A new directive from the U.S. State Department could see immigrant visa applicants turned down if they suffer from specific medical conditions, as confirmed by the agency.

This policy empowers officers to refuse visas to those immigrants whose health issues might make them more prone to depend on public assistance.

The guidance, communicated to State Department staff via an internal memo, instructs officials to take into account an applicant’s health status alongside their financial stability when deciding on visa issuance.

The memo highlights that certain medical conditions—such as cardiovascular diseases, respiratory ailments, cancers, diabetes, metabolic disorders, neurological issues, and mental health conditions—can demand extensive and expensive care.

Officials are prompted to consider: “Does the applicant possess sufficient financial means to afford the necessary treatment throughout their expected lifetime without resorting to public financial aid or needing long-term institutional care funded by the government?”

The directive appears to resurrect the “public charge” rule from the first Trump administration that sought to deny green cards to any immigrant who received at least one designated public benefit — including Medicaid, food stamps, welfare or public housing vouchers — for more than 12 months within any three-year period. 

Fox News first reported the development.

It comes amid a broader Trump administration campaign to dissuade immigrants from coming to the U.S. 

“It’s no secret the Trump administration is putting the interests of the American people first. This includes enforcing policies that ensure our immigration system is not a burden on the American taxpayer,” principal deputy spokesman Tommy Pigott said in a statement.

A medical examination is mandatory for all persons outside the U.S. applying for an immigrant visa and all refugees coming to the United States. The new directive takes it further.  

The cable directs officers to develop “their own thoughts about what could lead to some sort of medical emergency or sort of medical costs in the future.”

State Department officers don’t have medical training but are asked to weigh a variety of factors when determining whether to issue a visa, including finances and the likelihood those on a travel visa will return to their home country, as well as make judgments about any flags that come up during a criminal background check.

Still, the measure opens the door to a number of refusals given the widespread nature of some listed conditions.

About 10 percent of the world has diabetes, and according to the Centers for Disease Control and Prevention, 40 percent of Americans are obese. According to the World Health Organization, cardiovascular diseases are the leading cause of death globally.

A State Department official stressed to The Hill that the decision to issue a visa has always been at the discretion of an officer.

Officers aren’t being instructed to reject an applicant because they have a certain medical condition, they said, but rather consider the “overall impact” if someone would be unlikely to be able to pay for their own medical care.

“It’s addressed on an individual, case-by-case basis,” the official said.

They gave the example of a diabetic, adding that they would not face rejection because they need insulin, but could be rejected if Medicaid would be needed to cover the drug.

Public charge policies were shifted under the first Trump administration, greatly expanding who would be considered a public charge. Previously, the term only applied to those primarily reliant on the government through cash assistance. 

The Biden administration unwound the public charge rule in 2022, reverting the definition to those “primarily dependent on the government for subsistence.” The administration at the time noted the Trump definition led eligible citizens to not apply for coverage, especially in households where parents held different immigration statuses than children.