WASHINGTON, Nov 9: Foreigners seeking visas to live in the United States may be denied entry if they have certain medical conditions, including diabetes or obesity, according to new guidance issued Thursday by the Trump administration.

The directive, sent in a cable from the US State Department to embassy and consular officials and reviewed by KFF Health News, instructs visa officers to consider applicants ineligible for several new reasons, including age or the likelihood that they might rely on public benefits. Individuals with chronic health conditions or disabilities could be deemed a “public charge,” potentially placing a financial burden on US resources.

While assessing the health of visa applicants has long been part of the process—including screening for communicable diseases such as tuberculosis and checking vaccination records—experts say the new guidance dramatically expands the list of medical conditions that can influence visa decisions. Visa officers now have greater discretion to make judgments about immigration based on an applicant’s health.

The directive is part of the Trump administration’s broader policy to reduce unauthorized immigration and limit the number of people permitted to enter the US, which has included daily mass arrests, bans on refugees from certain countries, and stricter caps on immigration.

The cable emphasizes that nearly all visa applicants must have their health assessed, but it is expected to be most relevant for those seeking permanent residence, said Charles Wheeler, senior attorney for the Catholic Legal Immigration Network, a nonprofit legal aid organization.

“You must consider an applicant’s health,” the cable states. “Certain medical conditions—including, but not limited to, cardiovascular diseases, respiratory diseases, cancers, diabetes, metabolic diseases, neurological diseases, and mental health conditions—can require hundreds of thousands of dollars’ worth of care.”

Globally, about 10% of the population has diabetes, and cardiovascular diseases remain the leading cause of death worldwide. The guidance also highlights obesity, citing its links to asthma, sleep apnea, and high blood pressure.

Visa officers are directed to determine whether applicants have the financial means to pay for medical care without relying on U.S. government assistance. “Does the applicant have adequate financial resources to cover the costs of such care over his entire expected lifespan without seeking public cash assistance or long-term institutionalization at government expense?” the cable reads.

Critics argue that the guidance conflicts with the State Department’s Foreign Affairs Manual, which prohibits visa officers from making decisions based on hypothetical scenarios. Wheeler said the directive could prompt untrained officials to make projections about applicants’ health care needs based on personal bias rather than medical expertise.

The guidance also extends to dependents, including children and elderly parents. Visa officers are asked to evaluate whether family members have disabilities or chronic conditions that might affect the applicant’s ability to work.

Immigrants already undergo medical examinations by approved physicians, who check for communicable diseases, mental health conditions, drug or alcohol use, and vaccination compliance. The new guidance, however, encourages officers and examining doctors to consider chronic conditions, speculate on future medical costs, and assess employment prospects based on health history, said Sophia Genovese, an immigration lawyer at Georgetown University.

“Considering someone’s diabetic or heart health history in this manner is expansive,” Genovese said. “This guidance could immediately create challenges for applicants during consular interviews, requiring speculation about potential medical emergencies and the applicant’s ability to work.”