New State Department Guidance: Chronic Health Conditions, Including Obesity, Can Be Grounds to Deny U.S. Visas

On November 6, 2025, Secretary of State Marco Rubio issued a cable to U.S. embassies and consulates worldwide instructing visa officers to more aggressively factor certain chronic health conditions into visa adjudications under the “public charge” rule. According to reporting from multiple outlets, the guidance explicitly highlights obesity, as well as cardiovascular and respiratory diseases, cancers, diabetes, metabolic and neurological conditions, and certain mental health conditions, as factors that can justify visa refusals based on projected long-term medical costs.

The directive expands prior health-related screening, which historically focused on communicable diseases and a narrow set of conditions likely to result in long-term institutionalization at government expense. Visa officers are now asked to consider whether an applicant’s health conditions could generate “hundreds of thousands of dollars” in care over their expected lifetime and to weigh whether the applicant has sufficient resources to cover those costs without relying on public benefits. The cable also instructs officers to consider age (including being past retirement age), number of dependents, and whether any dependents have disabilities or special needs when assessing the likelihood of becoming a public charge.

Rubio’s guidance applies to both temporary (nonimmigrant) and permanent (immigrant) visa categories, including employment-based visas such as H-1B and family and work-based immigrant visas. Certain humanitarian categories, such as refugees, are largely exempt, though reporting notes that several humanitarian pathways have already been narrowed or ended by the Trump administration.

The directive was drafted by political leadership at the State Department and did not go through the standard internal review process that typically involves career staff. Immigration attorneys quoted in the coverage emphasize that consular officers already have broad discretion in public-charge determinations and warn that this guidance significantly widens the scope of that discretion by treating common, non-communicable conditions—such as obesity or type 2 diabetes—as negative factors in their own right. Critics argue that the policy goes beyond existing CDC medical guidance for immigrant medical exams and may allow officers to deny visas based on speculative assessments of future health-care costs.

For high-skilled professionals and employers, the key takeaway is that consular posts have been instructed to scrutinize chronic health conditions and overall household circumstances more closely when applying the public-charge standard, even in cases involving work-authorized applicants. While the guidance does not change the underlying statute, it signals a more restrictive interpretation that can affect both temporary work visas and employment-based permanent residence cases processed abroad. Well-documented evidence of private health coverage, robust financial resources, and employer support will likely become even more important in consular strategy for applicants with known chronic health conditions.

What This Means for O-1, EB-1, and NIW Applicants

Even though the new guidance is framed around the “public charge” rule generally, it has practical implications for high-skilled applicants processing at consulates abroad:

Chronic health conditions will get more scrutiny. Obesity, diabetes, heart and respiratory disease, some cancers, and certain mental health conditions may now be treated as negative factors in public charge assessments by consular officers.
Stronger proof of financial independence is key. Applicants with any chronic condition should be prepared to document robust private health insurance, personal savings, and—where applicable—employer support to demonstrate they can cover treatment costs without relying on U.S. public benefits.
Household circumstances matter. Age, number of dependents, and whether any dependents have special medical or educational needs may now weigh more heavily in a public charge analysis, even in otherwise strong O-1, EB-1, or NIW cases.
Consular discretion is expanded. Officers already had broad authority on public charge decisions; this guidance encourages them to use that discretion more aggressively, which can increase the risk of refusals for applicants with disclosed health issues.
Consular strategy becomes more important. For talent-based categories like O-1 and EB-1, as well as NIW self-petitioners, advance planning around what to disclose, how to frame medical history, and how to present financial/insurance evidence will be increasingly critical when a case is processed at a consulate rather than inside the U.S.

This analysis is based on reporting from The Washington Post (“U.S. visas can be denied for obesity, cancer and diabetes, Rubio says,” November 13, 2025) The Washington Post, NPR’s November 12, 2025 coverage of new Trump administration guidance on health conditions and visa adjudications (NPR link provided by user), and Politico (“Rubio instructs US diplomats to consider obesity as a cause for rejecting visas,” November 13, 2025). politico.com

This post is provided for informational purposes only and does not constitute legal advice. Reading this summary does not create an attorney–client relationship, and you should not act or rely on any information here without consulting a qualified U.S. immigration attorney about your specific situation.