The United States has rolled out a sweeping directive to its embassies and consulates globally, ordering the strict enforcement of the “public charge” provision of immigration law. The move marks a return to the broader, more stringent interpretation of the rule that was heavily implemented during US President Donald Trump’s previous term and eased during the subsequent administration.
The latest guidance instructs consular officers to deny visas to individuals who are deemed likely to rely on US government assistance. This determination will now weigh a significantly expanded list of factors, including:
- Age and English proficiency
- Financial stability
- Health and potential need for long-term medical care
Chronic Illnesses Now Grounds for Denial
The most significant change is the dramatic expansion of health factors used in the assessment. While previous screenings primarily focused on communicable diseases (like tuberculosis) and vaccination status, the new rules mandate that officers assess the cost and longevity of non-communicable, chronic health conditions.
According to the State Department cable, officers must now factor in conditions that can “require hundreds of thousands of dollars’ worth of care” over time. Conditions explicitly named for review include:
- Cardiovascular diseases
- Diabetes
- Metabolic disorders
- Obesity
- Neurological ailments
- Certain mental-health conditions
The guidance directly instructs officers to assess whether an applicant has “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.
Restoration of Trump-Era Framework
The State Department’s communication emphasized that the principle of “Self-sufficiency has been a longstanding principle of U.S. immigration policy” and that the public charge ground has been a part of immigration law for over a century.
However, critics argue that the broadened criteria grant consular officers—who are not medically trained—vast, subjective authority to predict future healthcare costs, potentially leading to the rejection of otherwise qualified applicants with common chronic but manageable illnesses. The directive also allows officers to consider the health of an applicant’s family members and dependents.
Any history of receiving government cash benefits, or previous institutionalization at public expense, can now be used as grounds for denial, underscoring the administration’s renewed focus on financial self-sufficiency and the avoidance of any potential strain on public welfare systems.