Rochester Regional Health said a new $100,000 H-1B visa fee is slowing its international nurse recruitment as the health system tries to fill local staffing gaps and manage rising labor costs.
Dan Ireland, executive vice president and chief nursing executive at Rochester Regional Health, warned that the added per-worker cost forces hard choices inside hospital budgets that already compete with day-to-day patient care needs.
“When you add a large amount of money for each individual nurse, that puts a damper on your ability to bring those nurses here. At some point, you have to decide on where’s the money best spent in health care. we want to be good stewards of our health care dollars across our region and across the country,” Ireland said.
RRH response and recruitment effects
Rochester Regional Health, also known as RRH, tied the added cost to its Greater ROC Global recruitment effort and framed the new fee as a trade-off between expanding staffing through international hiring and spending those same dollars on other ways of keeping units open.
Healthcare employers have described the fee pressure as immediate because it lands on a single line item tied to each recruit, rather than spreading gradually across payroll. Those employer concerns can differ from federal rationales for the change, which the government has cast as a restructuring of the H-1B program’s incentives.
Federal actions, rules and dates
A Presidential Proclamation issued on September 19, 2025, titled “Restriction on Entry of Certain Nonimmigrant Workers,” mandated the $100,000 fee and required employers to pay the additional amount per visa as a condition of eligibility.
The policy applied to new H-1B visa applications, creating a new headline expense for employers that use the program for hard-to-fill roles. Employers must plan around publication dates, effective dates and court rulings that determine what rules apply when they file.
USCIS defended the fee and related selection reforms in a press release dated December 23, 2025. Matthew Tragesser, a USCIS spokesperson, argued that the previous system rewarded lower-wage filings and did not align with congressional intent.
“The existing random selection process of H-1B registrations was exploited and abused by U.S. employers who were primarily seeking to import foreign workers at lower wages than they would pay American workers. The new weighted selection will better serve Congress’ intent for the H-1B program and strengthen America’s competitiveness by incentivizing American employers to petition for higher-paid, higher-skilled foreign workers,” Tragesser said.
A legal challenge by 20 states and the U.S. Chamber of Commerce failed to block the fee at the district court level. U.S. District Judge Beryl A. Howell ruled on December 23, 2025, that the administration has the authority to impose this fee.
DHS published a final rule on December 29, 2025, replacing the H-1B lottery with a “weighted selection process,” and it set an effective date of February 27, 2026.
What the weighted selection and fee mean for employers
The government’s approach combines a large new per-case charge with a selection method designed to prioritize higher-paid roles and advanced education. In practice, employers that used H-1B as one avenue for nursing hires now have to assess whether the total cost and selection odds still justify building an overseas pipeline.
Weighted selection influences job design and compensation strategy because prioritization favors applicants in higher-paid roles and those with advanced education. Typical nursing positions often do not carry the same wage profiles as other H-1B-heavy occupations, complicating employers’ calculations.
Other fee and processing changes
Beyond the proclamation fee and selection change, other DHS and USCIS fee updates have added to the budgeting challenge for employers with large caseloads. Effective January 1, 2026, several USCIS fees increased under H.R. 1 (“One Big Beautiful Bill Act”).
For example, Form I-765 (EAD) increased from $550 to $560. Premium processing costs also rose: on January 9, 2026, DHS announced a further increase effective March 1, 2026, raising the cost for Form I-129 (H-1B) from $2,805 to $2,965.
- Smaller fee increases can accumulate quickly for systems filing repeated cases.
- A single large fee like the $100,000 can dominate headlines but is compounded by other incremental increases.
RRH’s pipeline and immediate effects
Rochester Regional Health reported that it successfully relocated approximately 150 international nurses recently, but it said recruitment has now slowed to a crawl. At least 80 nurses are awaiting visas, RRH said, describing them as stuck because of the financial and procedural hurdles created by the new framework.
The slowdown can force hospitals to lean more heavily on other staffing approaches that cost money in different places. Employers have framed the issue as a choice among options that include paying overtime, expanding internal training pipelines, leaning on contract labor, or reducing services when staffing cannot be secured fast enough.
- Overtime. Short-term solution that increases per-shift labor costs.
- Expanded training. Investment in local pipelines that takes time to yield staff.
- Contract labor. Often more expensive per hour than permanent staff.
- Service reductions. Reducing or consolidating services when staffing cannot be maintained.
Effects on international nurses and communities
International nurses themselves have described added uncertainty. Nurses from the Philippines, identified as a major recruitment source, face increased doubts about whether hiring plans still lead to visas under the new fee and selection rules.
Some nurses already in the U.S. on H-1B visas described feeling “forced to stay put” and afraid to travel home to visit family for fear that they will not be allowed to re-enter under the more restrictive 2026 policies. For hospitals, that travel hesitation can affect scheduling stability and retention.
The Association of American Medical Colleges has noted that these fees disproportionately affect rural and high-poverty counties, which rely more heavily on foreign-born medical professionals. Rural hospitals and safety-net providers often operate with smaller labor pools and less slack in staffing, making vacancy spikes harder to absorb.
Planning, timing and case strategy
For HR and legal teams inside hospitals, the new environment requires modeling multiple cost layers per worker, not only the proclamation fee. An H-1B case can involve employer filings, worker-side documents and timing decisions that affect whether premium processing becomes attractive.
Premium processing represents a separate cost decision that hospitals may consider when a unit needs staff by a specific date and delays could trigger overtime spikes or extra contract labor. The most urgent needs can push employers toward faster adjudication even as other costs rise around them.
The fee stack can also influence filing timing across a calendar year. Employers may rush to file before an increase takes effect or delay filings while budgets reset, shifting the timing of arrivals and complicating unit-level staffing plans.
Guidance and resources for employers
As hospitals try to align recruiting, visas and start dates, employers also have to monitor official guidance closely and confirm what rules apply on the day they act. USCIS posts fee updates and announcements in its USCIS Newsroom, which employers use to track agency messaging and timing.
The Federal Register remains the definitive source for the text of final rules and their effective dates, including the H-1B weighted selection rule published on December 29, 2025. For visa processing context that can affect travel, consular timing and other steps outside USCIS adjudication, employers and workers also monitor U.S. Department of State resources such as the Visa Bulletin.
Summary
Ireland’s warning about the $100,000 fee underscores how quickly a single policy change can reshape healthcare hiring plans that hospitals say they rely on to keep care staffed. Hospitals must weigh the new per-case expense and selection odds against other approaches to maintain operations.
The combination of a large proclamation fee, weighted selection, and additional USCIS fee increases has created a complex planning environment for healthcare employers. That complexity affects budgeting, travel decisions, recruitment pipelines and—ultimately—patient care delivery.
