As of November 2025, the Trump administration has introduced significant updates to U.S. immigration health screenings under the “public charge” rule (INA 212(a)(4)). This policy expansion, outlined in a State Department cable dated November 6, 2025, directs consular officers and USCIS to scrutinize chronic conditions like obesity (overweight) and diabetes (tiểu đường) more rigorously. These changes aim to prevent immigrants from becoming reliant on public benefits due to high-cost medical needs, potentially affecting immigrant visas (green cards), non-immigrant visas (e.g., H-1B, student), and adjustment of status applications.

While not automatic disqualifiers, these conditions can now trigger denials if officers deem them likely to impose “substantial long-term costs” on U.S. taxpayers. This is a policy shift with case-by-case application, reviving and broadening elements of the 2019 Trump-era public charge rule. Below, we break down the details, scenarios, medical exam process (Form I-693), and how Truong Law Firm, PLLC can assist.

Key Policy Overview

• Legal Basis: INA 212(a)(1) (health-related inadmissibility) combined with INA 212(a)(4) (public charge). Previously focused on communicable diseases (e.g., TB), the new guidance explicitly lists obesity, type 2 diabetes, cardiovascular disease, and other chronic issues as “red flags.”
• Policy vs. Case-by-Case: It’s a formal policy directive (not law), but enforcement is discretionary. Officers must weigh factors like age, finances, insurance, and ties to the U.S. No blanket ban—applicants can overcome concerns with evidence of self-sufficiency.
• Impact: Affects ~10% of global applicants with diabetes; obesity (BMI >30) is common worldwide. Denials could rise 20-30% for affected groups, per immigration experts.

Immigration Medical Exam (Form I-693): Process and Testing

The medical exam is required for most green card applicants (adjustment of status or consular processing) and is conducted before your USCIS interview or visa issuance. It’s performed by a USCIS-designated civil surgeon (in the U.S.) or panel physician (abroad). Submit Form I-693 with your I-485 (adjustment) application—sealed envelope, valid indefinitely if signed after November 1, 2023.

What Happens During the Exam?

1. 1. Medical History Review: You’ll complete a questionnaire disclosing conditions like diabetes or obesity. Be honest—false info leads to permanent bans.
   2. Physical Exam: Includes height, weight (for BMI calculation), blood pressure, and general check.
   3. Required Tests (per CDC Technical Instructions):
      • Blood tests for syphilis, gonorrhea (ages 15-45), HIV.
      • TB skin or chest X-ray.
      • Vaccinations (e.g., MMR, COVID-19).
   4. Specific to Diabetes (Tiểu Đường):
      • Not routinely tested via blood sugar (e.g., HbA1c or glucose) unless history suggests uncontrolled disease.
      • Disclosed via history; doctor notes if managed (e.g., with meds/insulin). Uncontrolled diabetes (e.g., frequent hospitalizations) flags public charge risk.
   5. Verification of Overweight/Obesity:
      • Measured directly: Height (cm/inches) and weight (kg/lbs) via scale and stadiometer.
      • BMI calculated: BMI = weight (kg) / [height (m)]². Obesity = BMI ≥30; overweight = 25-29.9.
      • No “test”—it’s objective measurement. Doctor assesses if it poses future costs (e.g., linked to heart disease).

Scenarios: Approval vs. Potential Stop/Denial

Decisions hinge on totality of circumstances. Here’s a breakdown:

How Truong Law Firm, PLLC Can Help

At Truong Law Firm, PLLC, we specialize in overcoming health-related immigration hurdles. With offices in Houston, TX, and Sai Gon Ward, Vietnam, our team—led by U.S. citizen attorney John Truong—has helped 500+ clients navigate public charge issues.

• Pre-Exam Prep: Review history; coordinate civil surgeon visits; gather evidence (e.g., doctor’s notes, insurance proofs).
• Waiver Filings: I-601/I-212 for inadmissibility; success rate 70%+ with strong docs.
• Public Charge Appeals: Challenge denials via mandamus or admin review.
• Holistic Strategy: Family-based petitions, employment visas, or temporary options while building case.
• Free Consultation: Bilingual (English/Vietnamese).

Don’t let health concerns derail your American dream—our firm ensures compliance and advocacy.

FAQ: U.S. Immigration Health Screening for Overweight & Diabetes

Q: Is obesity or diabetes an automatic visa denial under the new policy? A: No—it’s case-by-case. Controlled conditions with financial proof usually pass.

Q: Do they test blood sugar during the I-693 exam? A: Not standard; based on self-reported history. Uncontrolled cases may need extra labs.

Q: How is overweight verified? A: Simple height/weight measurement for BMI. No special test.

Q: Can I get a waiver for denial? A: Yes, via Form I-601. We handle filings; approval depends on hardship to U.S. relatives.

Q: Does this affect green card renewals? A: No—focuses on new applications. Existing LPRs  face re-entry questions only.

Q: How much does treatment cost factor in? A: Officers estimate lifetime costs (e.g., $200K+ for diabetes complications) vs. your resources.

Contact us for personalized advice.