The U.S. Department of Homeland Security (DHS) has announced a major change to the H-1B visa selection process that will directly affect healthcare organizations, hospitals, and staffing agencies that rely on international nurses and other healthcare professionals.
Instead of relying on a purely random lottery, the government will now prioritize H-1B petitions for higher-paid and higher-skilled foreign workers. For healthcare employers, this means careful planning, accurate wage levels, and strategic petition preparation will be more important than ever.
At VisaMadeEZ, an immigration law firm focused on helping healthcare organizations hire international nurses, we’ve broken down what this new rule means for your H-1B hiring strategy, particularly if you employ or plan to employ foreign-educated RNs, advanced practice nurses, and other specialized healthcare workers.
Overview of the New H-1B Selection Rule
Under the current system, when the number of H-1B registrations exceeds the annual cap, U.S. Citizenship and Immigration Services (USCIS) uses a random lottery to select which registrations can move forward. Critics have long argued that this system allows some employers to game the process by submitting large numbers of low-wage, lower-skilled H-1B registrations, limiting opportunities for truly specialized roles.
DHS is now replacing that pure random lottery with a weighted selection system that gives preference to:
- Higher-skilled foreign workers, and
- Higher-paid foreign workers (based on prevailing wage levels).
The annual statutory cap of 65,000 regular H-1B visas, plus an additional 20,000 visas for U.S. master’s and higher degree holders, remains in place. What changes is how those limited visa slots are allocated.
Effective date: The final rule takes effect February 27, 2026
First use: It will apply to the FY 2027 H-1B cap registration season
Why the Government Is Changing the H-1B Process
Federal officials have stated that the prior random lottery system has been abused by some U.S. employers, particularly those seeking to fill lower-wage positions with foreign labor. According to the government, these practices have:
- Put downward pressure on American wage levels
- Undermined working conditions for U.S. workers
- Allowed bulk registration strategies aimed at maximizing selection odds for low-cost workers
The new rule aims to:
- Align the program more closely with Congress’s original intent to fill specialty occupations that genuinely require specialized knowledge and skills
- Reward employers who are willing to pay competitive, higher wages to foreign workers
- Protect American workers’ job opportunities and wages
For healthcare organizations, particularly those hiring international nurses and advanced practice providers, this shift underscores the importance of properly classifying positions, documenting specialty occupation requirements, and paying fair, competitive wages.
How the Weighted H-1B Selection Will Work
Under the weighted selection process, H-1B registrations will no longer be treated equally in the lottery. Instead, USCIS will assign greater selection probability to registrations where the proffered wage is higher relative to the prevailing wage for that specific occupation and location.
In practice, this means:
- Petitions for jobs in higher wage levels (e.g., Wage Level III or IV) will have a better chance of being selected.
- Lower wage level petitions will still be eligible, but with reduced odds compared to higher-paid positions.
- Employers will have an incentive to accurately and competitively set wages for H-1B positions.
This is especially important in healthcare, where salary benchmarks vary significantly by region, facility type, and nursing specialty. For example, H-1B petitions for:
- Nurse practitioners,
- Clinical nurse specialists,
- Nurse anesthetists, or
- Highly specialized roles (e.g., informatics nursing, oncology nursing, critical care nursing)
may be more competitive if the offered wage is aligned with higher prevailing wage levels and the role clearly qualifies as a specialty occupation under H-1B standards.
Impact on Healthcare Organizations Hiring International Nurses
Healthcare employers already face serious staffing shortages, especially in nursing. Many hospitals and healthcare systems depend on international nurses to maintain safe staffing levels and ensure consistent patient care. This new H-1B rule does not change the cap numbers, but it changes who is most likely to receive a visa.
Here’s what healthcare organizations need to consider:
1. Specialty Occupation Classification Becomes Even More Critical
Many traditional bedside RN positions may not always qualify as “specialty occupations” under H-1B standards, while more advanced or specialized roles often do. Hospitals and healthcare employers will need to:
- Clearly define positions that require a bachelor’s degree or higher in a specific field
- Emphasize advanced clinical skills, certifications, and responsibilities
- Carefully structure job descriptions for roles such as ICU nurse, OR nurse, or specialized RN positions where advanced knowledge is essential
This is where a focused immigration law firm for healthcare employers like VisaMadeEZ—can help frame and support your H-1B case effectively.
