H-1B Visa Health Care Sector Seeks Exemption from $100,000 Fee

February 11, 2026 is now a key date for employers preparing the FY 2027 H-1B visa cap season. A bipartisan, bicameral group of 100 lawmakers asked DHS to exempt the health care sector from a new $100,000 fee tied to certain consular-processed H-1B filings. The request arrives weeks before cap registration typically opens in March, when hospitals and clinics finalize budgets and hiring plans for an October 1 start.

Representatives Yvette D. Clarke (D-NY) and Michael Lawler (R-NY) led the effort, with support that includes Senator Kirsten Gillibrand. Their letter urges DHS Secretary Kristi Noem to grant a sector-wide exemption for healthcare. The argument is operational, not theoretical. Many facilities recruit physicians, researchers, and specialized technologists on H-1B timelines that cannot absorb an extra six-figure cost.

This matters now because the H-1B cap process is front-loaded. Employers must register in March, file in April through June if selected, and often plan consular appointments months ahead. A sudden fee shock can freeze offers, delay start dates, and reduce patient coverage in already thinly staffed departments.

📅 Key Date: H-1B cap registration for FY 2027 is typically early-to-mid March 2026, with selections released in late March.

FY 2027 H-1B cap timeline (employment start: October 1, 2026)

USCIS continues to run the cap under the beneficiary-centric model. That means one registration per person, even if multiple employers submit registrations. It reduces duplicate entries, but it does not reduce competition. Employers still need clean job descriptions, correct SOC coding, and a wage offer that fits the role and location.

For context, last year’s cap season remained highly competitive. FY 2026 saw about 442,000 registrations, with roughly 120,000 selected to fill the 85,000 cap numbers. That implied a selection rate near 27%, after accounting for expected non-filings and denials. FY 2027 demand could stay elevated, especially in clinical and health tech roles.

The new fee issue comes from a Presidential Proclamation issued in September 2025 that created a “national interest” fee concept. DHS was granted authority to exempt sectors when an exemption is in the national interest, and when it does not threaten security or welfare. In practice, DHS can ask for evidence that the exemption supports continuity of essential services.

USCIS later drew an operational line that matters for planning. The fee applies to certain new H-1B petitions where the beneficiary is outside the United States and will complete consular processing. USCIS indicated the fee does not apply to a change of status filed for someone already in the U.S., such as many F-1 graduates. That distinction changes which candidates are most expensive for employers to onboard.

⚠️ Employer Alert: Budget separately for standard H-1B filing fees and any national-interest fee exposure for consular cases. Do not shift required employer fees to the worker.

Lawmakers framed the healthcare exemption request as a national welfare issue. They cited HRSA-related data that 87 million Americans live in areas with insufficient access to health professionals. They also pointed to a projected physician supply gap of up to 86,000 over the next decade. Those numbers are used to match the exemption standard: national interest and national welfare.

The letter also focused on where the fee would hit hardest. Rural hospitals and urban safety-net systems operate with thin margins and high Medicaid or uninsured populations. Those facilities also rely on international recruitment pipelines for specialty coverage and overnight call rotations. A six-figure fee can convert a “yes” hire into a “no,” even when the position is clearly a specialty occupation.

Public statements around the letter were direct about downstream effects. The lawmakers warned the fee could worsen staffing challenges and leave critical roles unfilled. That message is aimed at DHS’s exemption criteria, but it is not a guarantee of a policy change.

Hospital leadership echoed the concern in practical terms. Ken Raske of the Greater New York Hospital Association said New York hospitals have long used the H-1B program to deliver care, and the fee threatens that mission. Statements like these can matter because DHS often weighs real-world service impacts, including patient access and system stability.

For hospitals and clinics, the immediate issue is how to recruit while the exemption request is pending. Hiring teams may need two cost models for the same role. One model assumes a U.S.-based candidate who can file change of status. The other assumes a consular case that may carry the $100,000 fee. Smaller employers may pause international recruitment if leadership will not approve that exposure.

For physicians, researchers, and specialized allied professionals, the impact shows up as a higher entry barrier when the role requires consular processing. Some employers may prefer candidates already in the U.S. in F-1, J-1, or another work-authorized status. That can affect job search strategy, timing, and interview outcomes, even for fully qualified candidates.

💼 Employee Tip: Ask early whether the employer expects change of status or consular processing. That answer can affect cost, timing, and offer viability.

Compliance and wage planning still control the core H-1B case. Employers must pay at least the higher of the prevailing wage or actual wage for the SOC code and worksite location. Wage Level I roles face higher scrutiny when duties appear junior or generic. Healthcare employers should align job duties, supervision, and credential requirements to the wage level.

A separate practical issue is payment logistics. USCIS previously noted it raised the daily credit card limit to $99,999.99 in response to these high-fee filings. Employers should confirm payment method rules before filing. A rejected payment can mean a rejected filing, and that can be fatal in a capped season.

If selected in the lottery, the next step is an LCA and full petition filing during the April 1 to June 30 window. Employers must be ready to document specialty occupation requirements, the offered wage, and the worksite details. Employees should confirm the title, work location, and whether third-party placement is involved, since those facts drive USCIS scrutiny.

If not selected, employers and workers should shift quickly to alternatives. Cap-exempt H-1B is often viable for universities, affiliated nonprofits, and some research hospitals. Other options can include O-1 for extraordinary ability, L-1 for intracompany transferees, TN for eligible Canadian and Mexican professionals, and continued F-1 OPT/STEM OPT when available. Each has its own timing and evidentiary standards.

Looking ahead, the projected FY 2028 cycle should follow the same cadence. Registration is expected in March 2027, with an April filing window and an October 1, 2027 start date. Employers in the health care sector should treat March as a fixed deadline and build recruiting calendars backward from it.

Action items now (before March 2026):

• Employers: Identify which FY 2027 hires require consular processing, and quantify potential $100,000 fee exposure. Finalize SOC codes and prevailing wage targets using flcdatacenter.com. Prepare compliant offer letters with consistent worksite details.
• Employees: Confirm whether your case is likely change of status or consular processing. Verify the job requires a specific degree field and that the wage aligns with the correct level. Keep transcripts, licenses, and credential evaluations ready.
• Key upcoming dates: Expect registration in March 2026, selections in late March, and filing from April 1 through June 30, 2026. Plan start dates for October 1, 2026.
• Track updates on USCIS cap season pages, and monitor DHS exemption developments tied to healthcare.

📋 Official Resources: – H-1B Program: uscis.gov/h-1b-specialty-occupations – Cap Season: uscis.gov/h-1b-cap-season – Prevailing Wages: flcdatacenter.com