The State Department directed consular officers to weigh common chronic health conditions — including obesity, diabetes and cancers — when deciding visa eligibility under the “public charge” standard, according to a Nov. 6 cable issued by Secretary of State Marco Rubio. The guidance also tells officers to factor in an applicant’s age, number of dependents, and whether dependents have disabilities or “special needs.”
It applies to both immigrant and non-immigrant visas, with humanitarian programs excluded, The Washington Post reported.
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Immigration attorneys told The Post and KFF Health News that the directive broadens medical review beyond communicable diseases and expands consular officers’ latitude to determine whether an applicant is likely to become a public charge.
The White House and State Department framed the move as a long-standing application of the “public charge” rule, which bars immigrants deemed likely to depend on government support, Fox News reported.
How the rule works
The cable says officers “must consider an applicant’s health,” including cardiovascular, respiratory, metabolic, neurological and mental health conditions that “can require hundreds of thousands of dollars’ worth of care.”
It encourages consideration of obesity and related risks like sleep apnea and high blood pressure, and asks whether an applicant has the financial resources to cover lifetime care without assistance or long-term institutionalization.
A State Department spokesperson told Fox News the directive puts “the interests of the American people first.” The guidance applies across visa categories, with humanitarian programs excluded, The Post reported.
What’s different from before
According to immigration attorneys cited by KFF Health News, previous screenings were generally limited to communicable diseases or conditions requiring institutionalization. The new directive significantly expands the scope, directly linking common chronic conditions to their potential long-term costs.
One attorney told KFF the language appears broader than the Foreign Affairs Manual’s caution against “what if” scenarios. The Post also reported that the cable was drafted by the State Department’s political leaders and did not go through a typical internal review.
What happens next
Fox News reports that there is no “bright-line test,” meaning consular officers will assess the “totality” of an applicant’s financial and medical situation.
While administration officials describe this as full enforcement of existing law, attorneys told The Post and KFF Health News the guidance effectively provides officers with new reasons to deny visas.
