According to the recently revised Centers for Disease Control and Prevention (CDC) guidelines, medical examinations for immigrant and refugee status, as well as for some non-immigrants, should include screening for physical or mental disorders associated with harmful behavior, alongside substance use disorders. This is based on regulations outlined in the Immigration and Nationality Act (INA), identifying three areas of inadmissibility related to such conditions.
The guidelines delineate harmful behavior as actions linked to physical or mental disorders or non- Controlled Substances Act (CSA) substance use disorders resulting in psychological or physical harm to the individual or others, serious threats to health or safety, or significant property damage. Specific disorders commonly associated with such harmful behaviors include mood disorders, anxiety disorders, personality disorders, sexual disorders, and schizophrenia.
For substance use disorders, the diagnosis is based on a set of cognitive, behavioral, and physiological symptoms indicating substance use despite related issues. An applicant must meet at least two out of 11 criteria to establish a diagnosis, and a panel physician must review these during the screening.
If physicians are unable to determine if an applicant has an inadmissible condition, they may postpone the diagnosis and classification for 3-6 months to obtain additional medical evidence. Laboratory testing for substances should not be conducted on all applicants but must be carried out in certain circumstances, designed to inform specific diagnoses and classifications.
The guidelines recognize the concept of remission, meaning if harmful behaviors associated with the condition have not occurred in the past 12 months and the condition is managed through medication or therapy, it can be considered in remission.
The updated guidelines further cover topics on sexually dangerous people, screening results and classifications, and conditions such as marijuana use, prescription drug misuse, and pedophilic disorder. Ultimately, the guidelines are intended to standardize the process to ensure the safety and health of the U.S. population while treating immigrant and refugee applicants fairly and equitably.
1. October 2025 Visa Bulletin Released: Important Actions to Take
The new fiscal year’s October 2025 Visa Bulletin has been released. This bulletin may create opportunities for those awaiting their employment-based green cards to either file their Adjustment of Status (I-485) or get their pending case approved. The bulletin guidelines include:
– Group 1: Those who are now able to submit the I-485 based on the Dates for Filing chart.
– Group 2: Those with an already pending I-485 becoming current under the Final Action Dates chart — signaling that a visa number may soon be available.
The bulletin acts as a guide to green card processing, with monthly updates. In particular, October marks the start of the federal fiscal year, which often brings new visa numbers and category movement. For group 1, those eligible to file their I-485, this represents a significant milestone. For group 2, those whose I-485 is pending and near approval, it’s crucial to stay prepared to avoid further delays. Some cases may benefit from delay litigation if they’ve lingered due to background checks, misplaced files, or agency slowdowns.
Other notes include the possibility of a family-based F2A strategy being beneficial for EB applicants and the need for individuals to refresh their medical exams proactively, use the Supplement J document correctly, consider suitable entry into a new category, and respond promptly to USCIS. Applicants should also adhere to travel rules and work regulations while their cases are pending.
2. Trump admin changes requirements for green cards ‘effective immediately’
The Trump administration has implemented an immediate change to green card requirements, reversing a policy that was established just over a year ago. The United States Citizenship and Immigration Services (USCIS) now requires that every new permanent residency application must include a renewed medical examination form. This imposes an additional cost, as medical exams can range from $100 to $500. Furthermore, if a person withdraws their application or has it denied, they must undergo another medical exam when they reapply.
President Trump also introduced a “gold card” option, allowing individuals to buy a green card for $5 million. Though he claimed this could erase the national debt, experts suggest it would allocate between $25 and $40 billion.
3. Trump Admin Makes Green Card Change ‘Effective Immediately’
The Trump administration announced changes to the green card application process. The USCIS highlighted that the policy changes could directly impact immigrants currently applying for adjustment of status. Previously, USCIS had stated that medical exam forms would be valid indefinitely, however, under the new rule set to commence June 11, 2025, the I-693 form will be considered invalid if an application is withdrawn. Green card applicants are now required to file this medical exam form which can range between $100 and $500 in costs.
4. Trump administration announces immediate changes to green card policy
The Trump administration has announced alterations to the green card application process with immediate effect. These changes invalidate previously used medical forms in the event of an application withdrawal or reapplication for different immigration benefits. Applicants must obtain a new medical exam and then submit a new Form I-693. This new policy comes into effect from June 11, 2025. This will likely cause several thousands of South Asian immigrants, applying for adjustment of status to face additional costs. Attorneys suggest that this is more than a minor change as it has immediate enforcement, affecting the many applicants mid-submission, and potentially requiring them to restart significant parts of the process.
