Updated English Language Proficiency (ELP) exams and score requirements by the Health Resources and Services Administration (HRSA)

In response to the publication of updated English Language Proficiency (ELP) exams and score requirements by the Health Resources and Services Administration (HRSA) on May 12, 2026, TruMerit offers the below insights and implications:

English language proficiency is an important requirement for effective communication with patients, their families, and other healthcare professionals, ultimately contributing to quality of care and patient safety. Foreign-educated healthcare professionals seeking entry into the United States must, therefore, successfully complete an ELP examination.

TruMerit (formerly CGFNS) is authorized by the US Customs and Immigration Service (USCIS) to issue health care worker certifications (VisaScreen®) to foreign-educated healthcare professionals seeking an occupational visa to work in the United States—a verification process that includes validation of successful completion of a USCIS-recognized ELP examination. Note: TruMerit is the only organization approved by USCIS to issue these certifications for all nine health professions¹ identified in Section 343 of the Illegal Immigration Reform and Immigrant Responsibility Act (IRRIRA).

What does the HRSA update mean for TruMerit applicants?

In alignment with HRSA’s updated exam requirements, TruMerit will adapt its policies and processes for VisaScreen® certificate issuance to reflect the new requirements published by HRSA, which are effective as of May 12, 2026.

This means that:

• All exams taken prior to May 12 will still be certified according to the previous criteria.
• All exams taken on or after May 12 will be certified according to the new criteria.

What about TOEIC test results?
TruMerit will no longer accept the Test of English for International Communication (TOEIC) for VisaScreen® certification after the May 12 implementation date, as this test is no longer listed by HRSA as an approved exam.

TruMerit’s commitment to patient safety
For years, TruMerit has been working with other stakeholders, including ELP test providers, to improve ELP standards. In January of 2025, TruMerit hosted a convening for all USCIS-recognized ELP test publishers to discuss how equivalency among the minimum required scores could be better established between the exams. Several recommendations were subsequently submitted to HRSA on behalf of the organizations who participated in the convening, and a formal position statement was published.² TruMerit is pleased to see that some of those recommendations are reflected in the new criteria.

Following the availability of new concordance information for several ELP exams, TruMerit issued an amendment to its report in August of 2025. A statement was also subsequently released in January of 2026, addressing the introduction of TOEFL’s new scoring system. Collectively, these recommendations focused on improved score equivalence between the tests, which called for an increase in overall scores and subtest scores for some exams, a decrease in others, or no change at all, depending on the exam. The proposed changes also emphasized implementing a speaking subtest score for exams that previously lacked one, as well as strengthening the minimum required speaking subtest scores overall.

We are committed to improving the scientific evidence and concordance of scores across all professions. To that end, TruMerit is exploring a long-term ELP standard-setting study specific to healthcare settings in collaboration with other stakeholders—an endeavor which has not been conducted at this scale to date for the U.S. These efforts would continue to promote patient safety in the delivery of healthcare as well as fair and equitable requirements for foreign-trained healthcare workers seeking practice in the U.S.