Healthcare organizations across the U.S. that rely on international nurses and other foreign-trained clinicians are watching a major legal battle unfold over a new $100,000 fee on H‑1B visa petitions. This development could dramatically affect hospitals, long-term care facilities, and staffing agencies that use the H‑1B visa to fill critical nurse and healthcare worker shortages.
At VisaMadeEZ, an immigration law firm focused on helping healthcare organizations hire international nurses, we’re closely tracking this case so employers can understand what it means for their workforce planning and visa strategy.
Below is a clear breakdown of what’s happening, why it matters, and how it may affect healthcare employers using the H‑1B visa program.
1. The New $100,000 H‑1B Fee Is Being Challenged in Court
On December 12, California Attorney General Rob Bonta, along with a coalition of 19 other state attorneys general, filed a lawsuit against the White House over a new $100,000 fee imposed on certain H‑1B visa petitions.
The states argue that this additional H‑1B fee is unlawful and unconstitutional, and that it violates the Administrative Procedure Act (APA). The lawsuit states that the federal government exceeded its authority when it imposed such a substantial cost on employers filing new H‑1B petitions.
For healthcare employers who depend on the H‑1B visa to hire foreign nurses, physicians, and specialized healthcare professionals, the outcome of this lawsuit could significantly impact the cost and viability of international recruitment.
2. Who Is Behind the Lawsuit?
The legal challenge is being led by:
- Rob Bonta, Attorney General of California
- Andrea Joy Campbell, Attorney General of Massachusetts
They are joined by attorneys general from the following states:
- Arizona
- Colorado
- Connecticut
- Delaware
- Hawaii
- Illinois
- Maryland
- Michigan
- Minnesota
- Nevada
- North Carolina
- New Jersey
- New York
- Oregon
- Rhode Island
- Vermont
- Washington
- Wisconsin
This broad coalition highlights how many states rely on the H‑1B program including for healthcare staffing and how deeply they are concerned that a $100,000 H‑1B fee could disrupt access to essential workers, including international nurses and other foreign-trained clinicians.
3. How the White House Is Defending the H‑1B Fee
In response to criticism, a White House spokesperson defended the policy by framing it as a way to protect American workers and prevent misuse of the H‑1B visa system. The statement argued that:
- The fee is intended to discourage companies from “spamming the system” with large numbers of H‑1B petitions.
- It is meant to reduce downward pressure on American wages.
- It is described as a lawful, incremental step toward broader H‑1B reforms.
The Department of Justice has also issued a statement backing the policy, positioning it as part of an “America First” agenda and emphasizing enforcement against companies that misuse the H‑1B program.
For healthcare organizations, this means the administration views this fee as a legitimate regulatory tool, even though many hospitals and clinics see it as a barrier to filling critical vacancies.
4. When and How the $100,000 H‑1B Fee Was Introduced
The fee was introduced in a presidential proclamation on September 19, with an effective date of September 21. Initially, the announcement created widespread confusion among employers and immigration attorneys about its scope.
The White House later clarified:
- The $100,000 fee applies only to new H‑1B visa applicants outside the United States.
- Employers do not have to pay this fee for H‑1B candidates already residing in the U.S., such as international students in F‑1 status changing to H‑1B.
This distinction is crucial for healthcare organizations that recruit international nurses from abroad versus those transitioning foreign graduates already in the U.S. A recruitment model based on overseas hiring would be much more heavily impacted than one focused on nurses who are already in the United States.
5. Why the H‑1B Visa Matters to Healthcare Employers
The H‑1B visa is a cornerstone of U.S. employment-based immigration, particularly in healthcare. It allows U.S. employers to hire foreign workers in “specialty occupations” that require at least a bachelor’s degree in a specific field.
In the medical sector, H‑1B visas are commonly used for:
- Physicians and surgeons
- Advanced practice providers
- Certain specialized nursing and allied health roles (when they meet the specialty occupation standard)
In fiscal year 2024, nearly 17,000 H‑1B visas were granted for medicine and health roles, with about half going to physicians and surgeons. At the same time, the U.S. is projected to face a shortage of 86,000 physicians by 2036, and many regions are already struggling with a shortage of nurses.
For healthcare employers especially those serving rural, underserved, or high-need populations international recruitment is not optional; it’s a critical part of their staffing strategy. Anything that raises the cost or complexity of H‑1B filings can directly affect patient care capacity.
6. What the Lawsuit Claims About the H‑1B Fee
In the complaint, the coalition of states argues that the $100,000 fee:
- Exceeds congressional authority: The states claim Congress did not authorize such a large, additional fee for H‑1B petitions.
- Contradicts congressional intent: The H‑1B program was designed to allow U.S. employers to fill specialized roles when they cannot find qualified U.S. workers. The fee, they argue, undermines that purpose by making the program financially inaccessible for many employers.
- Bypasses required rulemaking procedures: Under the Administrative Procedure Act, significant policy changes generally require notice-and-comment rulemaking. The lawsuit claims the administration sidestepped that process.
