US visa guidance: The US State Department has issued new instructions that could allow visa officers to deny entry to foreign nationals with certain long-term medical conditions, including diabetes, heart disease and obesity, because they might become a financial burden on the country.
The directive, circulated to embassies and consulates and reviewed by KFF Health News, expands how officers assess whether an applicant could be classified as a “public charge.” While health screenings have long been part of the immigration process, the new guidance broadens the list of medical issues to consider and gives officers more discretion to judge whether an applicant might require costly treatment in the future.
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The move fits into the Trump administration’s broader push to restrict immigration and tighten the criteria for those seeking to live permanently in the US. In recent years, the administration has rolled out policies aimed at lowering refugee admissions, stepping up deportations and narrowing the pathways to legal residency.
Under the latest instructions, officers are asked to look closely at an applicant’s age, medical history and likelihood of relying on public resources. “Certain medical conditions, including cardiovascular and respiratory diseases, cancers, diabetes, metabolic and neurological disorders, and mental health conditions, can require extensive, long-term care,” the cable states. The guidance also singles out obesity because of its links to complications such as asthma, hypertension and sleep apnea.
The State Department also directs officers to assess whether applicants have the financial means to manage chronic illnesses without turning to government assistance.
Applicants’ family members may also come under scrutiny. Officers are instructed to consider whether dependents, such as children or elderly parents, have conditions that might limit an applicant’s ability to work and support themselves.
People applying for immigrant visas already undergo mandatory medical checks conducted by US-approved physicians. Those exams focus mainly on communicable diseases such as tuberculosis, vaccination records and disclosures related to mental health or substance use. The new instructions go much further, placing chronic illness at the centre of the evaluation.
The State Department has not commented publicly on the directive.
