The State Department has quietly circulated new instructions to consular sections world-wide directing officers to weigh an applicant’s current medical conditions and their ability to pay for care when deciding whether to issue a visa. The cable, dated November 7 and confirmed by several posts, took effect on November 8, 2025 and applies to all non-immigrant and immigrant visa categories.
Under long-standing rules, applicants must already show that they are not likely to become a “public charge.” The new guidance, however, expands that finding beyond communicable diseases to a far broader list of chronic conditions—including diabetes, heart disease, obesity, cancer and certain mental-health diagnoses. Officers are now permitted to request additional documentation such as recent laboratory results, proof of insurance valid in the United States, or evidence of sufficient personal funds to cover lifetime treatment.
![U.S. visa officers told to scrutinize applicants’ health and finances]()
Practitioners say the policy marks the first time that routine, non-communicable illnesses have been singled out as potential grounds for refusal. Business immigration attorneys are warning corporate mobility teams to build extra time into assignment planning, particularly for older assignees and dependent family members. Several multinational companies have already begun requiring pre-assignment medical screenings and enhanced insurance coverage to avoid last-minute visa denials.
For health-care providers and insurers, the directive could create new demand for portable, employer-sponsored international medical plans. Conversely, critics argue that it hands untrained visa officers too much discretion and risks discriminatory outcomes—especially toward applicants from developing countries where treatment records are harder to verify.
In the short term, companies should expect longer administrative processing and be prepared to demonstrate that an employee’s compensation package will fully cover anticipated medical costs. Mobility managers are also advised to alert traveling executives who rely on the Visa Waiver / ESTA program that they, too, could face secondary questioning on arrival about chronic medical issues and proof of coverage.
Under long-standing rules, applicants must already show that they are not likely to become a “public charge.” The new guidance, however, expands that finding beyond communicable diseases to a far broader list of chronic conditions—including diabetes, heart disease, obesity, cancer and certain mental-health diagnoses. Officers are now permitted to request additional documentation such as recent laboratory results, proof of insurance valid in the United States, or evidence of sufficient personal funds to cover lifetime treatment.
Practitioners say the policy marks the first time that routine, non-communicable illnesses have been singled out as potential grounds for refusal. Business immigration attorneys are warning corporate mobility teams to build extra time into assignment planning, particularly for older assignees and dependent family members. Several multinational companies have already begun requiring pre-assignment medical screenings and enhanced insurance coverage to avoid last-minute visa denials.
For health-care providers and insurers, the directive could create new demand for portable, employer-sponsored international medical plans. Conversely, critics argue that it hands untrained visa officers too much discretion and risks discriminatory outcomes—especially toward applicants from developing countries where treatment records are harder to verify.
In the short term, companies should expect longer administrative processing and be prepared to demonstrate that an employee’s compensation package will fully cover anticipated medical costs. Mobility managers are also advised to alert traveling executives who rely on the Visa Waiver / ESTA program that they, too, could face secondary questioning on arrival about chronic medical issues and proof of coverage.