2. Competitive Wages Will Influence Selection Odds
Because the new selection process favors higher-paid roles, healthcare organizations that offer strong, competitive wage packages will have improved chances of selection. Employers should:
- Review existing compensation structures for international nurses and advanced practice roles
- Ensure the offered wage meets or exceeds the applicable prevailing wage
- Consider whether higher wage levels may improve the likelihood of H-1B approval and long-term retention
While this may increase upfront costs, it can help secure highly qualified international nurses in an increasingly competitive labor market.
3. Advanced Degree Nurses May Have an Edge
The existing 20,000 cap reserved for U.S. advanced degree holders still applies. For healthcare employers, this means:
- International nurses and healthcare professionals who hold a U.S. master’s or higher degree (such as MSN, DNP, or similar) will continue to benefit from the advanced degree allocation.
- Strategically recruiting or supporting foreign nurses to obtain U.S. graduate degrees can enhance both their H-1B prospects and long-term contributions to your organization.
Additional Financial and Compliance Requirements
The administration has also tied this reform to broader efforts to “strengthen the integrity” of the H-1B program. Among the notable changes is a Presidential Proclamation requiring employers to pay:
- An additional $100,000 per H-1B visa as a condition of eligibility.
This is a substantial cost increase and underscores the government’s intention to ensure that:
- H-1B visas are used for truly high-value, specialized roles, and
- Employers are committed to investing seriously in the foreign professionals they sponsor.
Although this financial threshold is high, it also means that employers who proceed with H-1B sponsorship will be those who genuinely need and value their international talent especially in critical sectors like healthcare.
What Healthcare Employers Should Do Now
Even though the new H-1B selection system will not take effect until the FY 2027 cap season, healthcare organizations should act early to adapt.
Here are actionable steps to take:
1. Audit Your Current and Planned International Nurse Roles
- Identify positions where H-1B sponsorship is realistic (e.g., advanced practice nurses, highly specialized roles).
- Ensure job descriptions and responsibilities clearly reflect specialty occupation criteria.
2. Evaluate Wage Levels and Compensation Packages
- Compare current salaries to prevailing wage data for each location and position.
- Consider whether adjustments may improve both recruitment and H-1B selection odds.
3. Develop a Long-Term Workforce Strategy
- Account for the H-1B cap timing and the new weighted system in your staffing plans.
- Explore complementary visa options (e.g., TN for Canadian/Mexican RNs, EB-3 immigrant visas, or other nonimmigrant categories when appropriate).
4. Work with an Immigration Law Firm Focused on Healthcare Staffing
- The intersection of immigration law and healthcare staffing is specialized and complex.
- Partnering with a firm like VisaMadeEZ, which concentrates on helping healthcare organizations hire international nurses, can significantly improve your chances of success under the new rules.
How VisaMadeEZ Supports Healthcare Employers
At VisaMadeEZ, we understand the unique challenges hospitals, long-term care facilities, clinics, and healthcare staffing agencies face when recruiting foreign-educated nurses and healthcare professionals.
We assist employers with:
- Strategic planning for H-1B petitions for international nurses and advanced practice providers
- Crafting job descriptions and supporting evidence to clearly demonstrate specialty occupation requirements
- Wage analysis and compliance to align with prevailing wage and new selection priorities
- Exploring alternative pathways for international nurse immigration, including immigrant visas and other nonimmigrant classifications
- Ensuring full compliance with evolving U.S. immigration regulations affecting healthcare staffing
Preparing for the Future of H-1B in Healthcare
The shift from a random lottery to a wage and skill-weighted H-1B selection system is a pivotal change for employers who rely on foreign talent. For healthcare organizations, this is both a challenge and an opportunity:
- A challenge, because it raises the bar on compliance, planning, and financial investment.
- An opportunity, because those who plan ahead and structure their roles effectively can continue to attract and retain highly qualified international nurses and advanced practice professionals.
If your hospital or healthcare organization is planning to hire or retain international nurses under the H-1B program, now is the time to review your strategy.
Need guidance?
Contact VisaMadeEZ to discuss how these changes may affect your organization and how we can help you design a sustainable, compliant immigration strategy to meet your nursing and healthcare staffing needs.
