The US Lowered Every Score Except Speaking

Governments usually revise a requirement in one direction. This one went both ways at once, and the split is the story.

Overall scores fell. Speaking scores rose. Two tests were removed. Same revision, same day.

SpeakShark is free for the only column that went up, three AI conversation sessions a day with no card.

In this guide: the comparison · Cambridge · PTE · removed · therapists · why · which list · limits · method · FAQ

Key takeaways

• Cambridge: overall 176 to 169, speaking 185 to 194, in one revision.
• PTE: overall unchanged at 55, speaking floor 50 to 76.
• MET: overall 55 to 58, speaking 55 to 59.
• TOEIC and paper TOEFL left the list.
• Therapists gained four accepted tests they previously could not use.

Before and after

Both lists are published on the same HRSA page. This is the column for registered nurses and other bachelor's level health care workers.

The TOEFL row changed scale rather than direction, because ETS moved to a 1 to 6 band system on 21 January 2026, which we cover in TOEFL's new 1 to 6 scale.

Cambridge, down 7, up 9

The clearest single illustration is the Cambridge row, because both numbers are on the same scale and both moved.

A candidate who would have been rejected under the old rules for an overall of 172 now passes on that number. A candidate who scraped through on a speaking score of 186 would now fail.

The gap between the two requirements widened from 9 points to 25.

PTE speaking went 50 to 76

The Pearson row is the most dramatic, and it is easy to miss because the headline number did not move.

Previously PTE was 55, no section below 50. So the speaking requirement was 50, the same as everything else.

Now it is 55 overall, 76 speaking, 62 in reading, writing and listening.

The overall is identical. The speaking floor rose by 26 points, and it now sits 21 points above the overall a candidate is being asked for.

There is an intermediate step worth knowing about. TruMerit's VisaScreen page states that effective 1 December 2024 it required PTE applicants to reach 63 in speaking, with the overall of 55 and the 50 floor on other sections unchanged. That note still sits on the page alongside the new list. If PTE is your route, the safe move is to plan for 76 and confirm with the certifying body, which we flag in every US healthcare English test now ranks speaking highest.

Two tests left the list

TOEIC appeared twice on the old table, once for listening and reading and once for speaking and writing. It appears nowhere on the new one.

TruMerit is explicit about the consequence: it will no longer accept TOEIC for VisaScreen certification after the 12 May implementation date, because the test is no longer listed by HRSA as an approved exam.

The paper-delivered TOEFL is also gone, having previously carried its own scores of 560, 540 and 530 across the three professional levels.

An exam being removed from a government list is a different event from a score changing, and it is not reversible by studying harder. We cover what that means for candidates holding one in TOEIC is no longer accepted for US healthcare visas.

Therapists gained four options

This change runs the other way and is genuinely good news for one group.

Under the previous list, the column for occupational and physical therapists read not applicable for IELTS, the Michigan English Test, OET and PTE. TOEIC listening and reading was marked no. In practice a therapist had Cambridge or TOEFL and nothing else.

The updated list gives therapists a score on all six accepted tests.

Their Cambridge requirement also fell sharply, from 185 overall to 169 overall, while their speaking minimum rose from 185 to 194 like everybody else's.

So a therapist gained four test options and a lower overall bar, and a higher speaking bar, in the same revision.

Why it moved this way

TruMerit describes the process leading up to it, and the account matches the table.

It states that in January 2025 it hosted a convening for all USCIS-recognised English language proficiency test publishers to discuss how equivalency among the minimum required scores could be better established between the exams. Recommendations were submitted to HRSA, a formal position statement was published in July 2025, an amendment followed in August 2025 after new concordance information became available, and a further statement in January 2026 addressed TOEFL's new scoring system.

The description of what those recommendations focused on is the sentence that explains the whole table:

They 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 emphasised implementing a speaking subtest score for exams that previously lacked one, as well as strengthening the minimum required speaking subtest scores overall.

Two things follow. The mixed direction of the overall scores was the point, because the goal was equivalence between exams rather than a uniform tightening. And the speaking increase was the separate objective laid on top of it.

HRSA also states it relied on information obtained following requests for comments published in the Federal Register in May 2019 and November 2024.

Which list applies to you

Dated rather than graded, and the rule is simple.

• Exams taken before 12 May 2026: certified against the previous criteria.
• Exams taken on or after 12 May 2026: certified against the new criteria.

The previous list remains published on the HRSA page, which is unusually helpful, because a candidate with a two year old certificate can read the rules that actually apply to it.

