For many families, the U.S. immigration process is stressful enough even when everyone is healthy. When an applicant or a family member has a serious medical condition such as diabetes, heart disease, cancer, obesity, or a significant mental health condition, that stress often increases—especially now, in 2025, as consular officers are being instructed to look more closely at health when deciding whether someone may become a “public charge.”
From everything publicly available as of the date of this writing, the expansion of medical-exam and health-related inadmissibility considerations is not a new regulation. It is not in the Federal Register, not open for public comment, and not a formal change to the statutes. Instead, it comes from internal guidance—primarily from a State Department cable—telling consular officers to apply broader health-risk factors when assessing visa eligibility under the public charge framework. The effect, however, is very real for family-based immigrants going through a visa medical exam in 2025.
How Is the Visa Medical Exam Used in 2025?
Every immigrant visa applicant, including those in family-based categories, must complete a visa medical exam with a U.S.-approved physician. The exam is designed to screen for:
- Certain communicable diseases of public health significance
- Required vaccinations
- Serious physical or mental disorders associated with harmful behavior
- Substance abuse or dependence
Most common chronic illnesses—like controlled diabetes, hypertension, asthma, depression, or high cholesterol—do not automatically make someone medically inadmissible. In many cases, an applicant with a chronic condition can still “pass” the health portion of the immigration medical exam if the condition is stable and properly managed.
What has changed in 2025 is not the basic structure of the medical exam, but how consular officers are being told to use the medical information when evaluating whether an applicant is likely to become a public charge.
What Does “Public Charge” Mean for Family-Based Immigrants?
“Public charge” is a longstanding ground of inadmissibility in U.S. immigration law. The question officers must answer is whether the applicant is likely to become primarily dependent on the government for support in the future. In doing so, they must consider the “totality of the circumstances,” including:
- Health
- Age
- Family status
- Financial resources and assets
- Education and skills
- The strength of any financial sponsor (through the Affidavit of Support)
For family-based immigrants, the Affidavit of Support has traditionally been central: a U.S. citizen or lawful permanent resident relative commits to support the intending immigrant and demonstrates that their income meets certain thresholds. For many years, if the sponsor met the income guidelines and the applicant had no major red flags, the public charge analysis tended to be fairly routine.
The 2025 guidance shifts the spotlight more directly onto health and long-term health-carecosts as a public charge factor, even when the applicant technically passes the visa medical exam itself.
Why Are Chronic Health Conditions Drawing More Attention Now?
According to summaries of the internal guidance, consular officers are now being told to give greater weight to chronic and serious health conditions when assessing public charge risk. The memo instructs officers to think beyond communicable diseases and consider a broad list of conditions, including but not limited to:
- Cardiovascular diseases (such as coronary artery disease or serious hypertension)
- Respiratory diseases (such as chronic asthma or COPD)
- Cancers requiring ongoing treatment or close monitoring
- Diabetes and other metabolic diseases
- Neurological conditions that may require long-term care
- Significant mental health conditions requiring ongoing support or medication
- Obesity, especially when associated with other risk factors or complications
The core concern is cost and self-sufficiency: if a condition is likely to require substantial ongoing medical treatment, officers are being told to ask whether the applicant and their family can realistically bear that cost without relying on government-funded care. The guidance focuses not only on the diagnosis, but on expected lifetime expenses and the applicant’s ability to cover them.
At the same time, this is still internal policy guidance, not a published regulation. There is currently no notice-and-comment rulemaking formally expanding health-related inadmissibility grounds under INA 212(a)(1). But because consulates are already applying the guidance in practice, applicants are feeling its impact now, even though there has been no opportunity for public comment or formal challenge.
Which Immigrants Are Most Likely to Be Affected?
While the guidance can technically affect a wide range of applicants, it is most likely to be felt by:
Family-based immigrant visa applicants abroad.
Spouses, parents, and children of U.S. citizens or permanent residents going through consular processing must complete the immigrant visa medical exam and face a full public charge analysis. If they have a serious health condition, or if a spouse or child immigrating with them does, their case may draw extra scrutiny.
Applicants or dependents with serious or costly conditions.
An applicant who has diabetes, heart disease, cancer, serious mental health conditions, or other illnesses that typically involve regular specialist visits, expensive medications, or possible hospitalization will likely be asked—in effect—how those costs will be paid. The same is true when a dependent child or spouse has a major condition or disability. Even if the principal applicant is healthy, the officer may worry about long-term care expenses for the dependent.
Families with limited financial resources or weak Affidavits of Support.
