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The Donald Trump administration has issued instructions to American consular offices worldwide to deny entry or residency to visa applicants with certain medical conditions, on the grounds that such individuals could become dependent on public welfare programmes in the United States.

According to the new directive, outlined in a State Department cable sent to US embassies and consulates, advises officials to consider a wide range of medical and health-related factors when evaluating visa applications.

“You must consider an applicant’s health,” the cable reportedly 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.”

The guidance also instructs officers to take into account conditions such as obesity, noting its potential links to asthma, sleep apnoea, and high blood pressure. Visa officers are told to assess whether applicants are likely to require long-term or costly medical treatment and could therefore become a “public charge” — a term used to describe individuals who might rely on government assistance.

Applicants’ financial stability will also be scrutinised. Officers are directed to evaluate whether applicants have the means to pay for medical care throughout their lives “without seeking public cash assistance or long-term institutionalisation at government expense.”

The cable reportedly extends this consideration to applicants’ family members, asking officers to assess whether dependents — including children or elderly parents — have disabilities or chronic health conditions that could limit the applicant’s ability to remain employed.

The new policy marks a broader tightening of immigration regulations under the Trump administration, which has prioritised limiting entry for individuals perceived as potential burdens on public resources.

Legal experts have expressed concern over the directive. Charles Wheeler, senior attorney with the Catholic Legal Immigration Network, described the guidance as “troubling,” noting that visa officers lack medical training and are ill-equipped to predict how an applicant’s health condition may evolve or what financial impact it may have.

Sophia Genovese, an immigration lawyer at Georgetown University, added that while immigrants are already required to submit medical records as part of the Green Card process, the new rules significantly expand the level of discretion given to consular officers.

“Taking into consideration one’s diabetic history or heart health history — that’s quite expansive,” she said. “This change could create serious challenges during consular interviews if officers begin speculating about future medical costs or employability.”

The directive, according to information available, is expected to be applied primarily to those seeking permanent residency in the United States. However, advocates warn that it could have a chilling effect on prospective immigrants with health conditions or limited financial resources.

With agency inputs