Lawmakers, MGMA urge DHS to exempt health care from $100,000 H-1B fee

A bipartisan, bicameral group of lawmakers is urging Department of Homeland Security Secretary Kristi Noem to exempt the health care sector from a $100,000 fee tied to some H-1B petitions, arguing the cost could worsen clinician shortages and threaten patient access, particularly in rural and underserved communities.

The Medical Group Management Association (MGMA) backed the request Monday, saying medical practices rely on international clinicians and staff to keep services running and that the fee could leave “critical positions unfilled” while increasing strain on the remaining workforce.

The lawmakers’ letter, led by Reps. Yvette D. Clarke, D-N.Y., and Michael Lawler, R-N.Y., asks DHS to provide an exemption for health care from the $100,000 charge. Clarke’s office said the letter drew support from multiple health care groups and warned the fee could push some hospitals “to their financial brink.”

The $100,000 payment stems from a Sept. 19, 2025, presidential proclamation that directs DHS to restrict decisions on certain H-1B petitions not accompanied by the payment when the worker is outside the United States, while allowing for a national interest exception determined by DHS.

U.S. Citizenship and Immigration Services (USCIS) has issued public guidance and FAQs on how the proclamation is implemented. Summaries of that USCIS guidance say the $100,000 fee is aimed at new cases involving beneficiaries who are outside the U.S. and do not have a valid H-1B visa, and that it does not apply to previously issued and currently valid H-1B visas.

The USCIS guidance also outlines how the fee is handled procedurally: If a petition is subject to the proclamation, payment must be made via pay.gov before filing, and the petitioner must submit proof of payment or evidence of an exception, or USCIS will deny the petition, according to an American Immigration Council analysis of the agency’s posted instructions.

In their appeal to Noem, lawmakers pointed to ongoing workforce shortages and argued that a $100,000 charge on employers seeking to hire H-1B workers would further strain hospitals and other providers, particularly in areas already struggling to recruit clinicians.

MGMA said it supports a “clear exemption” for health care employers and urged DHS to act quickly, framing the issue as an access-to-care concern for communities that depend on internationally trained health professionals.

Separately, the State Department has described the proclamation as restricting H-1B visa issuance and entry in cases tied to petitions filed after the proclamation’s effective date unless the petition is accompanied or supplemented by the $100,000 payment, with exceptions determined by DHS.