From Obesity, Diabetes to Depression: The Hidden Health Criteria Now Used in U.S. Visa Decisions

Quick Answer

In November 2025, the U.S. Department of State (DOS) issued internal guidance directing consular officers to scrutinize visa applicants’ chronic health conditions — including obesity, diabetes, heart disease, and depression — when deciding who is “likely to become a public charge.”

While no law was changed, the application of INA § 212(a)(1) (health-related inadmissibility) and § 212(a)(4) (public charge) was quietly expanded.

For the first time, consular officers are instructed to evaluate lifetime medical costs, insurance coverage, and even dependents’ health conditions when deciding visa eligibility.

Fast Facts

• Date of change: November 6 2025
• Legal foundation: INA § 212(a)(1) and § 212(a)(4)
• New focus: Chronic, non-communicable conditions — obesity, diabetes, depression, heart disease
• Scope: Primarily immigrant visas, with spill-over to some non-immigrant categories
• Status: Internal DOS cable (not yet published in the Federal Register)
• Key phrase in guidance: “Does the applicant have adequate financial resources to cover the costs of such care over his entire expected lifespan without seeking public assistance?”

Sources: KFF Health News | Fragomen LLP | Murthy Law Firm

The Law Before 2025: Traditional Health Inadmissibility

Under INA § 212(a)(1) and the 9 FAM 302.2 manual, a visa applicant could be refused only for:

Historically, health screenings for U.S. visas prioritized communicable diseases like tuberculosis and certain mental health disorders.

• A communicable disease of public-health significance
• Missing required vaccinations
• A physical or mental disorder associated with harmful behaviour
• Drug addiction or abuse

Chronic illnesses like obesity or diabetes were not grounds for denial unless linked to a contagious disease or harmful conduct.

The 2025 Cable: What Changed

The internal DOS cable expanded the health-related inquiry. Officers were instructed to consider whether common chronic illnesses could result in significant long-term costs to the U.S. The Trump administration issued new guidance that allows U.S. consular officers to deny immigrant visas based on expanded health criteria, including conditions like diabetes and obesity.

“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.”

“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?”
— KFF Health News, Nov 2025

This is not a new statute but a reinterpretation of existing law.

Key Differences: Before vs. After November 2025

How Consular Officers Determine Health-Based Inadmissibility

1. Panel-Physician Examination

Applicants undergo a medical exam by a panel physician authorized by the U.S. government.
The physician completes Form DS-2054 and classifies any conditions as:

• Class A: Inadmissible (communicable or harmful disorder)
• Class B: Significant but not inadmissible (chronic diseases like diabetes or obesity)

The physician forwards findings to the consular post; only the consular officer decides inadmissibility.

2. Consular Review

The officer reviews the medical report, affidavit of support, and financial documents.
Under the new policy, they must assess:

• Whether chronic conditions could create future medical costs
• Whether the applicant has insurance or income to cover those costs
• Whether dependents’ medical needs might limit earning potential

The expanded criteria for visa denials includes chronic health conditions, such as cardiovascular diseases, respiratory diseases, cancers, obesity, and mental health conditions.

3. Evidence Considered

• DS-2054 medical report
• Financial statements and bank records
• Sponsor’s Form I-864 (Affidavit of Support)
• Proof of insurance or employer benefits
• Physician’s letter on stability and treatment
• Dependent health records and cost projections

4. Decision

If the officer concludes the applicant may become a public charge due to health-related costs, they issue a refusal under INA § 212(a)(4).

If the condition itself is disqualifying, the refusal cites § 212(a)(1).

5. Appeal or Waiver

There is no formal appeal of a consular decision, but applicants can:

• Submit new evidence for reconsideration, or
• Apply for a Form I-601 Waiver of Inadmissibility through USCIS for health-related refusals.

6. Mitigation Strategies

• Obtain updated medical documentation showing stability.
• Present valid U.S. insurance coverage.
• Show sufficient assets or income.
• Provide a legal brief clarifying Class B conditions are not inadmissible under 9 FAM 302.2.

7. Non-Immigrant Visas

Tourist (B-1/B-2) and student (F/J) visas generally don’t require a panel exam, but officers can still deny if the applicant appears likely to seek U.S. medical care they cannot afford.