That contrasts with the transition designs elsewhere in this series. When LanguageCert replaced a product in July 2025 the Home Office published a two year window for existing certificates, covered in English certificates that expire. Here there is no window: the exam date decides which table you are read against, permanently.

What to do with this

• Find your exam date first. It decides which table applies.
• If you are booking now, use the new numbers, and treat speaking as the binding one.
• Do not book TOEIC or paper TOEFL for this purpose.
• If you are a therapist, recheck your options. Four more tests are open than were.
• If you are using PTE, confirm the speaking figure before booking.

The direction of travel is not ambiguous. Overall requirements are being tuned for equivalence between exams; the speaking requirement is being raised on purpose, and speaking is the skill that does not improve by reading quietly. Role play scenarios and a daily speaking partner are the practical routes, speaking practice for nurses covers the clinical register, and testing your speaking level free shows where you stand. CEFR levels for speaking explains the scale, MET for US nurse licensure covers the state boards, and Cambridge speaking criteria by level shows how speaking is actually marked.

What we could not verify

We did not read the Federal Register comment rounds. HRSA cites requests for comments from May 2019 and November 2024, which we have not read.

We did not read TruMerit's position statement or its amendment. We have used its published summary of what they recommended.

We did not resolve the PTE discrepancy. Two published pages give 63 and 76 for the same section, and we have flagged it rather than choosing.

We did not verify the concordance claims. Whether the revised numbers are genuinely equivalent across exams is a psychometric question we cannot answer from a table.

We did not check how the removal of TOEIC affects existing certificate holders beyond the dated rule.

This is not immigration or licensing advice. It is a comparison of two published federal tables, linked below.

How we researched this guide

The comparison exists because HRSA publishes the old list underneath the new one, which almost nobody does.

That is the whole method here. A single table tells you what the rule is. Two tables on the same page, in the same format, tell you what the rule-setter was trying to achieve, and the direction of travel is worth more to a candidate planning a year ahead than either table alone.

Reading them column by column rather than row by row is what makes the pattern legible. Row by row, some numbers went up and some went down and it looks like tidying. Column by column, every overall figure fell or held and almost every speaking figure rose.

We then looked for a stated intention rather than assuming one, and found it in the certifying body's own account: the recommendations emphasised implementing and strengthening speaking subtest scores. The words and the arithmetic agree, which is the point at which an observation becomes a finding.

The therapist column we nearly missed, because it is the one furthest from most readers. Four cells that previously read not applicable now carry numbers, and that is a larger change for that group than any score movement.

Practise speaking, from SpeakShark

SpeakShark is an AI English speaking practice app, and this revision is the clearest external signal we have seen about where these requirements are heading.

When a government has the opportunity to revise a whole table and lowers overall scores while raising speaking scores, that is not a rounding decision. It is a view about which skill keeps patients safe.

You talk, the AI answers what you actually said, and you get speaking feedback while the conversation is still running. The free tier gives basic feedback; the detailed pronunciation and grammar breakdown is on Premium.

Being straight about the limits: a free session runs five minutes with four turns, we issue no certificates, and nothing here is recognised by HRSA, TruMerit or any exam board.

Start free with three sessions a day and no card. Paid sessions run ten minutes with unlimited turns. Limits are on the pricing page, and how it works walks through a session. Sign up here if speaking is the requirement that went up.

We are a speaking improvement tool. We are not an exam preparation provider, and we are not affiliated with Cambridge English, the IELTS partners, Pearson or any exam board. For test format, booking and official practice material, go to the exam body directly. Use SpeakShark to make your spoken English stronger, and use official material to learn the test.

• Site: speakshark.com
• Support: speaksharksupport@gmail.com
• Free tier: 3 AI conversation sessions per day, no card

Sources

• HRSA, updated list of tests and scores for foreign health care workers as of 12 May 2026: both the updated table and the previous list covering 24 May 2022 to 12 May 2026, including the Cambridge, TOEFL, TOEIC, IELTS, MET, OET and PTE rows across all three professional level columns, and the reliance on Federal Register comment requests in May 2019 and November 2024
• TruMerit, updated ELP exams and score requirements by HRSA: the 12 May 2026 effective date and the exam date rule, the removal of TOEIC, the January 2025 convening of test publishers, the July 2025 position statement, the August 2025 amendment and the January 2026 statement on TOEFL scoring, and the description of recommendations emphasising implementing and strengthening speaking subtest scores
• TruMerit, VisaScreen visa credentials assessment: the December 2024 PTE speaking note of 63 with the overall of 55 and 50 floor unchanged
• ETS, understand your TOEFL iBT scores: the 21 January 2026 move to a 1 to 6 band scale that the TOEFL row reflects

FAQ