The landscape of U.S. immigration has grown significantly more complex for visa applicants following a recent directive from the Trump administration. As reported by CBS News and KFF Health News, the State Department has issued new guidance to embassy and consular officials that vastly expands the scope of medical conditions considered grounds for denying a visa under the “public charge” rule.

This directive marks a worrying escalation in the use of public charge grounds to restrict legal immigration, potentially impacting millions of aspiring immigrants and their families. At Cohen, Tucker + Ades, we are closely tracking these developments to ensure our clients are prepared for this new level of scrutiny.

What Is the New Guidance?

The core of the issue lies in the interpretation of whether an applicant is likely to become a “public charge”—meaning, dependent on certain government benefits—because of their health status. While medical examinations have always been part of the visa process to screen for communicable diseases (like tuberculosis), this new guidance casts a far wider net.

The directive explicitly instructs visa officers to consider a broad list of chronic health conditions as factors that could render an applicant ineligible. These conditions include:

• Diabetes

• Obesity

• Cardiovascular Diseases

• Respiratory Diseases

• Cancers

• Metabolic and Neurological Diseases

• Mental Health Conditions

According to the cable sent to consular posts, these conditions are highlighted because they “can require hundreds of thousands of dollars’ worth of care” over an individual’s lifetime.

The Dangerous Expansion of Consular Power

Legal experts are raising serious concerns about the sweeping and subjective authority this guidance grants to visa officers.

The directive requires officers to develop “their own thoughts” and make projections about an applicant’s future health needs and their potential cost over their “entire expected lifespan.” Furthermore, officers are directed to assess whether the applicant (or their dependents) have disabilities, chronic conditions, or special needs that could interfere with the applicant’s ability to maintain employment.

This level of speculation is troubling for several reasons:

1. Lack of Medical Training: Visa officers are not medical professionals. Asking them to project the “entire expected lifespan” costs of managing conditions like diabetes or obesity is a highly subjective exercise prone to personal bias and error.

2. Contradiction with Existing Rules: The guidance appears to conflict with the State Department’s own Foreign Affairs Manual, which generally cautions against rejecting applications based on hypothetical “what if” scenarios.

3. Punishing Common Conditions: By targeting conditions as common as diabetes and obesity, the U.S. is effectively attempting to bar large segments of the world’s population from legal immigration, regardless of their education, skills, or personal resources.

This policy shift transforms the medical exam from a public health measure into a financial gatekeeping tool, making the path to permanent residency significantly harder for anyone with a chronic illness.

How Cohen, Tucker + Ades Can Help

The increased emphasis on health and financial capacity means that applicants for immigrant visas must prepare a robust and comprehensive defense against potential public charge findings.

If you or a family member is seeking a U.S. immigrant visa and has a chronic health condition, you must be proactive. Our firm advises clients on how to best demonstrate they will not become a public charge, even with a pre-existing medical condition, by compiling compelling evidence of:

• Financial Sufficiency: Documentation of substantial assets, employment, and income.

• Private Healthcare Coverage: Evidence of existing or guaranteed access to private, comprehensive health insurance in the U.S. or abroad.

• Affidavits of Support (Form I-864): Ensuring the petitioning sponsor’s Affidavit of Support is as robust as possible.

• Detailed Medical Management Plans: Presenting plans that show how a condition is currently managed, its low risk of acute emergency, and the applicant’s ability to afford necessary care without recourse to public assistance.

Do not allow a manageable health condition to derail your dream of immigrating to the United States. If you are concerned about how this new, expanded public charge guidance may affect your visa application or that of a loved one, contact the experienced immigration attorneys at Cohen, Tucker + Ades today for a confidential consultation. We are ready to defend your case and navigate this challenging new policy environment.