In a new directive from the Trump administration, shared with embassy and consular staff and reviewed by KFF Health News, visa officers are instructed to deny entry to applicants based on various new factors, such as age or the likelihood of relying on public services.
The directive indicates that these individuals may be considered a ‘public charge’ — a potential strain on US resources — due to health problems or advanced age. The updated criteria demand that the health of immigrants be given priority throughout the application procedure.
Experts note that these new guidelines greatly expand the list of medical conditions that must be considered and grant visa officers increased authority to evaluate immigration applications based on an individual’s health status. This evaluation has traditionally included screening for communicable diseases like tuberculosis and reviewing vaccine history.
The cable states, “You must consider an applicant’s health. Certain medical conditions – including, but not limited to, cardiovascular diseases, respiratory diseases, cancers, diabetes, metabolic diseases, neurological diseases, and mental health disorders – can necessitate hundreds of thousands of dollars in care.”
It also encourages visa officials to consider other issues, such as obesity, which can lead to asthma, sleep apnea, and high blood pressure, when assessing whether an immigrant might become a public charge and potentially be denied entry. “All of these can incur costly, long-term care,” it further noted.
Visa officers were additionally directed to assess if applicants have the means to pay for medical expenses without relying on US governmental aid. “Does the applicant possess sufficient financial resources to manage the costs of such care over their expected lifespan without requiring public cash assistance or long-term institutionalization at government expense?” the cable outlined.
As reported by Charles Wheeler, a senior attorney for the Catholic Legal Immigration Network, a non-profit legal aid organization, these guidelines pertain to nearly all applicants but are likely applied primarily in cases where individuals seek permanent residence in the country.
Wheeler also mentioned that officials are urged to formulate “their own assessments regarding potential medical emergencies or expenses in the future.”
Furthermore, the guidelines instruct visa officials to evaluate the health status of family members, such as children and elderly dependents. “Do any of the dependents have disabilities, chronic medical conditions, or other special needs requiring care that the applicant cannot sustain through employment?” the cable queries.
Immigrants are already required to undergo a medical examination conducted by a physician approved by the US embassy. They are screened for communicable diseases like tuberculosis and must complete a questionnaire detailing any history of substance use, mental health concerns, or violent behavior.
Sophia Genovese, an immigration attorney at Georgetown University, remarked that the new guidance goes further by emphasizing the management of chronic conditions. She noted that the directive’s language encourages officers and medical professionals assessing applicants to speculate on the costs associated with their medical care and their ability to find employment in the US.
