New Trump administration directive lets consular officers deny visas to immigrants with chronic illnesses seen as likely to require costly US medical care.
The United States has on Friday November 7, 2025, issued new visa guidance allowing immigration officials to deny entry to applicants with chronic illnesses that could lead to high long-term medical expenses. The directive, introduced by the Trump administration, significantly broadens the criteria for visa denial under the existing “public charge” rule.
According to a State Department cable obtained by KFF Health News, consular officers are now instructed to consider an applicant’s long-term health outlook and potential medical costs when deciding whether to grant a visa. The rule applies not only to communicable diseases but also to non-communicable conditions such as diabetes, cardiovascular disease, obesity, certain cancers, neurological disorders, and mental health issues.
Officials say the move aims to reduce the financial burden on the US healthcare system and ensure that immigrants can support themselves without relying on public assistance. “The Trump administration has brought an end to the era of mass immigration,” a State Department official told Fox News, describing the measure as a correction to what they called the “open borders agenda” of the previous government.
The updated guidance expands the long-standing “public charge” doctrine, historically used to deny visas to people likely to depend on government support. Now, officers can assess whether an applicant or their dependents may require extensive or costly medical treatment in the future.
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Applicants must demonstrate that they have adequate private resources or insurance to cover any foreseeable medical needs. Those unable to do so could be deemed ineligible for entry.
Immigration lawyers have voiced concerns that the directive grants excessive discretion to consular officers, many of whom lack medical training. Charles Wheeler of the Catholic Legal Immigration Network said the rule appears to “contradict the Foreign Affairs Manual,” which discourages visa denials based on speculative health scenarios.
Sophia Genovese, an immigration attorney at Georgetown University, warned that the new approach could create “a myriad of issues” for applicants during consular interviews, as officials may now ask more probing questions about lifetime medical costs.
Applicants will still be required to complete mandatory health screenings conducted by US-approved physicians, but those examinations are now expected to include broader inquiries into chronic illnesses and mental health conditions.
The policy marks a major shift in how the United States screens potential immigrants—moving from assessing immediate health risks to projecting long-term financial implications of care.