What’s Happening
Recent media reporting indicates that the U.S. Department of State (DOS) has issued internal guidance instructing consular officers to place greater emphasis on an applicant’s health when evaluating potential “public charge” concerns, which may deem them ineligible for a visa. A wider range of chronic, non-communicable, and long-term medical conditions may now factor into visa decisions, particularly in the immigrant visa process.
“Public charge” is a U.S. immigration term used to describe someone who is likely to depend mainly on government assistance for income or long-term care and serves as a ground of inadmissibility that immigration officials may rely upon when deciding to approve or deny certain immigration benefits.
What We Currently Know
According to media outlets that reviewed the internal cable, consular officers are now directed to weigh numerous health conditions - such as diabetes, high blood pressure, asthma, obesity, cardiovascular disease, sleep apnea, cancer, and neurological, metabolic, respiratory, or mental health disorders - when assessing whether an individual may become financially dependent on government support.
The cable reportedly states that if an officer determines an applicant may be unable to cover future medical expenses throughout their expected lifetime without relying on government-funded cash assistance or long-term institutional care, the officer may deny the visa application based on public charge grounds.
Another significant shift involves consideration of the health issues of family members who are not visa applicants. Under the reported guidance, these conditions may still be relevant to the officer’s overall determination of the applicant’s future financial burden and, thus, admissibility to the U.S. on public charge grounds.
Impact on Immigrant vs. Nonimmigrant Applicants
Immigrant visa applicants are expected to experience the greatest practical impact, as they are required to undergo a panel physician medical exam and are subject to a more comprehensive “totality of the circumstances” review when assessing public charge grounds of inadmissibility. Historically, the medical exam has focused on communicable diseases, vaccinations compliance, and substance-use history. The new reported approach would considerably broaden the adjudicating officer’s scrutiny of this medical assessment.
Nonimmigrant visa applicants are less likely to be impacted. Individuals applying for temporary visas are generally not required to complete medical exams unless there is a specific concern, such as prior substance use. Whether consulates will request additional medical or financial documentation in nonimmigrant cases is not yet clear.
Context: The Evolving Public Charge Framework
Public charge is a longstanding ground of inadmissibility under the Immigration and Nationality Act (INA), requiring adjudicators to evaluate multiple factors under a totality-of-circumstances test, including age, health, income, assets, education, and skills.
The reported changes at the DOS come as the Department of Homeland Security (DHS) recently submitted a new public charge regulation for federal review. The substance of the DHS rule is not yet public. Taken together, these developments reflect a return toward the broader public charge interpretation embodied in the 2019 Public Charge Inadmissibility Rule in effect under the first Trump Administration which were subsequently dialed back under the Biden Administration.
D&S is continuing to monitor this developing situation and will provide updates as they become available.