The Department of Homeland Security (DHS) is rolling out a major change to the H-1B visa program and it could significantly impact healthcare employers that rely on international talent, especially nurses and other clinical professionals. At VisaMadeEZ, an immigration law firm dedicated to helping healthcare organizations hire international nurses, we’re closely tracking these developments so you can plan your staffing strategy with confidence.
Below, we break down what’s changing, what it means for hospitals, health systems, and long-term care facilities, and how your organization can navigate the new H‑1B environment.
1. New H‑1B Selection Rule Takes Effect February 27
DHS has announced that its new H‑1B selection rule will take effect on February 27. This reform replaces the purely random H‑1B lottery with a selection process that places greater emphasis on higher skills, specialized roles, and higher wages.
For healthcare employers, this means:
- The type of position you sponsor and how you structure the offered wage will matter more than ever.
- Roles that clearly qualify as specialty occupations, such as advanced nursing roles, clinical specialists, informatics nurses, and certain leadership positions, may have a better chance under the new system.
- Strategic planning and careful petition preparation will be critical to remain competitive in the H‑1B pool.
At VisaMadeEZ, we help healthcare organizations evaluate whether their nursing and clinical positions meet specialty occupation standards and how to present those roles in the strongest possible way.
2. H‑1B Caps Remain the Same but Who Gets Selected May Shift
The annual H‑1B cap is unchanged:
- 65,000 visas under the regular cap
- An additional 20,000 visas reserved for workers with a U.S. advanced degree (master’s or higher)
What is changing is how those limited slots are allocated. Under the prior system, employers entered a random lottery, which did not distinguish between higher-skilled, highly paid professionals and lower-paid entries. Critics argued that this allowed some employers to flood the system with large volumes of applications for lower-skilled roles.
Under the new weighted selection process, DHS will give priority to:
- Positions requiring higher skills and specialized knowledge
- Applicants with higher levels of education
- Roles offering higher wages, relative to the prevailing wage for that occupation
For healthcare employers, this could benefit:
- Nurse practitioners, clinical nurse specialists, nurse anesthetists, and other advanced practice nurses
- Nursing leadership roles (e.g., nurse managers, clinical nurse leaders)
- Specialized nursing positions in fields such as critical care, oncology, cardiology, and informatics
Even for staff nurse roles, a carefully structured job description and wage level can make a difference. VisaMadeEZ works with HR and recruitment teams to align job requirements and wage levels with H‑1B criteria while remaining compliant with labor and budget constraints.
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3. $100,000 H‑1B Fee Under Legal Challenge
On December 12, twenty states filed a lawsuit challenging a $100,000 fee imposed on certain new H‑1B petitions. This fee was created by a September 10 presidential proclamation and would dramatically increase the cost of sponsoring H‑1B workers if implemented as written.
Key points for healthcare employers:
- The fee has been heavily contested and is currently the subject of litigation.
- If it stands, the added cost could make employers think twice about filing H‑1B petitions, particularly for roles already under financial pressure.
- For hospitals, skilled nursing facilities, and other healthcare systems operating on tight margins, such a fee could significantly impact workforce planning.
Our team at VisaMadeEZ is monitoring this lawsuit closely. We advise clients on the timing of filings, potential cost exposure, and contingency strategies if the fee is enforced or modified.
4. H‑1B Visas Remain Critical to the U.S. Healthcare Workforce
Despite the policy shifts, one fact has not changed: the U.S. healthcare system relies heavily on international professionals.
In fiscal year 2024, nearly 17,000 H‑1B visas were issued in medicine and health. About half were granted to physicians and surgeons, but a significant number also supported other healthcare roles, including nursing and allied health professionals.
At the same time, the United States is projected to face a shortage of 86,000 physicians by 2036. While this statistic speaks directly to doctors, it reflects a broader strain on the healthcare workforce. Physician shortages almost always increase demand for:
- Registered nurses
- Advanced practice nurses
- Clinical care coordinators
- Nurses with specialized training in high-acuity settings
For many healthcare organizations, international nurses are an essential part of the solution. While the H‑1B visa is not the only pathway for nurses (immigrant visas and other classifications may also be appropriate), the H‑1B category can be a powerful tool for:
- Specialized nursing roles requiring a bachelor’s degree or higher in a specific field
- Advanced practice nursing positions
- Clinical leadership and education positions in hospitals and health systems
VisaMadeEZ focuses on helping healthcare employers design immigration strategies that blend H‑1B, immigrant visa, and alternative options to build a sustainable international nurse pipeline.
5. Some Healthcare Employers Have Paused H‑1B Filings Others Are Adapting
The uncertainty around the new $100,000 H‑1B fee and the evolving selection rules has already affected employer behavior:
- Some hospitals and health systems have temporarily paused H‑1B petitions, concerned about the potential costs and unclear long-term impact.
- Others are continuing to file, but are doing so more strategically:
- Prioritizing critical or hard-to-fill roles
- Focusing on high-skill, specialty positions more likely to succeed under the new weighted selection
- Seeking legal guidance to minimize risk and avoid wasted resources
From our vantage point at VisaMadeEZ, the healthcare employers who fare best are those who:
1. Plan early for cap season and off‑cycle needs
2. Evaluate all available visa options, not just H‑1B
3. Work closely with immigration counsel to match visa strategy with workforce goals
For facilities facing acute nurse shortages, pausing all immigration activity may not be realistic. Instead, many are refining their approach targeting specific nursing roles for H‑1B sponsorship while pursuing permanent residency or other categories for long-term staffing stability.
What This Means for Healthcare Organizations Hiring International Nurses
If you are a hospital, long-term care facility, clinic, or healthcare system looking to hire international nurses, these changes to the H‑1B program should prompt a fresh look at your strategy.
Key takeaways:
- The H‑1B process is becoming more selective and more focused on skills and wages.
- Specialized and advanced nursing roles may be better positioned under the new weighted system.
- The proposed $100,000 fee though under challenge could dramatically change the cost calculus if it moves forward.
- Delaying action entirely may worsen staffing shortages in a market already struggling with nurse burnout, turnover, and an aging patient population.
At VisaMadeEZ, we specialize in immigration for healthcare organizations and have deep experience helping employers:
- Identify which nursing roles qualify as specialty occupations
- Develop job descriptions and wage levels that are realistic, compliant, and competitive under H‑1B rules
- Structure a long-term immigration plan that supports recruitment, retention, and workforce stability
- Navigate evolving regulations, fees, and selection standards with minimal disruption
How VisaMadeEZ Can Help Your Organization
If your hospital or healthcare facility is:
- Planning to sponsor international nurses or other healthcare professionals
- Unsure how the new H‑1B weighted selection rules affect your recruitment pipeline
- Concerned about potential cost increases or compliance risks
VisaMadeEZ can guide you through every step of the process.
We offer:
- Strategic consultations tailored to healthcare employers
- Case assessments for nurse and clinical positions
- End‑to‑end H‑1B petition support
- Alternative immigration options for nurses when H‑1B is not the best fit
If you’d like help adjusting your immigration strategy to the new H‑1B landscape or you’re ready to build a dependable pipeline of international nurses VisaMadeEZ is here to support you.