The I-601 Waiver of Health Grounds of Inadmissibility

Applicants refused under INA § 212(a)(1) for a medical condition may seek a Form I-601 Waiver.
To qualify, the applicant must demonstrate:

1. The condition is under control or in treatment; and
2. Admission would not pose a public-health or financial burden; and
3. Denial would cause extreme hardship to a U.S. citizen or LPR spouse, parent, or child.

The waiver, once approved, authorizes visa issuance despite the medical ground.
Processing typically takes 6–12 months.

Detailed guide: Waiver of Inadmissibility (I-601/I-601A)

Expert Commentary

“This isn’t about infection anymore — it’s about economics,”
says Richard T. Herman, founder of Herman Legal Group.
“Applicants must prove financial self-reliance even when perfectly healthy.
It’s a fundamental change in how America defines admissibility.”

Who Is Most at Risk

• Immigrant visa applicants without insurance or steady income
• Family-based sponsors with low financial capacity
• Elderly parents with age-related conditions
• Refugees and parole applicants with chronic illnesses
• Students and workers whose conditions require expensive care

More on Which Immigrant Visa Applicants Are Most Impacted — And How to Minimize Risk

Most Affected Subgroups

While the guidance technically applies to all immigrant visa categories, several groups are at disproportionate risk because of age, medical history, or limited income support:

1. U.S. Citizens Sponsoring Elderly Parents (IR-5 Category)
   • Aging parents often have chronic conditions (hypertension, diabetes, arthritis) classified as Class B on medical reports.
   • Consular officers now weigh whether these parents will need costly medical care after arrival and whether the U.S. sponsor can afford it.
   • Even though parental visas are not numerically capped, financial scrutiny has intensified for older applicants.
2. Family-Based Applicants With Ill Spouses or Children (IR/CR or F-Category)
   • Spouses or children with ongoing medical treatment abroad may trigger review if dependents are included in the application.
   • The officer may question the principal applicant’s ability to work or pay for dependents’ care.
3. Employment-Based and EB-2/EB-3 Applicants With Chronic Conditions
   • Though employer-sponsored, officers may assess whether the applicant’s health could affect productivity or generate high insurance costs.
   • Self-employed entrepreneurs (EB-2 NIW, EB-5) face added scrutiny because there is no third-party health-coverage guarantee.
4. Refugee or Humanitarian Parole Applicants
   • Those applying under humanitarian grounds may face longer processing or denials if their medical conditions are viewed as costly, even when treatments are available.

Practical Strategies to Minimize Risk

1. Secure Private or Employer-Based Health Insurance Before the Interview

• Present proof of active or pre-approved coverage valid in the United States.
• For IR-5 parents, purchase temporary private insurance that covers the first six months in the U.S.
• Include a policy letter or coverage certificate in your visa packet.

2. Strengthen the Financial Evidence of the U.S. Sponsor

• File an updated Form I-864, Affidavit of Support, showing income at least 125% above the federal poverty line.
• Add joint sponsors if necessary.
• Attach recent W-2s, tax returns, and employer letters confirming job stability.

3. Provide a Physician’s Letter of Prognosis and Functional Stability

• Request a concise letter from a treating doctor confirming:
  • The diagnosis is controlled;
  • Treatment is ongoing;
  • The applicant is capable of daily functioning and employment (if applicable).
• Officers rely heavily on the clarity of this medical narrative.

4. Prepare a Detailed Post-Arrival Medical Plan

• List healthcare providers, community clinics, or specialists in the applicant’s intended U.S. city.
• Include evidence of affordability or existing relationships with providers.
• For elderly parents, include written confirmation from family members about living arrangements and care support.

5. Pre-Interview Legal Preparation

• An attorney can prepare a medical-financial summary that references 9 FAM 302.2, clarifying that Class B conditions (such as diabetes, hypertension, depression) are not grounds for inadmissibility.
• If denial occurs, counsel can immediately file for reconsideration or a Form I-601 waiver.

6. Avoid Omissions or Incomplete Health Disclosures

• Concealing medical information can cause a permanent misrepresentation bar.
• Honesty paired with strong documentation is far safer than omission.

