(UNITED STATES) Foreign nationals seeking visas to live in the United States 🇺🇸 face new hurdles under a Thursday directive from the administration of President Trump, which tells consular officers to weigh immigrants’ health conditions and age more heavily when deciding if an applicant is likely to become a public charge. The internal cable, reviewed by KFF Health News, requires officers to consider chronic diseases, the cost of care, and whether a person has enough resources to pay for treatment without help from the U.S. government.
Experts who read the guidance say it expands medical factors beyond long-standing screenings for communicable diseases and gives visa officers broader power to deny applications. Spokespeople for the State Department did not immediately comment.
Policy shift and what it means at a glance
The cable explicitly tells officers: “You must consider an applicant’s health.” It lists the following as examples of conditions that “can require hundreds of thousands of dollars’ worth of care”:
- Cardiovascular diseases
- Respiratory diseases
- Cancers
- Diabetes
- Metabolic diseases
- Neurological diseases
- Mental health conditions
The guidance also:
- Encourages a look at obesity, noting links to asthma, sleep apnea, and high blood pressure.
- Places emphasis on age.
- Focuses on whether family members’ needs could keep an applicant from working.
The central question throughout is whether the person, because of health or age, would be likely to depend on public programs — the public charge ground in immigration law and policy.
Who is affected under this visa guidance
According to Charles Wheeler, a senior attorney at the Catholic Legal Immigration Network, the guidance applies to nearly all visa applicants, but it will probably be used mainly in cases where people seek to live in the country permanently.
- Most affected: Immigrant visa seekers (people applying to live in the U.S. permanently).
- Also implicated: Spouses, children, and older parents whose health or care needs could affect the applicant’s employment.
Short-term visitors are less likely to face these long-term health-cost questions.
How health conditions now influence decisions
Medical screening has long been part of visa processing. Applicants already:
- See a doctor approved by a U.S. embassy.
- Are checked for communicable diseases (e.g., tuberculosis).
- Share vaccine history.
- Complete a medical history form covering substance use, mental health, and violent behavior.
What is different under this guidance is scope: officers and examining doctors are pushed to look beyond infection risks and assess chronic illnesses and their long-range costs.
- Sophia Genovese of Georgetown University called the reach “quite expansive,” warning that speculation about scenarios like “What if someone goes into diabetic shock?” could shape outcomes at consular interviews.
Step-by-step process: from medical exam to decision
Applicants can expect the decision flow to follow this practical sequence:
- Pre-application preparation
- Gather civil documents and schedule the required medical exam with an embassy-approved physician.
- Medical examination
- Doctor screens for communicable diseases, reviews vaccine history, and collects medical history (including drug/alcohol use, mental health, and violent behavior).
- Officer review with new focus
- Officers are instructed: “You must consider an applicant’s health.”
- They must weigh chronic illnesses (cardiovascular disease, cancer, diabetes, metabolic/neurological disorders, respiratory diseases, mental health conditions) and potential long-term costs.
- Financial capacity check
- Officers are told to ask, in substance: “Does the applicant have adequate financial resources to cover the costs of such care over his entire expected lifespan without seeking public cash assistance or long-term institutionalization at government expense?”
- Consideration of age and dependents
- Officers should consider age and whether dependents (children, older parents) with disabilities or chronic conditions might prevent the applicant from working.
- Final consular decision
- Officer decides whether the applicant is ineligible as likely to become a public charge or whether the application may proceed.
The cable’s approach appears to conflict with the State Department’s Foreign Affairs Manual, which, according to Wheeler, warns officers against denying visas based on hypothetical “what if” scenarios. Wheeler cautioned that consular staff “are not medically trained” and should not make projections based on personal bias.
Evidence applicants can prepare without guesswork
The guidance doesn’t introduce new forms, but it clarifies the kinds of evidence officers will want to see. Applicants can bring focused documentation to directly address the cable’s concerns:
- Health documentation
- Clear medical records showing diagnosed conditions and current treatment plans to prevent officer speculation.
- Proof of financial resources
- Statements or other evidence demonstrating the ability to pay for care without public assistance — directly addressing the lifetime-cost question.
- Employment plans
- Concise information about job prospects and caregiving arrangements if age or dependent care is relevant.
The guidance instructs officers to consider “what could lead to some sort of medical emergency or sort of medical costs in the future,” according to Wheeler’s reading — applicants are not required to predict emergencies themselves.
Family health and employment questions
A notable change is the explicit instruction to evaluate dependents’ health. Officers are asked whether disabilities or chronic conditions in children or older parents might require care that prevents the applicant from maintaining employment.
- This blends caregiving responsibilities with employability assessments.
- It may shape how families present care plans during interviews.
Human impact: why these questions matter
Chronic conditions are common globally:
- Diabetes affects about 10% of people in many populations.
- Heart disease is the leading cause of death.
