New State Department guidance allows visa officers to reject applicants with chronic conditions such as diabetes, obesity, or heart disease, citing potential public costs.
The Trump administration has issued new guidance that could allow U.S. visa officers to deny entry to foreign applicants with certain medical conditions, including diabetes, obesity, or cardiovascular disease, citing concerns that such individuals could become a “public charge” and strain U.S. resources.
The directive, outlined in a State Department cable sent to U.S. embassies and consulates and obtained by KFF Health News, instructs visa officers to consider a broader range of chronic and costly medical conditions when evaluating applicants.
“You must consider an applicant’s health,” the cable states. “Certain medical conditions — including cardiovascular diseases, respiratory diseases, cancers, diabetes, metabolic diseases, neurological diseases, and mental health conditions — can require hundreds of thousands of dollars’ worth of care.”
The cable further advises consular officials to weigh whether applicants have adequate financial means to cover lifelong medical expenses without relying on U.S. public assistance programs.
“Does the applicant have adequate financial resources to cover the costs of such care over his entire expected lifespan?” the guidance asks.
While immigration applicants have long been screened for communicable diseases like tuberculosis and must show proof of vaccinations, experts say the new rules dramatically expand how health can influence visa eligibility.
“This is troubling because visa officers are not medically trained,” said Charles Wheeler, a senior attorney with the Catholic Legal Immigration Network. “They shouldn’t be making projections about future medical emergencies based on personal judgment or bias.”
The guidance also allows officials to factor in the health of family members, including dependents with disabilities or chronic illnesses, when assessing whether an applicant can maintain employment or might require public aid.
Immigration lawyers warn that the directive could disproportionately impact older applicants or those from countries with higher rates of chronic illness.
“Taking into consideration one’s diabetic or heart health history — that’s quite expansive,” said Sophia Genovese, an immigration attorney at Georgetown University.
Critics argue the measure is part of the administration’s broader effort to tighten U.S. immigration policies, discourage legal immigration, and increase the power of consular officers to make subjective judgments.
The State Department has not yet commented publicly on the cable.
