2026 Immigration Regulatory Changes: What Academic Medical Centers Need to Know

Academic medical centers (AMCs) face a particularly complex set of immigration challenges as the federal government moves forward with regulatory changes affecting foreign students, exchange visitors and sponsored workers.  

Unlike many healthcare employers, AMCs often rely on multiple immigration categories across their clinical, research and educational missions—from J-1 residents and fellows and F-1 students to H-1B physicians and researchers and J-1 postdoctoral fellows. As a result, changes to admission periods, prevailing wages, exchange visitor compliance and public charge policy could create overlapping workforce, financial and administrative challenges. 

The Departments of Homeland Security, State and Labor recently issued their 2026 regulatory agendas, outlining rulemaking priorities and anticipated timelines for the coming months. Several of these priorities could have particular implications for AMCs given their reliance on international talent across clinical care, graduate medical education, research and academic programs. While the agendas provide a roadmap of expected regulatory activity, the specifics of each rule remain confidential until released for publication in the Federal Register, and anticipated publication dates are often deferred. 

Against this evolving regulatory backdrop, AMC leaders and the teams responsible for graduate medical education, international scholars, human resources, benefits and immigration compliance should consider how these changes could affect their institutions and what steps they can take now to prepare. 

Key Workforce and Cost Implications for Academic Medical Centers 

Two regulatory developments stand out for their potential to create significant and relatively widespread workforce, financial and administrative impacts for academic medical centers. Changes to periods of admission for F-1 students and J-1 exchange visitors could affect large populations of residents, fellows, researchers and other international talent, while proposed prevailing wage revisions could substantially increase the cost of sponsoring physicians and other employees. 

Given the potential scale of these changes, AMCs should begin assessing their affected populations, financial exposure and administrative processes now.  

Newly Finalized: Fixed period of admission for students, some residents and fellows and some post-doctoral fellows.  

Effective September 15, 2026, a new Department of Homeland Security regulation will end the longstanding practice of admitting foreign students (F status), and “exchange visitors” (J nonimmigrants) to the United States for the length of their program – known as “duration of status.” 

Instead, these individuals will be given a fixed expiration date, no more than four years from start of program, after which they will need to file additional paperwork with USCIS, pay fees and possibly attend biometrics and/or an interview in order to remain in the United States. Details of the rule can be found here.  

• • • Impact: International Medical Graduates comprise about 23% of all residents and fellows, per the American Medical Association. Roughly 17,000 of these residents and fellows are in J-1 status, according to the American Hospital Association. In addition, more than half of the postdoctoral students in the US are on temporary visas, and about two-thirds of those are J-1s. Only very few students entering medical school annually are not US citizens and may be in F status. However, over 2 million F-1 students are employed in Optional Practical Training (OPT), and it is estimated that roughly 11% of international students are in physical and life science or health science fields.    
       
      For AMCs, the new rule could result in a significant increase in immigration filings across clinical, research and academic populations, along with additional costs, tracking obligations and scrutiny. At current processing times, applications may need to be filed several months in advance to support timely adjudication. While individuals with timely filed applications may remain in an authorized period of stay while their cases are pending, delays could create practical complications involving driver’s licenses, dependent work authorization, documentation of lawful status and travel. For AMCs, these individual challenges can become workforce continuity issues when they affect residents, fellows, researchers and other essential personnel.

• • • What to do: AMCs and other healthcare employers should assess the number of J-1 and J-2 appointees as well as F-1 students or employees and their roles, and work with stakeholders to decide who will be responsible for these additional filings, who will bear the cost, make sure tracking systems are in place, and decide if and when to offer premium processing.  In addition, plans should be created to manage potential disruptions due to processing delays and possible denials. It is likely that USCIS will scrutinize proposed program lengths in more detail, so programs should be prepared to document justification for unusual or nonstandard timing. 

Proposed: Prevailing wage revisions for certain nonimmigrant visa types and PERM  

The Department of Labor intends to finalize a rule that would revise the prevailing wage levels applicable to the H-1B and E-3 nonimmigrant programs, and the PERM pathway. If implemented, entry-level wages for sponsored employees would increase, resulting in higher sponsorship costs for common temporary work visa filings and some permanent residence cases. 

• • • Impact: According to the JAMA, more than 11,000 physicians, or 1% of the entire US physician workforce, were sponsored for H-1B status in one single year, FY 2024. Of these, more were concentrated in poor or rural areas. Sample data based on four cities, from the “physician all other” category from the Institute for Progress indicate that H-1B physicians at the beginning of their careers may need to be paid $28,000 more annually, on average. This would raise costs and salary equity issues. Other roles will likely be affected as well. 
       