Insurance and Cost-Coverage Examples

• For IR-5 Parents: Obtain visitor-to-immigrant bridge insurance covering pre-existing conditions until Medicare eligibility.
• For Employment-Based Immigrants: Request employer confirmation that the company provides immediate coverage under its group health plan.
• For Self-Sponsored or Entrepreneur Applicants: Show evidence of funds allocated for private insurance premiums for at least one year.
• For Students or Dependents: Provide proof of university or exchange-visitor insurance benefits.

Tip:

HLG recommends attaching a one-page “Health Coverage Summary” in the applicant’s supporting documents, listing insurer name, policy number, and coverage period.

Legal Insight

“Elderly parents are the most exposed under this shift,” explains Richard T. Herman, founder of Herman Legal Group.
“They’re applying at an age when chronic illness is common. But solid insurance and financial documentation can transform a weak file into an approvable one.”

Bottom Line

Applicants are not being judged for being ill, but for how they plan to manage their care.
Health-related denials are preventable when applicants provide proof of treatment, insurance, and financial readiness that satisfies both the panel physician and the consular officer.

See: Medical Exam Guide for U.S. Immigration and Public Charge Inadmissibility Explained.

The Health-Cost Equation: Public-Charge Reimagined

Officers now merge health and finances.
Each case is a risk analysis of:

• Diagnosis and prognosis
• Estimated care costs
• Income and insurance
• Dependents’ medical needs
• Work capacity over time

Applicants must now treat medical records like financial proof.

Health as a Human Story

Behind every DS-2054 form is a person trying to reunite with family or pursue a dream.
This policy turns ordinary conditions — hypertension, obesity, depression — into potential grounds for exclusion.

For many, “inadmissible” means “unseen.”

When Hope Meets Policy

Here is a hypothetical example.

A mother from Lagos discloses controlled hypertension while applying to see her grandchild.
Her visa is refused after the officer questions her ability to pay for future care.
She walks out in tears — not because she’s sick, but because her health became a barrier to love.

The Ethical Crossroads of Immigration Medicine

Immigration medicine once protected public health. Now it polices economic fitness.
Public-health experts warn this approach revives old “fitness tests” and discriminates against lower-income immigrants.

The question ahead: Will America measure worthiness by health status?

Applicant Action Plan

1. Collect comprehensive medical records and letters of stability.
2. Obtain valid U.S. insurance coverage or documented access to care.
3. Provide financial proof of ability to self-fund care.
4. Present updated I-864 Affidavit of Support.
5. Prepare a legal memorandum if condition is Class B.
6. File Form I-601 if denied on health grounds.
7. Engage experienced counsel early.

Hypothetical Case Study: Diabetes and Reversal on Reconsideration

A 47-year-old Filipina applicant was initially denied as a “likely public charge.”
After submitting proof of insurance and updated medical records, her case was approved on reconsideration — showing that evidence can overcome discretionary denials.

Key Takeaways

• Chronic illness is no longer medically neutral in visa decisions.
• Officers now weigh long-term health costs and insurance coverage.
• Evidence of financial readiness and treatment stability is critical.
• There is no formal appeal; a waiver or reconsideration is the only path.
• Early legal preparation significantly improves outcomes.

Legal Tools and Resources

Official Government Sources

• USCIS Policy Manual – Health Grounds of Inadmissibility
• 9 FAM 302.2 – Health Grounds
• CDC Medical Exam Guidelines for Immigrants

Law-Firm and Policy Analysis

• KFF Health News Report
• Fragomen LLP – Expanded Health Review Alert
• Murthy Law Firm – Health-Based Visa Denials

Herman Legal Group Resources

• Public Charge Inadmissibility Under Trump 2.0
• Grounds of Inadmissibility Explained
• Waiver of Inadmissibility Guide (I-601/I-601A)
• Medical Exam Guide for U.S. Immigration
• Family Immigration and Health Issues
• Book a Consultation with Herman Legal Group

Monitoring Developments

Watch for future changes in:

• Federal Register – new proposed rules
• 9 FAM 302.2 – manual updates
• Herman Legal Group Blog – policy analysis and case insights

Call to Action

If you or a family member has a chronic condition and plans to apply for a U.S. visa, do not wait for a denial.

Early legal intervention and documented financial proof can make the difference between admission and inadmissibility.

Schedule your confidential consultation today:
Book Your Consultation with Herman Legal Group