored (March 2026) |
1. New: $275 million to recruit nurses for nursing homes
Speaking at a rally in Fort Myers, Florida, on 23 October, President Trump announced what the Centers for Medicare & Medicaid Services (CMS) has named “Nurses for Nursing Homes”. According to CMS and the American Hospital Association:
- What you get: up to $40,000 in student loan repayment, a $10,000 stipend, or both.
- What you give: a three-year commitment to work an average of at least 30 hours a week at a qualifying nursing home.
- Who qualifies: nurses with an active RN or LPN/LVN licence working in a Medicare- or Medicaid-certified long-term care facility. All rural nursing facilities qualify, plus others in areas with bigger staff shortages. Nursing students can apply before graduating, but receive benefits only once they are licensed and employed.
- Scale: more than 4,000 nurses nationwide, with all 50 states and DC taking part.
- Funding: $100 million from CMS and at least $175 million from states, all drawn from civil monetary penalties collected from nursing homes. CMS Administrator Dr Mehmet Oz said the programme does not take “a dime from taxpayers”.
- How to apply: applications opened on 26 October at NursesforNursingHomes.cms.gov.
HHS Secretary Robert F. Kennedy Jr. said the initiative “will recruit and retain thousands of nurses, expand care in rural and high-need communities”. Critics note the timing, just before the midterms, and point out that 4,000 nurses is small next to the nursing home workforce’s long-standing shortages. For an individual nurse with student debt, though, $40,000 is significant. Read the contract terms carefully, including what happens if you leave before three years.
2. The nursing home staffing rule was repealed
The new programme follows the repeal of a 2024 Biden-era rule that set minimum nurse staffing hours in nursing homes and required a registered nurse on site 24 hours a day, 7 days a week.
- Two federal courts, in Texas and Iowa, vacated the staffing standards in 2025, ruling that CMS had exceeded its authority.
- The 2025 budget law (H.R. 1) bars enforcement until October 2034.
- CMS formally repealed the standards in an interim final rule on 3 December 2025, effective 2 February 2026, restoring the earlier, looser requirements.
The administration’s case: CMS called the standards “one-size-fits-all”. It said they ignored local labour supply and resident needs and could have forced closures, especially in rural and Tribal areas. The other side: nursing unions and resident advocates argue that minimum staffing is the most direct way to keep residents safe, and that incentives alone won’t fix chronic understaffing.
3. Student loans: is nursing a “professional degree”?
This has been the biggest fight for nursing education this year.
- H.R. 1 ended Grad PLUS loans for new borrowers from 1 July 2026 and set two tiers of federal loan limits. “Professional” students can borrow up to $50,000 a year and $200,000 in total. Other graduate students can borrow up to $20,500 a year and $100,000 in total.
- On 30 April 2026, the Department of Education’s final rule listed 11 professional fields: pharmacy, dentistry, veterinary medicine, chiropractic, law, medicine, optometry, osteopathic medicine, podiatry, theology and clinical psychology. Graduate nursing was excluded.
- The Department’s case: the law tied it to an existing definition, and the list is not “an open-ended category”. Under Secretary Nicholas Kent argued that “when there is more money in the system, institutions of higher education are going to raise their prices”.
- The pushback: the American Nurses Association said the rule ignored more than 245,000 petition signatures, and that rural communities, where nurse practitioners, midwives and nurse anesthetists are often the only providers, would be hit hardest. More than 150 members of Congress from both parties asked the Department to include nursing. Senators Jeff Merkley (D) and Roger Wicker (R) introduced the Nursing is a Professional Degree Act.
Where it stands now
- On 24 June 2026, a federal court in Washington, DC set aside and stayed the rule’s extra requirements. The case is American Association of Nurse Practitioners v. McMahon, and the government did not appeal.
- On 29 June, the Department issued an interim list treating the MSN, DNP and DNAP as professional degrees while the stay lasts. The PhD in nursing was left off.
- More cases are pending, brought by 26 states led by Maryland, by the American Nurses Association and by the AFL-CIO. Summary judgment briefing runs through November 2026 to January 2027.
- In Congress, the House Appropriations Committee adopted a bipartisan amendment to raise borrowing limits for graduate nursing degrees.
What to do: if you are starting an MSN, DNP or nurse anesthesia programme, check with your financial aid office which limit applies to you this term. The interim designations “may change as litigation proceeds”. See also our guide to graduate nursing loans after Grad PLUS.
4. The budget: Title VIII and nursing research
The President’s FY2027 budget request, released in April, proposed:
- A cut of nearly 70% ($212.8 million) to Title VIII Nursing Workforce Development Programs, eliminating all except the Nurse Corps scholarship and loan repayment programme.
- A 30% cut ($59.3 million) to the National Institute of Nursing Research (NINR), which would remain a separate institute.
- Wider cuts of 12.5% ($15.8 billion) to HHS and $5 billion to NIH.
Congress writes the budget, not the President, and so far lawmakers have pushed back. The House Appropriations Committee’s bill, led by Republicans Tom Cole and Robert Aderholt, would instead give Title VIII $307.5 million (a small increase), keep NINR level at $197.7 million and add $20 million for Nurse Corps. The Senate has not finished its work, and the final numbers are still open.
Why it matters: Title VIII funds nurse faculty loans, advanced nursing education grants, nurse practitioner fellowships and workforce diversity programmes, the pipeline that trains the next generation of nurses and their teachers. Supporters of the cuts argue for a smaller federal footprint and fewer overlapping grant programmes. Nursing organisations argue the cuts would deepen the faculty shortage that already leads schools to turn away tens of thousands of qualified applicants. See 93,176 qualified applicants turned away.
