Author: Eli Greenspan, Policy Advisor for AAPPR through Foley Hoag, LLP

Last Updated: October 28, 2025

What happened?

Effective September 2025, a new policy imposes a $100,000 fee on certain new H-1B petitions. The H-1B visa allows companies to temporarily hire nonimmigrant foreign workers for certain roles, such as computer-related software development, architecture, engineering, and healthcare, among other fields. Computer-related technology jobs make up the majority (64%) of all H-1B visas issued, compared to just 4% in the healthcare sector in FY2024.

As of October 21, 2025, most healthcare hires changing status inside the U.S. (e.g., residents/fellows moving from J-1 or F-1 to H-1B, or H-1B extensions/transfers) are not subject to this fee under current guidance. The fee would apply primarily to new H-1B hires coming from abroad.

Why is this a threat to the healthcare sector?

H-1B physicians keep doors open in communities where recruiting is hardest. A $100,000 fee on new petitions would sideline hires that hospitals and practices cannot afford, leading to longer vacancies, reduced services, and longer waits for patients. With demand rising faster than we can train new doctors, this policy deepens shortages and pushes costs higher for everyone.

Did you know?

– 64% of foreign-trained physicians practicing in Medically Underserved Areas or Health Professional Shortage Areas in 2021.
– Over the last 25 years, nearly 23,000 H-1B physicians worked in underserved communities.
– The average economic output generated by each physician nationwide is $3.2 million.

What is the status of the $100,000 fee on H-1B petitions?

As of October 21, 2025, federal guidance says the $100,000 fee does not apply to people who are already living in the United States when you file. That includes amendments, changes of status, and extensions. It also does not apply if those same individuals later travel abroad for visa stamping or re enter on a valid H-1B based on the approved petition.

In practical terms, employers do not pay the fee for most in country cases—such as international medical graduates finishing residency or fellowship and changing to H-1B, or current H-1B employees extending or transferring.

The fee does still apply to new H-1B hires who are outside the United States and need to come to the U.S. to start work or training.

What is AAPPR doing about this situation?

AAPPR is working with lawmakers and national health stakeholders to request the Department of Homeland Security issue clarifying guidance that all H-1B trainees and physicians should be exempted from this fee. While there have been media reports that all physicians might be exempt from this new, higher H-1B filing fee, this has not yet been confirmed and this latest guidance did not fully alleviate concerns from the healthcare sector.

What is the status of lawsuits challenging the proclamation?

There are two lawsuits challenging the proclamation which are currently ongoing in federal court. Global Nurse Force v. Trump alleges the Administration exceeded its authority under Section 212(f) and 215(a) by imposing the $100,000 fee. The second suit – Chamber of Commerce v. Department of Homeland Security – alleges the Administration exceeded its lawful authority by imposing this fee on the H-1B program that are typically set by Congress or through notice-and-comment rulemaking. Both cases are expected to play out over several months leading to uncertainty for employers.

What can you do about this situation?

There have been numerous reports of health systems and hospitals pausing their recruitment of H-1B physicians. This is an unfortunate, yet understandable response to this higher fee on H-1B visas, which most healthcare organizations cannot absorb. The consequences of longer hiring timelines or, worse, cutting back services will directly and negatively harm patients. AAPPR encourages your organizations to reach out with any questions or concerns with the proposal or interest in engaging at the federal level to info@aappr.org.

Next Steps

Please share this update with your internal teams and legal counsel who are navigating this issue for your organizations. We will continue to provide updates and are available to answer any questions or partner on ways to elevate this important issue and the significant disruption it will cause to health organizations.