TOEIC Is No Longer Accepted for US Healthcare Visas

Scores change all the time. This is a different kind of event.

TOEIC is not on the federal list any more, and there is no score on it that fixes that.

SpeakShark is free for the skill every remaining test now ranks first, three AI conversation sessions a day with no card.

In this guide: what happened · what it used to require · the date rule · why · the four skill problem · what to do instead · the general lesson · limits · method · FAQ

Key takeaways

• TOEIC appears nowhere on the list published as of 12 May 2026.
• It previously appeared twice, as two separate products.
• Exams taken before that date are still read against the old criteria.
• The paper-delivered TOEFL went at the same time.
• Six tests remain, and speaking is the highest bar on all six.

What happened

HRSA published an updated list of tests and scores for foreign health care workers as of 12 May 2026. TOEIC is not on it.

TruMerit, the body that issues VisaScreen certification, states the consequence directly: it will no longer accept the Test of English for International Communication for VisaScreen certification after the 12 May implementation date, as this test is no longer listed by HRSA as an approved exam.

That is worth separating from every other change in that revision. Scores moved on the remaining tests, some up and some down, and we work through those in the US lowered every score except speaking. A score you can prepare for. A removal you cannot.

What TOEIC used to require

On the previous list, covering 24 May 2022 to 12 May 2026, TOEIC occupied two rows.

Two things stand out even before the removal.

Therapists could not use it at all, which was true of several tests on that older list. And the two products are separate: one covers listening and reading, the other covers speaking and writing.

The rule is dated, not graded

The transition here is unusually clean, and unusually unforgiving.

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

So a TOEIC sat in March 2026 is read against a table that includes TOEIC. A TOEIC sat in June 2026 is read against a table that does not, whatever the score.

There is no grandfathering window of the kind the UK Home Office published when LanguageCert replaced a product in July 2025, giving existing certificate holders two years, which we cover in English certificates that expire. Here the exam date is the whole rule.

Ordinary validity limits still sit on top of that, so an old TOEIC being readable against the old table does not make it usable indefinitely.

Why a test gets removed

HRSA does not publish a reason on the table itself, and we are not going to invent one. What we can do is set out what is visible.

The revision that removed TOEIC came out of a process TruMerit describes: a convening of all recognised test publishers in January 2025 to discuss how equivalency among the minimum required scores could be better established, recommendations submitted to HRSA, a position statement in July 2025, an amendment in August 2025 after new concordance information, and a further statement in January 2026 about TOEFL's new scoring system.

Its summary of what those recommendations focused on is the useful part. They called for increases in some exams, decreases in others and no change in others, and they emphasised implementing a speaking subtest score for exams that previously lacked one, as well as strengthening the minimum required speaking subtest scores overall.

Read the TOEIC rows again against that sentence, and one structural feature is hard to ignore.

The two product problem

TOEIC listening and reading contains no speaking section. TOEIC speaking and writing is a separate purchase.

So under the old list, a candidate covering all four skills through TOEIC was sitting two exams from the same provider and combining the results, where every other route was one exam.

That is a genuinely different shape of evidence, and other regulators have taken positions on it. The UK nursing regulator publishes six criteria a test must satisfy before it will consider accepting it, and one of them is that the test must assess reading, writing, speaking and listening, covered in the NMC wants speaking marked by a person. A two-product arrangement does not obviously satisfy a single-test criterion of that kind.

We are pointing at a feature, not asserting a cause. HRSA has not said why TOEIC came off, and a plausible explanation is not evidence.

What to take instead

Six tests remain on the updated list:

• Cambridge B2 First, C1 Advanced or C2
• TOEFL internet-based test
• IELTS
• Michigan English Test
• Occupational English Test
• Pearson PTE

Every one of them sets speaking as the highest requirement in its row, which is the single most useful thing to know before choosing between them. We set out the full table in every US healthcare English test now ranks speaking highest.

Two practical notes on choosing. OET is healthcare-specific and its scores here are given as four sub-test numbers rather than an overall. PTE carries the widest gap between overall and speaking on the list, at 55 against 76, and it also carries a published discrepancy we flag in the same guide.

Whichever you pick, the binding number is a spoken one, 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, the nine professions Section 343 covers sets out who this applies to, and TOEFL's new 1 to 6 scale explains the bands in the TOEFL row. For how examiners mark spoken English, Cambridge speaking criteria by level works from real scored candidates.

A list is not a fact about quality

Worth saying plainly, because a removal invites the wrong conclusion.

A test coming off a government list is a statement about what that government will read, not a verdict on the instrument. TOEIC remains widely used by employers and institutions elsewhere, and nothing here says otherwise.

The same logic runs in the other direction across this whole series. EF SET is free and CEFR aligned and appears on no immigration list, covered in what a free test buys you. The Oxford Test of English is modular and permanent and is not a Secure English Language Test, covered in modular and permanent. Being off a list and being weak are different things.

What matters to a candidate is narrower and harsher: only the list counts, and the list changed.

What we could not verify

HRSA publishes no reason for the removal. Our observation about the two-product structure is a feature we noticed, not a cause anybody has stated.

We did not check whether ETS has changed the TOEIC products. The removal is from the federal list; what the provider has done is a separate question.

We did not verify whether the paper TOEFL still exists. It left the list; whether it left because the product was retired is not something we established.

We did not check other US uses of TOEIC. This is the healthcare visa screening list only.

We did not test how the date rule interacts with validity limits. Both apply and we have not seen a worked example.

This is not immigration or licensing advice. It is a reading of a published federal table and a certifying body's statement, both linked below.

How we researched this guide

The removal is invisible if you read the new list on its own. Nothing on a table announces what used to be on it.

It is visible because HRSA keeps the previous list published underneath the current one, on the same page, in the same format. Comparing the two rows by row is a five minute job and it is the only way to see that two entries disappeared.

That is the method worth taking away. When a body publishes a superseded version alongside a current one, the diff is usually more informative than either document, and almost nobody reads it, because the old one looks like archive material.

We then went looking for a stated reason and did not find one, which is where the discipline matters. The two-product structure is a real feature of TOEIC and it sits awkwardly beside a four-skill expectation, and that is still not a reason anybody has given. It is in the body as an observation and in the limits as an unknown.

Practise speaking, from SpeakShark

SpeakShark is an AI English speaking practice app, and if you are reading this because your certificate just stopped counting, the practical position is unfortunately simple.

You are sitting one of six remaining tests, and on every one of them the speaking number is the highest thing in the row. That is where the preparation goes.

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 on anybody's approved list either.

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 you are starting a new test from scratch.

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

• TruMerit, updated ELP exams and score requirements by HRSA: the statement that TOEIC will no longer be accepted for VisaScreen certification after the 12 May implementation date because it is no longer listed by HRSA as an approved exam, the rule that exams taken before that date are certified against the previous criteria, and the account of the January 2025 convening, the July 2025 position statement, the August 2025 amendment and the January 2026 statement on TOEFL scoring
• HRSA, updated list of tests and scores for foreign health care workers as of 12 May 2026: the current six-test table and the previous list covering 24 May 2022 to 12 May 2026 including the two TOEIC rows and the paper-delivered TOEFL scores
• NMC, accepted English language tests: the published criterion that an accepted test must assess reading, writing, speaking and listening, used as a comparison rather than as an explanation
• TruMerit, VisaScreen visa credentials assessment: the current accepted exam list and the refusal of at-home versions

FAQ