Rep. Sewell Calls DHS to Exempt Healthcare Workers from H-1B Fee

(UNITED STATES) — Employers sponsoring H-1B professionals must meet one non-negotiable obligation: pay and document the required wage while maintaining compliant working conditions, from the Labor Condition Application (LCA) through the employee’s start date.

For healthcare employers, that obligation now sits alongside a major budgeting risk. A new $100,000 additional payment applies in certain “new entry” cases and can land directly in the recruiting pipeline for hard-to-fill roles.

The controversy is acute for rural and underserved facilities, where foreign-trained physicians and specialty clinicians often backstop coverage. VisaVerge has detailed how the rural hospital impact can widen care gaps.

1) Overview: The $100,000 H-1B fee and its policy context

The $100,000 amount is not a normal USCIS filing fee. It is an additional payment tied to eligibility for entry under a 2025 Presidential Proclamation. Standard H-1B fees still apply, including the I-129 fee, ACWIA, and the Fraud Prevention fee.

The administration’s stated rationale has been to reshape H-1B usage and discourage certain overseas hiring patterns. Critics argue the payment functions like a barrier that hits essential sectors unevenly.

Healthcare systems feel this sharply because many hires are time-sensitive and location-specific. That includes rural hospitals, community health systems, and safety-net facilities.

Many healthcare roles are also tied to coverage schedules and patient access. A delayed hire can mean closed service lines, longer wait times, or locum tenens costs.

⚠️ Employer Alert: Treat the $100,000 payment as a “case routing” issue. It changes which candidates are financially viable for overseas consular processing.

2) Legislative action: Letter from lawmakers to DHS (Jan. 14, 2026)

On January 14, 2026, Rep. Terri Sewell (AL-07) and Rep. Emilia Sykes (OH-13) led a letter to the Department of Homeland Security (DHS) requesting relief for healthcare workers. The letter asked DHS to exempt, or provide meaningful carve-outs, for healthcare hires affected by the new payment.

This matters because the Proclamation places practical discretion with the Department of Homeland Security (DHS). Congress can pressure and request, but a letter does not change the rule by itself. Employers should watch for follow-on DHS implementation steps, including updates in USCIS announcements.

A key planning point: letters like this can lead to guidance updates or exception processes, but timelines are uncertain. Employers should plan as if the payment remains in force for FY 2027 cases.

The FY 2027 season will also track the usual cap cycle. Registration is typically in March, with selections by late March or early April. Petitions are then filed in the spring. Exact milestone dates should be confirmed each year on USCIS cap season updates.

📅 Key Date: FY 2027 cap registration is typically early-to-mid March 2026, with an October 1, 2026 start date for cap-subject winners.

3) Policy specifics: Who the $100,000 fee affects and exceptions

The operational question is simple: Is your hire outside the United States and needing consular processing? If yes, the $100,000 additional payment may be triggered.

Most affected cases include new hires abroad who will enter the U.S. in H-1B status after consular visa issuance, and cases filed with consular notification rather than a change of status in the U.S.

• New hires abroad who will enter the U.S. in H-1B status after consular visa issuance
• Cases filed with consular notification rather than a change of status in the U.S.

Often not affected are extensions for current H-1B workers, amendments due to job changes if the worker remains in the U.S., and many change-of-status filings for workers already in the U.S., including many F-1 students moving to H-1B.

• Extensions for current H-1B workers
• Amendments when the worker remains in the U.S.
• Change-of-status filings for workers already in the U.S.

This distinction is the triage tool for healthcare HR teams. If the candidate is already in the U.S., the fee risk may be lower. If the candidate is abroad, the fee can dominate the cost per hire.

National interest exceptions are described by USCIS as extraordinarily rare and controlled by DHS. Healthcare employers should treat them as a contingency, not a baseline plan.

Evidence themes that tend to matter in healthcare cases include:

• Critical shortage coverage in a defined service area
• Documented patient access impact, including wait times and closures
• Facility-level harm, such as loss of trauma coverage or specialty call
• Recruitment history showing unsuccessful U.S. worker sourcing

4) Related policy: Premium Processing Fee increase (Jan. 9, 2026)

Premium processing is an optional acceleration mechanism for certain filings. It speeds USCIS adjudication, but it does not guarantee approval and does not fix weak specialty occupation evidence or wage issues.

DHS announced a premium processing adjustment on January 9, 2026, effective March 1, 2026. The Form I-129 premium fee increased from $2,805 to $2,965.

Operationally, healthcare employers often use premium processing to meet credentialing and onboarding timelines, reduce schedule gaps in clinical coverage, and support visa timing for candidates who must travel for stamping.

Premium processing should be weighed against risk controls that cost less. Earlier case initiation and stronger job duty documentation often matter more than speed.

5) Impact assessment: Healthcare workforce and recruitment

Rural and underserved facilities often recruit for roles with thin domestic pipelines. When the overseas route triggers an extra $100,000 payment, the “all-in” immigration cost can exceed typical recruiting budgets and shift pipelines toward candidates already in the U.S. or toward locum coverage.

Employers should forecast immigration costs per hire using a consistent internal policy on who pays what. The wage obligation always stays with the employer. Several H-1B fees must also be paid by the employer, not the employee.

