According to media reports, the U.S. Department of State (DOS) issued new public charge guidance to U.S. embassies and consulates worldwide on or about November 6, 2025. This guidance applies to visa applications processed outside the United States, including immigrant visas and nonimmigrant visas such as H-1B and L-1, among others. These reported DOS directives do not change the Department of Homeland Security’s (DHS) public charge policy for applicants inside the United States, though DHS published rulemaking on November 19, 2025 that proposes to rescind the 2022 public charge regulations.
Under long-standing DOS policy, consular officers assess whether an applicant is likely to become primarily dependent on the U.S. government for subsistence. This includes reviewing the applicant’s age, health, family status, financial resources, education, and skills, along with the affidavit of support (when required). These factors must be weighed based on the totality of the circumstances, not speculation.
According to reports, the DOS cable directs an expanded approach to reviewing public charge factors including age, likelihood of future reliance on benefits, and a wide range of chronic medical conditions. It encourages review of conditions that would ordinarily not be disqualifying under the ordinary medical grounds such as obesity, sleep apnea, asthma, and high blood pressure due to potential long-term medical costs, and requires officers to assess whether applicants can pay for medical care without government assistance. The cable also covers factors such as employability, insurance coverage, and English language proficiency.
Notably, applicants for immigrant visas (green cards) undergo medical examinations by embassy-approved physicians. Most nonimmigrant visa applicants do not complete medical exams. The reported guidance introduces new, broader health-related considerations for both groups, raising questions of the potential for inconsistent or subjective decision-making.
Claire Pratt © Jewell Stewart Pratt Beckerson & Carr PC 2025