H-1B Visa Fees: What Healthcare Employers Need to Know

Healthcare employers that rely on international workers to fill critical positions are facing another potential increase in the cost of H-1B visas, even as an earlier $100,000 fee remains tied up in court.

Background

In September 2025, the Trump administration issued a presidential proclamation requiring a $100,000 payment for certain new H-1B petitions involving workers outside the United States. The policy raised immediate concerns among hospitals and health systems already struggling with workforce shortages, particularly in rural and underserved communities.

The American Hospital Association (AHA) urged the administration to exempt healthcare personnel from the fee, arguing that restricting access to internationally trained professionals could exacerbate workforce shortages and affect patient care. An AHA survey of more than 1,000 hospitals and health systems found that more than 70% expected the fee to affect patient care, while 64% of organizations that used or planned to use H-1B visas said they would pause, defer or limit recruitment because of the increased cost.

The $100,000 fee was struck down by a federal district court in June, which found that the administration had exceeded its authority. After a temporary stay, a federal appeals court in July declined to keep the fee in effect while the government appeals the ruling. As a result, the $100,000 payment is not currently required, although litigation continues.

The Latest

Now, the Department of Homeland Security (DHS) has proposed a separate $103,265 filing fee for H-1B petitions subject to the program’s annual numerical cap. Federal law generally limits new cap-subject H-1B visas to 65,000 annually, with an additional 20,000 available for individuals who have earned a master’s degree or higher from a qualifying U.S. institution.

The impact of the proposed fee would vary among healthcare employers. Academic medical centers and some nonprofit hospitals affiliated with institutions of higher education may qualify for cap-exempt H-1B petitions and therefore would not be subject to the proposed fee. Other hospitals and healthcare organizations that rely on cap-subject H-1B petitions to recruit physicians and other highly skilled professionals could face the additional cost. The proposed fee would be imposed in addition to existing H-1B filing costs.

DHS says the fee would help recover federal costs associated with administering the immigration system. The proposal is not yet final, and DHS is accepting public comments through Sept. 24.

For healthcare organizations already confronting persistent workforce shortages, the latest proposal adds another consideration to an increasingly complex immigration and recruitment environment.