5. Medicaid changes and hospital finances
H.R. 1, the 2025 tax and spending law, includes close to $1 trillion in Medicaid reductions over the coming decade, including new work requirements for some adults. Because Medicaid pays a large share of many hospitals’ bills, the effects reach nurses directly.
- Georgetown University’s Center for Children and Families has documented early cuts. They include a hospital in Nebraska ending dialysis, a New Hampshire clinic closing, and a large Oklahoma health system closing dermatology, paediatric and mental health clinics after a $130 million loss.
- An analysis published in April identified several hundred hospitals at heightened risk of closure, many of them rural.
- To offset the impact, the law created a $50 billion Rural Health Transformation Program over five years, averaging about $200 million per state each year. Dr Oz has argued that the fund is about changing how rural care is delivered, through technology, telehealth and new models, rather than “paying for older programs”.
The debate: supporters say the changes curb waste, promote work and give states flexibility. Hospital groups and nursing unions warn of layoffs, unit closures and unsafe workloads. Some Republicans, including Senator Thom Tillis, have warned publicly that parts of the cuts are coming “too soon”. For nurses, the practical signs to watch are hiring freezes, closed units and redeployment, especially in rural and safety-net hospitals.
6. Immigration: what international nurses need to know
Immigrants make up a significant share of US registered nurses, and many readers of this site are working towards US licensure. Immigration has changed faster this year than any other area.
The $100,000 H-1B fee
- A presidential proclamation on 19 September 2025 imposed a $100,000 payment on new H-1B petitions. A second proclamation on 18 September 2026 extended it for another year.
- Most foreign-educated nurses come to the US on employment-based green cards (EB-3), not H-1B. But H-1B is used for some nursing roles, such as nurse managers and advanced practice positions, and widely for doctors in training.
- On 30 September 2026, a federal judge in California (Global Nurse Force v. Trump) blocked agencies from enforcing the fee until they complete formal notice-and-comment rulemaking. A judge in Massachusetts separately held that the fee was an unconstitutional tax. Further appeals are likely.
Travel ban and visa pauses: Nigeria, Ghana and others
- Proclamation 10998, effective 1 January 2026, places Nigeria under a partial suspension covering immigrant visas (green cards) plus visitor, student and exchange visas. Other African countries under partial suspension include Senegal, Tanzania, Zambia, Zimbabwe, Malawi and Côte d’Ivoire. Several others, including Sierra Leone, Niger and Mali, face full suspension.
- A separate 75-country immigrant visa pause from 21 January 2026 covered Nigeria, Ghana, Cameroon, Uganda, Liberia and many more. A federal judge in New York vacated it on 21 August 2026, and embassies began reprocessing some refused cases. The government has appealed.
- Then, from 25 August 2026, the State Department paused immigrant visa interview scheduling worldwide. Some posts have reportedly resumed interviews, and this too is being challenged in court.
- Inside the US, USCIS has held applications, including green cards and work permits, for people born in 39 countries including Nigeria, citing vetting for “high-risk countries”. NPR reported that health workers are among those affected.
The administration’s case: it says stronger vetting is needed for national security and immigration integrity. Critics, including employers and immigration lawyers, say the pauses are stranding qualified health workers in the middle of a shortage.
If you are a Nigerian or African nurse on the US pathway: keep going with your NCLEX, credentials evaluation and VisaScreen, because these take time anyway. But don’t resign your job or sell property on the strength of an expected interview date. Use a licensed immigration attorney, not an agent, and check the US Embassy’s official notices. Our US licensure guide covers the steps you can control.
7. VA nurses and union rights
The Department of Veterans Affairs employs one of the largest groups of nurses in the US. On 6 August 2025, following a March 2025 executive order, the VA terminated most of its union contracts, including with National Nurses United. VA Secretary Doug Collins said unions “fight against the best interests of veterans”. NNU called the decision “class warfare against working people”. In March 2026, a federal judge in Rhode Island ordered the VA to restore an agency-wide AFGE contract, finding that the termination was likely unlawful retaliation. Other litigation over the executive order continues.
What it all means for nurses
| If you are… | Watch for |
|---|---|
| A nurse in a nursing home or rural facility | The new $40,000 loan repayment and $10,000 stipend; staffing levels now that the federal minimum is gone |
| A graduate nursing student | Which loan limit applies to you; the court rulings due between November and January |
| A nurse in a Medicaid-heavy hospital | Hiring freezes, unit closures, redeployment |
| An internationally educated nurse | Visa interview scheduling, travel ban reviews every 180 days, H-1B fee litigation |
| A VA nurse | The status of your union contract and grievance rights |
Nursing policy is on the ballot on 3 November, with at least 16 nurses running for Congress or governor. See nurses on the ballot. Whatever your politics, the decisions above affect your pay, your training, your patients and, for many readers, whether you can work in the US at all.
We will update this guide as courts rule and Congress finalises the FY2027 budget.
Sources
- CMS announcement via the American Hospital Association and Fox News (23 October 2026)
- Manatt Health, “Trump Administration Repeals Minimum Staffing Standards” (December 2025)
- Higher Ed Dive, Education Department final rule (30 April 2026); American Nurses Association statement (30 April 2026)
- AACN, interim professional degree list (30 June 2026); Sigma statement on the court decision (2 July 2026); Thompson Coburn, Higher Education Litigation Summary (September 2026)
- Fortune (17 June 2026)
- AACN press releases on the FY2027 budget request (6 April 2026) and House Appropriations bill (10 June 2026)
- Georgetown University Center for Children and Families (1 May 2026); Scripps News on the Rural Health Transformation Program (December 2025)
- Justice Action Center, Global Nurse Force v. Trump case page
- Immigration Analytics (14 September 2026); NPR (28 April 2026)
- Government Executive (6 August 2025); Rhode Island court ruling via Yahoo News (13 March 2026)