Under a fresh policy from the Trump administration, foreign nationals dealing with medical conditions such as diabetes, obesity, or other chronic illnesses may face denial of US visas or permanent residency, according to a new government directive. The State Department has circulated these instructions to American embassies across the globe, KFF Health News reported. While the rules technically cover all visa categories, immigration experts say they will have the greatest impact on applicants seeking long-term or permanent residence in the United States.

The internal cable tells consular officers to identify applicants whose health profiles—ranging from heart disease and cancer to metabolic disorders, neurological issues, mental health conditions, and obesity—could potentially generate “hundreds of thousands of dollars” in medical expenses. Such individuals may be classified as potential “public charges,” meaning they could rely on government-funded care.

According to Charles Wheeler of the Catholic Legal Immigration Network, the directive is expected to play a major role in green-card assessments. He noted that the definition of a public charge is being broadened to include a wide range of chronic illnesses, some of which have not historically led to visa rejections.

The cable also asks visa officers to consider related health complications associated with obesity—such as sleep apnea, hypertension, and asthma—when determining whether an applicant might become financially dependent on the state. “These conditions can require costly, long-term treatment,” the guidance states.

Since President Trump began his second term, his administration has rolled out strict immigration actions aimed at tightening the entry of foreign workers and long-term residents. Earlier measures included increases in H-1B visa fees and heightened scrutiny for green-card holders applying for US citizenship, moves that are expected to significantly affect Indian applicants.

CAN HEALTH ISSUES LEAD TO VISA DENIAL?

As part of the expanded review, visa officers are now instructed to assess whether applicants can personally afford future medical expenses without relying on government assistance. Officers are directed to ask whether the applicant has sufficient financial resources to manage expected medical needs “over their entire lifetime” without depending on public cash benefits or government-funded long-term care.

Wheeler expressed concern over this requirement, pointing out that consular officials lack medical expertise. “They’re being told to make predictions about future medical risks or expenses even though they are not trained to do so. That opens the door to subjective decisions and potential bias,” he told KFF Health News.

FAMILY MEMBERS’ HEALTH ALSO UNDER SCRUTINY

The assessment will not be limited to the applicant alone. Visa officers have also been asked to evaluate the medical needs of accompanying family members, including children or elderly dependents. The cable raises questions about whether caring for a dependent with chronic illness or disabilities might prevent an applicant from maintaining stable employment.

While immigrants already undergo mandatory medical examinations—covering infectious diseases, mental health history, substance use, and required vaccinations—the new directive pushes evaluators to go beyond communicable illnesses. Georgetown University immigration attorney Sophia Genovese noted that the cable encourages both doctors and visa officers to speculate on long-term medical costs and a person’s employability based on their chronic health conditions.

According to KFF, this marks a significant shift in how medical history may influence visa decisions, potentially creating new barriers for individuals with long-term health conditions seeking to live in the United States.