If an applicant has a significant health condition but limited savings, no significant assets, no realistic access to private health insurance, and a sponsor who only barely meets the minimum income requirements, the public charge risk will be seen as higher. Officers now have explicit permission to weigh health-related costs heavily when deciding whether that financial support appears adequate.
Applicants whose work prospects may be affected by health.
If a condition could reasonably limit an applicant’s ability to work full-time, or to remain in a physically demanding job, officers may factor that into their assessment of future self-sufficiency. Even where the applicant has skills or education, the officer might question whether they will be able to maintain steady employment if their health declines.
Nonimmigrant (temporary) visa applicants are generally less affected, since many do not undergo a medical exam and are not pursuing permanent residence. However, the public charge ground technically exists for them as well, and in unusual cases health conditions can still come up.
How Can You Prepare for the Visa Medical Exam if You Have a Serious Health Condition?
The 2025 guidance makes preparation more important than ever. Simply showing up to the exam and interview without a plan can leave you vulnerable to a public charge denial, even if your doctor says you are medically admissible. Practical steps include:
1. Bring complete and honest medical documentation.
Do not try to hide or minimize serious diagnoses. The panel physician’s job is to report accurately, and missing information can damage your credibility. Instead, arrive with:
- A summary letter from your treating doctor
- Records showing your diagnosis, treatment plan, and current status
- A list of medications and dosages
- Any evidence that your condition is stable or in remission
A well-documented history that shows your condition is managed can be more reassuring than a vague or incomplete record.
2. Document how you will pay for care in the United States.
Because health-care cost is central to the new approach, you should be ready to demonstrate your ability to cover medical expenses over time. Helpful evidence may include:
- Proof of current or expected health insurance that will cover you in the U.S.
- Statements from savings, investment accounts, or other assets
- Evidence of your sponsor’s income and employer-provided health benefits
- Any letters or documentation showing that you have a solid job offer or strong work history in a field where you are likely to find employment
The message you want to send is: I understand my health needs, and I have concrete resources to meet them without relying on government support.
3. Address the situation of any family members with health issues.
If your spouse, child, or parent who is immigrating with you has a serious condition, be prepared to show you have thought through both caregiving and costs. That may mean:
- Explaining who will provide day-to-day care
- Showing that you or your sponsor will still be able to work
- Providing evidence of specialized services, schools, or providers you have researched or contacted
- Demonstrating that you have the financial means or insurance to cover their needs
Officers are being told to consider dependents’ health when assessing public charge risk, so leaving this unaddressed is risky.
4. Highlight your positive factors in the totality of circumstances.
Public charge determinations are not supposed to be based solely on health. Make sure the officer can see your strengths, such as:
- Education, training, and professional skills
- English language ability
- Stable work history
- Strong family and community ties
- A robust Affidavit of Support from a well-established sponsor
Well-organized evidence can help shift the officer’s view from “Will this illness overwhelm them?” to “This person has the tools to manage their condition and succeed in the U.S.”
5. Avoid inconsistencies between your forms, your medical exam, and your interview.
With health receiving more attention, contradictions—such as denying a condition at the interview that appears in your medical records—can hurt your case. Before the interview, carefully review your forms and supporting documents so that your answers are accurate and consistent.
When Does It Make Sense to Work With an Immigration Attorney?
Under this 2025 approach, public charge decisions are more subjective and more complex, especially for family-based immigrants with serious health conditions. Officers have wide discretion, and a refusal on public charge grounds can be difficult to overcome and may disrupt a carefully planned immigration path.
An experienced immigration lawyer can:
- Review your medical and financial circumstances through the lens of current public charge policy
- Help you gather targeted evidence to address the issues officers now focus on
- Prepare a legal memorandum explaining why, under the totality of the circumstances, you are not likely to become a public charge
- Coach you for the consular interview so you can explain your situation clearly and confidently
- Advise you on timing, strategy, and any available options if a concern is raised by the consulate
For many families, especially where there is a serious diagnosis, the stakes are simply too high to go it alone.
Talk to an Immigration Lawyer About Your Medical Exam and Public Charge Concerns
If you or a loved one have a serious health condition and are preparing for a visa medical exam in 2025, you are right to be cautious. The law on paper has not dramatically changed, but internal public charge guidance means that health issues like diabetes, heart disease, obesity, cancer, and serious mental health conditions now play a larger role in visa decisions—even without a formal new regulation.
A careful strategy, thorough documentation, and a clear presentation of your finances and future plans can make a real difference. A law firm that focuses on immigration can help you understand how these 2025 public charge developments apply to your family, anticipate the concerns a consular officer may have, and build the strongest case possible so that your health history does not stand in the way of your immigration goals. Contact us today for your immigration needs.
