The U.S. Department of State has quietly re-written a core section of its Foreign Affairs Manual, instructing consular officers to treat a much wider range of medical conditions as potential grounds for refusing a visa under the long-standing “public-charge” test.
For decades, visa medical exams focused almost exclusively on communicable diseases such as tuberculosis and on verifying vaccination records. The new policy, disclosed this week in a State-Department cable obtained by health-policy reporters and first highlighted by Times of India, directs panel physicians and consular staff to make forward-looking judgments about whether an applicant’s condition could create “substantial long-term costs” to U.S. public resources. Obesity, diabetes, heart disease, metastatic cancers, serious mental-health disorders, and any illness “likely to require chronic institutional care” are explicitly listed as red-flag conditions.
Practically, the change gives individual visa officers wider discretion to demand additional financial guarantees, deny visas outright, or place applicants in administrative processing until they can prove private health-insurance coverage that will follow them into the United States. Attorneys say even short-term non-immigrant applicants—including business travelers and international students—could be caught by the new language if consular posts interpret it strictly. Because the policy is framed as an interpretation of existing Immigration and Nationality Act §212(a)(4), it takes immediate effect and does not require a notice-and-comment rulemaking period.
![U.S. tightens visa rules: obesity and other chronic health issues now grounds for denial]()
Corporate mobility managers are already advising traveling employees to travel with evidence of private insurance coverage, proof of ability to pay medical expenses, and, where possible, letters from physicians demonstrating that a condition is well controlled. Universities that sponsor large numbers of F-1 students are preparing webinars to explain the new criteria and warn students that routine ailments noted during a panel-physician exam could now trigger additional scrutiny.
The broader “public-charge” doctrine itself is not new—attempts to toughen health-based inadmissibility surfaced during previous administrations but were never implemented on this scale. Health-policy analysts warn that the measure could disproportionately affect applicants from countries with high obesity and diabetes prevalence, potentially souring bilateral relations. Questions also remain about how the directive squares with existing anti-discrimination provisions in U.S. law and international disability conventions.
In the short term, the policy is likely to lengthen medical exam backlogs and increase visa-refusal rates. Long term, multinational employers may need to build higher contingency budgets for supplemental insurance or be prepared to shift projects to third countries if critical talent cannot clear U.S. medical screening. Visa applicants already in process should monitor consular websites daily; re-submission of updated medical forms (DS-2054/DS-3025) may be required before an interview can be scheduled or finalized.
For decades, visa medical exams focused almost exclusively on communicable diseases such as tuberculosis and on verifying vaccination records. The new policy, disclosed this week in a State-Department cable obtained by health-policy reporters and first highlighted by Times of India, directs panel physicians and consular staff to make forward-looking judgments about whether an applicant’s condition could create “substantial long-term costs” to U.S. public resources. Obesity, diabetes, heart disease, metastatic cancers, serious mental-health disorders, and any illness “likely to require chronic institutional care” are explicitly listed as red-flag conditions.
Practically, the change gives individual visa officers wider discretion to demand additional financial guarantees, deny visas outright, or place applicants in administrative processing until they can prove private health-insurance coverage that will follow them into the United States. Attorneys say even short-term non-immigrant applicants—including business travelers and international students—could be caught by the new language if consular posts interpret it strictly. Because the policy is framed as an interpretation of existing Immigration and Nationality Act §212(a)(4), it takes immediate effect and does not require a notice-and-comment rulemaking period.
Corporate mobility managers are already advising traveling employees to travel with evidence of private insurance coverage, proof of ability to pay medical expenses, and, where possible, letters from physicians demonstrating that a condition is well controlled. Universities that sponsor large numbers of F-1 students are preparing webinars to explain the new criteria and warn students that routine ailments noted during a panel-physician exam could now trigger additional scrutiny.
The broader “public-charge” doctrine itself is not new—attempts to toughen health-based inadmissibility surfaced during previous administrations but were never implemented on this scale. Health-policy analysts warn that the measure could disproportionately affect applicants from countries with high obesity and diabetes prevalence, potentially souring bilateral relations. Questions also remain about how the directive squares with existing anti-discrimination provisions in U.S. law and international disability conventions.
In the short term, the policy is likely to lengthen medical exam backlogs and increase visa-refusal rates. Long term, multinational employers may need to build higher contingency budgets for supplemental insurance or be prepared to shift projects to third countries if critical talent cannot clear U.S. medical screening. Visa applicants already in process should monitor consular websites daily; re-submission of updated medical forms (DS-2054/DS-3025) may be required before an interview can be scheduled or finalized.
