Overview
- The guidance applies to immigrant visas and authorizes refusals based on chronic conditions deemed likely to require expensive or prolonged care.
- Named examples include obesity, diabetes, cardiovascular and respiratory diseases, cancers, neurological disorders, and mental‑health conditions.
- Officers are told to judge applicants’ ability to pay for treatment over their entire expected lifespan, weighing age, family status, finances, education, skills, prior benefit use, and English proficiency.
- State Department officials describe the shift as protecting taxpayers, while legal advocates cite conflicts with earlier instructions against speculative denials and warn that nonmedical officers are being asked to make medical projections.
- Applicants who document private means to cover care may still qualify, and the move comes alongside higher H‑1B fees and a new “Gold Card” option that together signal a tighter immigration posture.