Baseline H-1B fee items employers commonly track (excluding the $100,000 payment) include registration, Form I-129 filing, ACWIA, Fraud Prevention, and optional premium processing. Treat premium processing as optional and note the updated amount effective March 1, 2026.

• Registration: $215 — Employer
• Form I-129 filing: $780 — Employer
• ACWIA: $750–$1,500 — Employer
• Fraud Prevention: $500 — Employer
• Premium processing (optional): $2,965 (effective Mar. 1, 2026) — Either

The $100,000 payment is separate from these baseline fees. Employers should budget it only when the case is a “new entry” pattern.

Workforce planning steps for healthcare:

1. Build lead times that account for cap selection, LCA timing, and credentialing.
2. Create backup coverage plans for start dates that slip past October 1, 2026.
3. Align offer letters with immigration contingencies and start-date flexibility.
4. Communicate early with candidates about consular processing risks and timing.

Step-by-step: Sponsoring an H-1B worker for FY 2027

Step 1: Confirm the role is a specialty occupation

USCIS requires a position that normally needs at least a bachelor’s degree in a specific specialty. Healthcare examples include many physician, pharmacist, and certain clinical specialist roles.

Entry-level roles at low wage levels can draw scrutiny. Broad duties can also trigger requests for evidence.

Step 2: Determine the SOC code and wage level

Use flcdatacenter.com to benchmark the prevailing wage. The employer must pay the higher of the prevailing wage or actual wage.

• Level I: entry, close supervision
• Level II: qualified, limited judgment
• Level III: experienced, independent
• Level IV: expert level

Step 3: File the Labor Condition Application (LCA)

The LCA is filed with the Department of Labor. It requires three core attestations: wage, working conditions, and notice.

1. Wage: Pay at least the required wage.
2. Working conditions: No adverse effect on U.S. workers.
3. Notice: Provide notice of the LCA filing.

Posting requirement: Employers must post notice at the worksite or provide electronic notice. Multi-site healthcare systems must post where the H-1B worker will work.

⚠️ Employer Alert: Maintain a compliant Public Access File. Missing postings and wage documentation are common audit triggers.

Step 4: Register for the cap, if cap-subject

FY 2027 registrations are typically submitted in March 2026. Selection notifications usually come in late March or early April. Cap-subject filings are then submitted in the spring window.

Step 5: File Form I-129 with a complete evidence package

Build a filing that matches the wage level, degree field, and duties. Healthcare job descriptions should be specific, with percentage breakdowns and supervision structure.

Step 6: Plan onboarding and travel

If the worker is abroad, map consular steps and possible delays. If the worker is in the U.S., confirm whether change of status is appropriate.

Required documentation checklist (employer and employee)

Employer documents

• Detailed job description with duty percentages
• Worksite addresses and rotation details, if any
• Organizational chart and supervisor credentials
• Wage offer documentation and pay structure
• Financial and business proof, as needed for new entities
• LCA posting evidence and Public Access File contents

Employee documents

• Passport biographic page and immigration history
• Degree(s), transcripts, and evaluations for foreign degrees
• Professional licenses, where required for the role
• Detailed CV and experience letters, if needed
• Prior approval notices and I-94 records, if in the U.S.

Common compliance violations and penalties

Common pitfalls in healthcare settings include paying below the required wage due to shift differentials misapplied, worksite changes without an amendment, untracked rotations to clinics that were not covered by posting, and benching without pay when schedules change.

Penalties can include back wages, civil fines, and debarment from the H-1B program.

6) Current status and legal challenges

As of January 16, 2026, there is no blanket healthcare exemption. “Case-by-case” relief means employers must assemble evidence and accept uncertainty.

Litigation is pending, including business and state challenges. Employers should watch for injunctions that pause implementation, USCIS policy updates or revised filing instructions, and changes to how national interest exceptions are adjudicated.

Risk management steps that help in audits and disputes include decision logs, consistent fee policies, and documented recruiting timelines.

7) Official government sources and where to verify

Use official pages for updates, not screenshots or reposts:

• USCIS newsroom updates: https://www.uscis.gov/newsroom
• USCIS cap season updates: https://www.uscis.gov/h-1b-cap-season
• H-1B filing guidance: https://www.uscis.gov/working-in-the-united-states/h-1b-specialty-occupations
• Department of Labor foreign labor pages: https://www.dol.gov/agencies/eta/foreign-labor
• Proclamation text

Employers should classify each FY 2027 hire by location first. Label candidates as “in the U.S.” or “outside the U.S.” before budgeting. Employers should begin SOC and wage work in January and February 2026. That timing supports March registration and spring filing.

Employees should confirm the SOC code, wage level, and worksite list before filing. Both parties should track cap season announcements and filing rules at https://www.uscis.gov/h-1b-cap-season.

📋 Official Resources:

– H-1B Program: https://www.uscis.gov/working-in-the-united-states/h-1b-specialty-occupations

– Cap Season: https://www.uscis.gov/working-in-the-united-states/temporary-workers/h-1b-specialty-occupations/h-1b-cap-season

– Prevailing Wages: https://flcdatacenter.com