Healthcare Horizons: What Healthcare Employers Should Watch in the 2026 Immigration Regulatory Agenda

The United States Departments of Homeland Security, State and Labor have issued their 2026 regulatory agendas, setting forth their rulemaking priorities and timelines for the coming months. 
 
Upcoming changes have the potential to greatly increase staffing costs and administrative burden for healthcare employers, as immigrants comprise 17% of the healthcare workforce, including 28% of physicians and surgeons and 30% of direct care workers in long-term settings.  

Therefore, paying attention to these plans is critical for hospitals, academic medical centers (AMCs), research institutions, as well as clinical and healthcare employers of any size. Creating realistic and practical contingency plans will be key to ensuring continuity of patient care and retaining staff.   

The Administration recently finalized a new rule related to students and exchange visitors and is planning to finalize proposed rules related to prevailing wages and “public charge.” Additional proposed reforms will affect the labor market test for PERM labor certification, H-1B program eligibility and compliance requirements and foreign student practical training programs, among other regulatory priorities. 

This blog provides an overview of the three planned changes expected to have the greatest impact on the healthcare sector. It is the first in a series of articles and videos that will explore these developments in greater detail, offering practical insights and actionable steps for employers as they prepare for and respond to the changes. 

Top Three Changes for Healthcare Employers 

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

Effective September 15, 2026, foreign students (F status) and “exchange visitors” (J nonimmigrants) will be given a fixed expiration date, no more than four years from the start of their program, after which they will need to file additional paperwork with USCIS in order to remain in the United States. Details of the rule can be found here.  

• • • Impact: Tens of thousands of clinical residents and fellows and a significant number of other staff maintain J-1 or F-1 status. This rule would add additional administrative filings, cost, and scrutiny for all of these groups, and add further tracking requirements. Applications would need to be filed several months in advance to guarantee on-time processing.  

• • • 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 additional costs, monitoring and processing. Plans should be created to withstand greater scrutiny of extensions, manage potential disruptions due to processing delays and handle possible denials.  

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: 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. 

• • • 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” may be appropriate. (H-1B staff subject to collective bargaining agreements will not be affected.)   

Proposed: Expansion of J-1 Exchange Visitor Termination Rules

A newly proposed rule will raise penalties for noncompliance with DOS rules for J-1 individuals. Certain violations which were grounds for discretionary termination would be grounds for mandatory termination. Among examples given are providing incorrect proof of U.S. address, educational qualifications or lack of sufficient physical presence at the exchange program activity site. Of particular significance, failure to maintain health insurance coverage that meets regulatory requirements will be grounds for mandatory termination. 

• • • Impact: The threat of mandatory termination for even minor or inadvertent lapses will put increased pressure and raise institutional costs for compliance. Insurance requirements are quite specific regarding coverage amounts and deductibles, for example.  

• • • What to do: Review your compliance regime for all J-1 program rules, particularly health insurance. Additionally, reach out to Fragomen’s Center for Strategy and Applied Insights to discuss commentary surrounding this rule. 

On the Horizon 

Several additional immigration policy and regulatory developments are on the horizon, with the potential to create new compliance considerations, workforce impacts and administrative challenges for healthcare employers. Key developments to watch include: 

• • • Broader Discretion in applying the “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. For healthcare organizations, the changes may also have downstream implications for benefit participation and uncompensated care, particularly if some noncitizen households become more hesitant to access public benefits.

• • • Fee increases. The government will propose an increase in baseline fees, likely including fees for certain humanitarian applications, under the H.R. 1 legislation passed by Congress in July 2025. The proposed rule is slated for publication in September 2026.

• • • Final elimination of automatic EAD extension. A regulation expected soon will eliminate the maximum 540-day automatic extension of employment authorization documents (EADs) for certain foreign nationals who filed renewal applications on or after October 30, 2025. This will mostly impact employees who are in H-4 status and those relying on the EAD in the final stage of the green card process.  

Additional developments to monitor include expanded biometrics collection, which could extend beyond sponsored employees to immigration services staff; potential revisions to H-1B cap exemption, third-party placement and program “violator” rules; possible new restrictions on F-1 practical training; and changes to the PERM labor certification process, including the labor market test and related requirements. 

Need to Know More?  

For questions related to the healthcare immigration landscape, please contact Counsel Christopher Wendt at [email protected]. Stay tuned for more updates as part of Fragomen's Healthcare Horizons content series. 

This blog was published on August 17, 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.