New U.S. Visa Guidance Raises Health Risk Barriers

The U.S. State Department has quietly issued a directive that could dramatically change how visa officers evaluate health, and that could put many visa applications at new risk. Under guidance issued by Secretary of State Marco Rubio in November 2025, consular officers are now instructed to more closely examine chronic medical conditions like diabetes, cancer, cardiovascular disease, respiratory illness, obesity, and mental health when assessing whether an applicant is likely to become a “public charge.” This is not a small tweak, it is a significant expansion of how health factors into visa decisions. Understanding what this means and how to prepare is critical for anyone applying for an immigrant visa. 

What Exactly Is the Change?

A Broader Public Charge Framework

Historically, visa medical screening emphasized communicable diseases such as tuberculosis and other public-health risks. The new guidance from the State Department goes much further. Consular officers are now asked to evaluate a wider set of chronic and noncommunicable conditions when deciding whether someone might be a public charge. The cable mentions conditions such as:

• Cardiovascular disease

• Respiratory disease

• Cancer

• Diabetes and metabolic disorders

• Neurological and mental health conditions

• Obesity, which the directive links to sleep apnea, high blood pressure, and other costly conditions

The key new question is whether the applicant can afford the cost of care for their condition over their lifetime without relying on U.S. government-funded programs.

Financial Capacity Under Spotlight

The guidance instructs officers to request detailed financial evidence. Consular staff may ask for bank statements, proof of assets such as savings, trusts, and retirement accounts, and other documentation to evaluate whether a visa applicant has sufficient resources to manage their health-related expenses without turning to public programs.

Officers are also instructed to consider dependents. If an applicant’s family members have medical conditions that might require long-term care, that could weigh heavily against granting a visa.

Is This a New Law? Not Really

Despite how dramatic it sounds, this is not a change in U.S. immigration law passed by Congress. It is an internal policy disclosed via a consular cable. Here is what that means in legal terms:

• The underlying statute remains the same: Immigration and Nationality Act Section 212(a)(4), which allows visa officers and U.S. immigration officials to deny a visa if someone is likely at any time to become a public charge.

• The new directive is not a final regulation issued by DHS or USCIS. It is operational guidance to consular officers, expanding how they apply their discretion.

• Because it is internal guidance, posts may begin applying it relatively quickly, but it is also vulnerable to change, litigation, or future policy shifts.

How This Affects Visa Applicants

Higher Bar for Medical Documentation

Visa applicants with chronic illnesses will need to provide more robust medical evidence than before. Officers may want detailed reports, long-term prognosis, and physician letters explaining treatment plans and future risks. These documents are now more likely to drive decisions.

Stronger Financial Proof Required

It is no longer enough to show you have a sponsor or minimal savings. Officers may deeply scrutinize whether you can genuinely afford care over many years. This means gathering comprehensive financial documentation, including bank statements, trust fund records, employer letters, and possibly evidence of private health insurance.

Case-by-Case Risk Assessment

Applications will be evaluated under a holistic totality of the circumstances standard. Officers should weigh age, health, family status, skills, education, and financial resources together. Compared to prior practice, health now plays a more central role.

Potential for Refusals or Delays

If medical reports are vague or if an applicant’s financial disclosure does not convincingly cover projected health costs, officers may issue a 221(g) refusal. This essentially asks for more information before granting a visa.

What You Can Do to Prepare

If you or a loved one is applying for a U.S. visa and has a known chronic medical condition, taking action now is vital:

1. Gather Comprehensive Medical RecordsRequest detailed summaries from your doctor, including your diagnosis, treatment plan, prognosis, and projected medical needs.

2. Document Your Financial CapacityCollect bank statements, savings and trust documents, retirement account statements to show that the petitioner or immigrant visa applicant has the means to purchase private health insurance when the applicant immigrates to the U.S.

3. Work with a Qualified Immigration AttorneyA lawyer experienced in public charge issues can help you frame your financial and medical profile in the best light. At Tran Flores Law, we assist clients in building strong, defensible visa applications under this new policy landscape.

Final Thoughts

This recent change marks one of the most significant shifts in U.S. visa health screening in a long time. For immigrants with chronic health conditions or sponsors who support them, it raises real risks. With careful planning and proactive preparation, you can put together a strong case.

If you are concerned about how this new guidance might affect your visa application, or want to strategize your documentation and interview plan, schedule a consultation with Tran Flores Law by calling (512) 894-9984. We are here to help.