These conditions often occur in families who otherwise meet visa requirements. By asking whether such needs could lead to heavy costs, the cable increases pressure on families to explain long-term treatment and support plans.
- Obesity is singled out because of its relationships with asthma, sleep apnea, and high blood pressure — applicants living with obesity may face more follow-up questions about condition management and potential long-term care costs.
Interview experience: what to expect
At the consular interview, applicants should expect direct, sometimes forward-looking questions tied to the cable’s examples:
- How is diabetes treated and how stable is it?
- Is a heart condition controlled?
- Is mental health care ongoing and effective?
- Who will care for a child or older parent with special needs, and how does that caregiving affect employment?
Because officers are asked to look ahead at potential costs, some questions may feel hypothetical. Wheeler reminded that the Foreign Affairs Manual discourages “what if” denials and warned against decisions based on officers’ personal knowledge or bias.
Timelines and processing pace
- The cable does not provide a timeline for how quickly health-centered reviews will be implemented or adopted at each post.
- Processing times will continue to vary by consulate.
- The guidance does not set new deadlines.
Official reference for medical exams
For official information on immigrant medical examinations, applicants can consult the U.S. Department of State’s guidance on medical exams for immigrant visa processing available at the U.S. Department of State website:
Expert concerns about discretion and consistency
Experts raised major concerns about broadened discretion:
- Wheeler said the cable encourages officers to develop “their own thoughts” about future medical crises and costs, which is troubling since consular staff aren’t medical professionals.
- Genovese noted the directive invites speculation on whether a chronic condition could suddenly worsen.
The guidance exists within a broader policy push by the administration to tighten immigration — including daily mass arrests, restrictions on refugees from certain countries, and plans to reduce the total number admitted. KFF Health News reviewed the cable; State Department spokespeople did not respond to requests for comment.
Scenario planning: how different cases may be viewed
Examples of how the guidance might be applied:
- Applicant with diabetes
- Officers may ask about treatment, medication access, and disease stability.
- Consistent management and proof of ability to pay routine care help, but long-term cost potential will still be weighed.
- Applicant with obesity and sleep apnea
- Questions on treatment and control of related conditions (e.g., high blood pressure).
- Cable notes these may require expensive, long-term care.
- Older applicant with a child who has a chronic condition
- Officers may ask who provides daily care and whether caregiving would prevent the parent from maintaining employment.
Practical steps for applicants facing health-related questions
To prepare, applicants should organize medical and financial information succinctly:
- Bring concise health records documenting current treatment plans for chronic conditions (diabetes, cardiovascular disease, etc.).
- Be ready to explain how ongoing care is arranged and paid for without government assistance.
- If caregiving for dependents is involved, explain daily routines and who helps so employment can be maintained.
Neutral summary of likely outcomes
Under this guidance, two outcomes are most likely:
- The consular officer determines the application can proceed after reviewing health and finances.
- The officer finds the person ineligible because they could become a public charge due to medical needs or age.
The cable does not describe appeals, alternatives, or introduce a new form to complete.
Why this is happening now
The directive aligns with the administration’s broader efforts to remove people living without authorization and discourage future migrants — part of policies that include refugee restrictions and proposals to lower overall admissions. Within that broader context, the cable elevates immigrants’ health conditions as a central factor in visa decisions.
One more thing to know
The cable’s list of conditions is nonexclusive. Language such as “including, but not limited to” signals officers can consider other chronic illnesses. The emphasis on discretion is the central theme that both Wheeler and Genovese flagged.
Key takeaway: The guidance increases officer discretion to consider a wide range of chronic health issues, age, and family caregiving needs when evaluating whether an applicant may become a public charge.
Where to read more before appointments
Applicants often consult plain-language visa guidance to prepare. Immigration news outlets, including VisaVerge.com, regularly track policy changes and explain what consular officers focus on, which can help applicants frame factual, direct answers during interviews.
Closing expectations for applicants and families
The guidance makes one principle unmistakable: health and age now sit at the center of many visa decisions.
- Expect detailed questions about chronic conditions, obesity-related risks, and the potential cost of care.
- Be prepared to explain how family caregiving affects employment.
- Officers will consider whether applicants can pay for treatment without turning to government programs.
As Sophia Genovese summarized, considering a person’s diabetic or heart health history is “quite expansive,” and if the change is applied immediately, it could create difficulties as people head into consular interviews.
This Article in a Nutshell
A recent internal State Department cable instructs consular officers to weigh health, age, and potential lifetime care costs more heavily when assessing immigrant visa applicants for the public-charge ground. The guidance expands review beyond communicable disease screening to include chronic illnesses such as cardiovascular disease, cancer, diabetes, neurological and mental health conditions, and obesity-related risks. Officers should consider applicants’ financial ability to cover treatment, dependents’ care needs, and whether caregiving could limit work. Experts warn the directive broadens officer discretion and could complicate permanent-residence visa approvals.
