The State Department has confirmed a new directive allowing consular officers to deny immigrant visas to applicants with medical conditions that could lead to significant public expenses.
The Hill reported that the policy instructs officers to weigh whether an applicant’s health might make them more likely to depend on government-funded care or long-term assistance once in the United States.
Outlined in an internal cable sent to department personnel, the guidance tells officers to evaluate an applicant’s overall health and financial situation before deciding on a visa.
Much of the process is not new. The State Department has a comprehensive list of medical-related issues posted online that could impact a visa request.
“Certain medical conditions, including, but not limited to, 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 states.
It asks officers to determine whether the applicant has the means to pay for such treatment “over his entire expected lifespan without seeking public cash assistance or long-term institutionalization at government expense.”
The directive echoes elements of the “public charge” rule introduced during the first Trump administration, which denied green cards to immigrants who received benefits such as Medicaid, food stamps, or housing aid for extended periods.
“It’s no secret the Trump administration is putting the interests of the American people first,” principal deputy spokesman Tommy Pigott said in a statement. “This includes enforcing policies that ensure our immigration system is not a burden on the American taxpayer.”
Applicants for immigrant visas are already required to undergo medical examinations, but the new order expands the review process.
Officers are now instructed to form “their own thoughts about what could lead to some sort of medical emergency or medical costs in the future,” according to the cable.
A State Department official told The Hill that officers retain discretion in every case, emphasizing that no one will be automatically rejected based solely on a diagnosis.
Instead, officers will assess “the overall impact” of whether an applicant can pay for necessary treatment without public aid.
For example, a diabetic would not be denied solely for needing insulin, but could be if they would likely depend on Medicaid to obtain it.
Officials say the change protects public resources while ensuring the immigration system supports applicants who can sustain themselves financially.
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