This month’s update highlights ongoing uncertainty around the $100,000 H-1B fee, which was struck down in court but remains temporarily in effect during appeal. It also covers potential changes to graduate loan caps, particularly for nursing programs, and new bipartisan legislation aimed at expanding physician placement in underserved areas. Additionally, Congress continues to support key workforce programs that strengthen healthcare access and provider training nationwide.

H-1B $100,000 Fee Update

On June 8, a federal district court in Massachusetts vacated the federal policy implementing the $100,000 fee on certain new H-1B petitions, finding that the fee exceeded executive authority and was unlawful under the Administrative Procedure Act.  The decision was a significant development for health care employers, physician and provider recruitment teams, and international medical graduates because the fee had created a major cost barrier for H-1B sponsorship in an already constrained workforce environment.

However, the practical effect of that ruling is now temporarily on hold. On June 12, the Massachusetts district court temporarily stayed its June 8 order while the First Circuit Court of Appeals considers the government’s expected request to keep the fee in place during the appeal.The government must file its stay request with the First Circuit by June 18 for the district court’s pause to remain in effect.

For now, USCIS may still require the $100,000 fee for approval of H-1B petitions that are filed. The next key milestone is the First Circuit’s decision on whether USCIS may continue collecting the fee while the government’s appeal proceeds. 

AAPPR will continue to closely monitor this case and support efforts to permanently exempt health care professionals from the $100,000 H-1B fee so health care employers can recruit the physicians, IMGs, and other providers their communities need.

Update on Graduate Loan Caps Rule

As you may know from last month’s update, the Education Department finalized a rule that caps most graduate borrowing at $20,500 annually and ends Grad PLUS in July. A recent House budget amendment could give advanced nursing programs a path back to higher federal borrowing limits by requiring the department to treat them as professional degree programs. If enacted, master’s- and doctoral-level nursing students could borrow up to $50,000 annually.

This would be a potential course correction for the nursing workforce, hospitals, and other organizations, but it is not final. The provision still must clear the House, Senate, and be signed into law, and it would not take effect until October 1 at the earliest. That means students and schools may still face several months of uncertainty, and financial aid offices could need to adjust midyear. Recruiters should stay engaged with nursing schools, especially in rural and underserved areas where workforce pipelines are already strained. AAPPR will continue tracking developments as the budget process moves forward.

Physician Workforce Optimization Act Introduced

AAPPR is supporting the bipartisan Physician Workforce Optimization Act, introduced by Sen. Kevin Cramer (R-ND) and Sen. Amy Klobuchar (D-MN), to strengthen the Conrad 30 J-1 Visa Waiver Program and help more communities access the physicians they need.

The bill would expand flex waivers from 10 to 15 per state and create a national secondary match portal to better connect J-1 physicians with states that have unused waiver slots. These updates would give states and healthcare organizations more flexibility to place physicians in rural and underserved communities where recruitment needs remain urgent. 

For AAPPR members, this legislation is a practical step toward improving physician placement, supporting workforce planning, and strengthening access to care nationwide. AAPPR appreciates Sen. Cramer and Sen. Klobuchar’s bipartisan leadership and looks forward to continued work on policies that advance physician recruitment.

Congress Supports Workforce Program Funding in FY27 Appropriations

The House Appropriations Committee’s approval of the FY 2027 Labor, Health and Human Services, Education, and Related Agencies appropriations bill marks an important step in the annual federal funding process. Although the bill reduces overall HHS funding from last year’s enacted level, it continues to support key HRSA health workforce programs that help train clinicians and expand access to care. These include the Children’s Hospitals Graduate Medical Education (CHGME) program, the National Health Service Corps, and Title VII and Title VIII workforce programs.

At a high level, these programs help ensure that communities have access to the health professionals they need. CHGME supports the pediatric workforce by helping children’s hospitals train doctors and dentists. The National Health Service Corps helps bring primary care, dental, and behavioral health providers to communities with provider shortages. Together with Title VII and VIII programs, continued funding for these efforts would support the next generation of health professionals and help improve access to care nationwide, especially in rural and underserved areas.