Understanding the Proposed H-1D Visa for Home Health Aides and Nursing Assistants

Last updated Oct 20, 2026

TL/DR –

The Brookings Institution has proposed a new temporary work visa, “H-1D,” allowing US employers to sponsor foreign home health aides and nursing assistants to address a growing caregiver shortage. The pilot program would issue 30,000 visas per year, requiring employers to pay near-top local wages, guarantee weekly hours, and potentially offer a pathway to permanent residence after six years. While the proposal has not been enacted, if it gains traction, healthcare staffing companies could face new recruiting opportunities and compliance obligations.

Proposed H-1D Visa for Foreign Caregivers – What It Means for Healthcare Staffing Firms

The Brookings Institution has proposed a policy for a new temporary work visa category, called H-1D, designed specifically for foreign home health aides, personal care aides, and nursing assistants. This unique visa policy aims to address the increasing shortage of direct-care workers in the US. The initial pilot program would offer 30,000 visas annually, potentially providing a vast recruitment opportunity for healthcare staffing companies. However, it also proposes new compliance obligations for employers. No legislation has been enacted for the H-1D proposal yet.

Why the H-1D Proposal Matters

As a respected public policy research organization, Brookings Institution’s propositions often influence national policy. With an anticipated need for approximately 1.28 million more direct-care workers in the next decade, the H-1D proposal is timely. Current visa classifications aren’t ideal for these caregiving occupations. The H-1D visa seeks to bridge this gap, offering a better alternative to existing programs. Read the detailed proposal here.

Key Points of the H-1D Proposal

Coverage: Direct-care workers including home health aides, personal care aides, and nursing assistants.
Visas: Initial pilot of 30,000 per year, increasing to 65,000 per year after three years.
Qualification: Applicants require two years of direct-care experience, basic English literacy, and no criminal history.
Duration: The H-1D visa initially lasts for three years, with renewal possibilities and a potential pathway to permanent residence after six years.

How the H-1D Visa Sponsorship Works

The proposal introduces an employment-based path enabling US employers to sponsor qualified foreign direct-care workers. It encompasses workers recruited from abroad and individuals already residing in the US, including those without lawful immigration status. Recruitment would be strictly controlled, and foreign workers would only be recruited through approved channels. Additionally, it offers job mobility for H-1D workers, letting them switch between qualifying employers, and the possibility of permanent residence after six years.

Employer Obligations Under the H-1D Visa

The H-1D proposal outlines several responsibilities for sponsoring employers:

Wage Floor: Pay at least the 75th percentile wage for the occupation in the geographic area.
Minimum Hours: Guarantee H-1D workers at least 25 hours of work per week.
Health Insurance: Provide affordable and adequate health insurance.
Payroll Taxes: Withhold and pay Social Security and Medicare taxes.
Transportation Plan: Document a safe travel plan for workers to/from work locations.
Liability insurance: Maintain appropriate coverage.
Equal Workplace Rights: Provide same protections and legal rights as other workers.
Recruitment Costs: Bear recruitment and application costs.
Audits and Enforcement: Subject to compliance reviews and potential audits.

The H-1D Visa and Healthcare Staffing

If the H-1D proposal becomes law, healthcare staffing firms will face specific opportunities and challenges. The H-1D visa would allow firms access to a new pool of qualified direct-care workers. Recruitment, sponsorship, and placement programs could be developed as new service lines. However, staffing companies need to consider how the 25-hour weekly minimum, 75th-percentile wage requirement, health insurance obligations, recruitment expenses, and other compliance costs would affect their business operations.

Preparatory Steps for Healthcare Staffing Companies

Staffing firms interested in the H-1D proposal can take some preliminary steps:

Monitor the proposal and any resulting legislation.
Review existing international recruiting relationships.
Run cost models that include the wage floor, health coverage, recruitment costs, and the 25-hour guarantee.
Assess how current assignment practices would fare under the proposed minimum-hours requirement.

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