In an unpublicised cable that reached U.S. embassies worldwide late on 11 November, the State Department instructed consular officers to treat a broad range of chronic medical conditions—including diabetes, obesity, cardiovascular disease and certain mental-health disorders—as potential grounds for refusing both immigrant and non-immigrant visas.
The directive tweaks the long-standing “public-charge” test, which already bars applicants likely to become dependent on government support. Officers must now weigh whether an applicant can shoulder lifetime medical costs without U.S. public assistance and whether dependants’ illnesses could keep the principal applicant from working. The cable even encourages officers to ask whether the family has a realistic long-term care plan if a relative becomes incapacitated.
![U.S. expands health-based visa denials to chronic conditions like diabetes and obesity]()
Historically, health screening focused on communicable diseases such as tuberculosis. Expanding it to non-communicable illnesses marks the biggest shift in medical inadmissibility rules in decades. Immigration lawyers warn that the guidance leaves enormous discretion to individual posts and could disproportionately affect older applicants, low-income families and nationals from countries with high obesity rates. Corporate mobility managers should expect more administrative processing, requests for medical files and delays in start dates for transferees.
For employers, the practical takeaway is to prepare foreign hires and assignees for intensive questions about insurance coverage and to budget extra time for visa issuance. Multinationals may also need contingency plans if key staff are refused or significantly delayed because of health-related findings.
While the cable took effect immediately, advocacy groups have already signalled litigation, arguing that the move revives elements of the 2019 public-charge rule that courts previously struck down. Until the courts speak, however, companies should treat the policy as operative and adjust relocation timelines accordingly.
The directive tweaks the long-standing “public-charge” test, which already bars applicants likely to become dependent on government support. Officers must now weigh whether an applicant can shoulder lifetime medical costs without U.S. public assistance and whether dependants’ illnesses could keep the principal applicant from working. The cable even encourages officers to ask whether the family has a realistic long-term care plan if a relative becomes incapacitated.
Historically, health screening focused on communicable diseases such as tuberculosis. Expanding it to non-communicable illnesses marks the biggest shift in medical inadmissibility rules in decades. Immigration lawyers warn that the guidance leaves enormous discretion to individual posts and could disproportionately affect older applicants, low-income families and nationals from countries with high obesity rates. Corporate mobility managers should expect more administrative processing, requests for medical files and delays in start dates for transferees.
For employers, the practical takeaway is to prepare foreign hires and assignees for intensive questions about insurance coverage and to budget extra time for visa issuance. Multinationals may also need contingency plans if key staff are refused or significantly delayed because of health-related findings.
While the cable took effect immediately, advocacy groups have already signalled litigation, arguing that the move revives elements of the 2019 public-charge rule that courts previously struck down. Until the courts speak, however, companies should treat the policy as operative and adjust relocation timelines accordingly.