- Oversteps executive authority: The complaint says the executive branch went beyond its power under the APA in imposing the fee.
If these arguments succeed in court, the $100,000 H‑1B fee could be blocked, suspended, or struck down. For healthcare employers and immigration law firms like VisaMadeEZ, the case will set an important precedent about how far the executive branch can go in reshaping employment-based immigration by proclamation.
7. The Lawsuit Joins Other Legal Challenges
The case filed in Massachusetts federal court is not the only challenge to the new fee. According to reporting from Reuters, at least two other lawsuits have been filed by employers and industry groups.
Before this new fee, employers typically paid between $2,000 and $5,000 in government filing fees per H‑1B petition, depending on factors such as company size and whether premium processing was used. The sudden jump to a $100,000 fee for certain filings is unprecedented and is seen by many as effectively closing the door on H‑1B usage for smaller employers and nonprofits, including many community hospitals and healthcare systems.
8. Immediate Impact on Hospitals and Healthcare Systems
Some hospitals and health systems responded quickly to the new fee by:
- Pausing new H‑1B petitions, particularly for candidates still abroad.
- Reevaluating their international recruitment pipelines for physicians, nurses, and other clinicians.
- Waiting for additional guidance from immigration counsel and regulators before proceeding with new filings.
Others have indicated they are in a “wait and see” mode, monitoring the court challenges and hoping for an injunction or reversal before making long-term strategic changes.
For healthcare organizations that rely heavily on international nurses and clinicians, this uncertainty complicates:
- Workforce planning
- Budgeting for immigration costs
- Long-term recruitment agreements with overseas partners
This is precisely where specialized immigration support becomes critical. Law firms like VisaMadeEZ help healthcare employers evaluate visa options, adjust filing strategies, and plan contingencies in light of fast-changing immigration policies.
9. H‑1B vs. J‑1: Key Visa Options for Foreign Clinicians
Foreign healthcare professionals typically come to the United States on one of two visa paths:
1. H‑1B Visa (Specialty Occupation)
- Temporary professional work visa for specialty occupations.
- Often used for physicians and, in some cases, highly specialized nursing roles that require a bachelor’s degree or higher in a specific field.
- Allows “dual intent” the ability to apply for a green card while maintaining H‑1B status.
- Subject to annual caps, complex rules, and changing policies like the new fee.
2. J‑1 Visa (Exchange Visitor)
- Commonly used for international medical graduates (IMGs) in residency or fellowship programs.
- Usually requires a two‑year home residency at the end of the program unless a J‑1 waiver is obtained (often through service in underserved areas).
- Does not inherently allow dual intent, making the transition to permanent residence more complex than on H‑1B.
For international nurses, the most common long-term path is typically a green card (EB‑3) rather than H‑1B or J‑1, but H‑1B can be relevant in certain advanced or specialized nursing positions. This is why healthcare immigration strategies must be carefully tailored to each employer’s needs and each clinician’s credentials and long-term goals.
What This Means for Healthcare Organizations Hiring International Nurses
For hospitals, long-term care facilities, and healthcare staffing agencies, the new $100,000 H‑1B fee and the wave of litigation challenging it raises several important questions:
- Cost and Budgeting: Can your organization absorb dramatically higher government fees if the policy is upheld?
- Recruitment Strategy: Should you shift focus toward nurses and clinicians already in the U.S., or toward alternative visa or green card options?
- Timing: Should you pause certain overseas recruitment plans while the courts decide, or move forward under a revised risk and cost assessment?
- Compliance and Risk Management: How do you stay compliant while also taking advantage of all lawful immigration pathways still available to healthcare employers?
How VisaMadeEZ Can Help
At VisaMadeEZ, we specialize in guiding healthcare organizations through the complexities of U.S. immigration, with a particular focus on:
- Hiring international nurses and other foreign-trained healthcare workers
- Navigating H‑1B visas, green cards, and other employment-based categories
- Developing comprehensive, long-term immigration strategies that align with clinical staffing needs
In light of the new H‑1B fee and the ongoing lawsuits:
- We monitor every update in the litigation and policy changes.
- We help clients evaluate whether H‑1B remains the best option, or if alternative visa or green card strategies make more sense.
- We provide practical guidance on budgeting, timelines, and risk management in a rapidly changing environment.
Next Steps for Healthcare Employers
If your organization is:
- Currently sponsoring H‑1B visas for clinicians, or
- Planning to hire international nurses or physicians in the coming months,
this is an important moment to review your immigration strategy with experienced counsel.
VisaMadeEZ can help you:
- Assess the impact of the $100,000 H‑1B fee on your hiring plans
- Identify more cost-effective, sustainable visa options for international nurses
- Design a compliant, long-term immigration program that supports your workforce and patient care goals
To discuss how these developments might affect your organization, consider scheduling a consultation with an immigration attorney who understands both healthcare staffing and employment-based immigration law.
Staying informed and proactive is the best way to protect your access to the skilled international nurses and clinicians your patients depend on.