      For AMCs, higher required wages could affect not only immigration sponsorship budgets but also physician recruitment, compensation structures and salary equity across similarly situated sponsored and nonsponsored employees. Other sponsored clinical, research and academic roles could also be affected. 

• • • What to do: Review salaries for any positions you commonly sponsor for H-1B and compare these to the proposed DOL standard. There is an Impact Calculator available from IFP allowing employers to generate wage differentials under the expected DOL rule. Discuss with your legal counsel whether a formal “prevailing wage request” based on an alternate, more accurate, data and methodology may be appropriate. (Note that if you have unionized H-1B employees, the collective bargaining agreement would still control.) 

Additional Compliance and Patient-Care Considerations 

Other regulatory developments may have more targeted effects but still warrant close attention from academic medical centers. Changes to J-1 termination rules could increase institutional compliance risks for programs hosting exchange visitors, while changes to the public charge framework could have implications that extend beyond an AMC’s workforce to the patients and communities it serves. 

AMCs should consider these developments as part of their broader immigration compliance and institutional planning efforts, particularly where responsibility extends across immigration, graduate medical education, human resources, benefits and patient-facing functions.  

Proposed: Expansion of J-1 Exchange Visitor Termination Rules 

A newly proposed rule will create challenges for J individuals as well as host and sponsor organizations. This rule will raise penalties for noncompliance with DOS rules. Certain violations which were grounds for discretionary termination would be grounds for mandatory termination, such as “falsification or failure to provide full and truthful information and documentation in their application or ongoing program.”   

Examples given include a foreign national’s proof of U.S. address, educational qualifications, and attendance at the exchange program activity site. Of particular significance, failure to maintain health insurance coverage which meets regulatory requirements will be grounds for mandatory termination. 

• • • Impact: As discussed above, a significant number of GME trainees and researchers utilize the J-1 exchange visitor visa. The threat of mandatory termination for even minor or inadvertent lapses will induce increased pressure and raise institutional costs for compliance. For AMCs, this is also a cross-functional issue. J-1 compliance may involve immigration and international scholar teams, GME, human resources, benefits departments, individual academic departments and the foreign national. Health insurance requirements, for example, include specific standards related to coverage amounts and deductibles. 

• • • What to do: Review your compliance regime for all J-1 program rules. Make sure benefits staff work with staff supporting international scholars to ensure that current insurance offerings, especially lower-cost health plans, meet the regulatory requirements. These include maximum deductibles ($500) and minimum per incident coverage ($100,000) for example, among other specific provisions.   

Newly Finalized: Broader Discretion In Application of “Public Charge” Rule 

Beginning September 18, 2026, immigration officers will have broader discretion when assessing whether an applicant is likely to become a “public charge” as part of the adjudication of certain immigration benefits.  

• • • Impact: For AMCs, the implications may extend beyond their foreign national workforce. According to at least one study, it is possible that these changes could increase uncompensated care due to both disenrollment and a “chilling effect” as households with some non-citizen members become reluctant to claim benefits which may be lawfully available to citizen members of the family. The study estimates that about 13.5 million Medicaid or CHIP enrollees, including 5.6 million US citizen children, live in a household with at least one noncitizen. 
    • What to do: Work with your internal experts to understand your payer mix and which communities you serve may be affected. Consider educating staff and patients about eligibility for benefits, including education about local legal aid programs which can advise patients and families about the risk of a public charge determination.   

Preparing Across the Institution 

For AMCs, the impact of these regulatory developments may extend well beyond the immigration function. Changes affecting residents and fellows can create clinical staffing and continuity challenges; new wage requirements can affect recruitment and compensation planning; heightened J-1 compliance obligations can require coordination across multiple administrative functions; and public charge policies may have implications for the patients and communities AMCs serve. 

Given these overlapping considerations, AMCs should consider bringing together immigration, GME, research administration, human resources, benefits, finance and other relevant stakeholders to assess institutional exposure and establish clear ownership for compliance and contingency planning. Taking these steps before new requirements take effect can help institutions identify potential workforce disruptions and prepare strategies to maintain continuity across their clinical, research and educational missions. 

Need to Know More? 

For questions related to the healthcare immigration landscape, please contact Counsel Christopher Wendt at [email protected].  

This blog was published on August 24, 2026, and may be subject to change. Updates may occur as policies evolve. To stay informed on the latest immigration news and analysis, please subscribe to our alerts and follow Fragomen on  LinkedIn, Facebook and Instagram.