Oakton Health Center

1. October 2025 Visa Bulletin Released: Important Actions to Take
The October 2025 Visa Bulletin is out marking the start of the new fiscal year, leading to the movement in green card queues and opening up possible pathways for those waiting for employment-based green cards. The bulletin guides two groups; firstly, those who can now submit their Adjustment of Status due to their priority date becoming current and secondly those with pending Adjustment of Status who will soon have a visa number available for approval. It also explains the difference between filing dates and final action dates. The former allows individuals to line up to file their I-485, while the latter signifies that a visa number is available for approval. For those preparing to file their I-485, the bulletin provides tips on gathering necessary documents and forms along with a recommended filing strategy. For those with pending I-485 forms, the bulletin advises on potential litigation possibilities if their case has stalled and also gives updates regarding medical exams and portability, among other topics. It also discusses a family-based F2A strategy that can fast track approval for certain families.

2. USCIS Immigration Medical Exam Guidance
The United States Citizenship and Immigration Services (USCIS) announced that from November 1, 2023, the immigration medical exam reports, Form I-693, completed by applicants will remain valid indefinitely. That being said, immigration officers may request an updated medical exam if they suspect a change in the applicant’s health status since the prior exam, or if the old form does not accurately reflect the applicant’s current health condition. Existing rules still apply to Forms I-693 completed before November 1, 2023, whereby these forms are only valid for two years from the date of signing by the civil surgeon. An exception has been made for certain Afghan parolees whose forms remain valid for three years.

3. MR #25.20 Medical PM/WAG Updates to Asylum Applicants and Torture Victims (AATV) and Victims of Trafficking, Torture or Other Serious Crimes (VTTC)
This manual release elucidates new procedures on processing AATV/VTTC cases. This includes new policies defining “Derivative Family Members” for VTTC cases, protocols for verifying AATV and VTTC status, and differentiating state-funded medical coverage and federally funded Medicaid. The amended VTTC eligibility rules indicate that an applicant for state-funded VTTC benefits must have a child or other derivative family member, have filed for T Visa, U Visa, or Asylum, and meet financial eligibility requirements. Single adult applicants who don’t fulfill the “derivative family members” criterion may still qualify for AATV benefits. The verification procedure for the filing status of AATV/VTTC applicants is also detailed.

The Trump administration has announced immediate changes to the green card application process. The United States Citizenship and Immigration Services (USCIS) has made it a requirement for every new permanent residency application to entail a renewed medical examination form. This is a change from the previous policy wherein applicants were allowed to use their completed and signed I-693 forms indefinitely. Consequently, this policy move will directly affect immigrants currently applying for adjustment of status, who would otherwise have been allowed to use a previous form signed by a civil surgeon until June 10, 2025.

USCIS clarified that the change would apply to the I-693 medical examination form, titled “Report of Immigration Medical Examination and Vaccination Record”, involving those applying for adjustment of status or seeking to be permanent residents. Notably, April 2024 saw fresh changes to the USCIS policy, which allowed any signed I-693 form from November 1, 2023, onwards to be used indefinitely, even if the immigrant withdrew a green card application and re-applied, or applied for a different immigration benefit later. However, as of June 11, 2025, if an application is withdrawn, the I-693 form is invalidated and the applicant would need to retake the medical examination.

The changes could potentially affect thousands of applicants looking to file their adjustment of status application, known as Form I-485. The exams, somewhat similar to physical examinations, include checks for specific conditions or diseases that could render a person inadmissible to the U.S. The examiner, a civil surgeon, also scrutinizes an applicant’s vaccination records. The exam can range from $100 to $500, making it a financial burden to some as the changed policy may force them to repeat the procedure.

In related news, the Department of Homeland Security (DHS) published a final rule on ‘public charge’, bringing clarity for noncitizens on how DHS will administer the public charge ground of inadmissibility concerning a person’s denial of a green card is likely to become a public charge.

Focusing on international students, visa processing has commenced for Harvard University students and exchange visitors. The move follows the issuance of a court order against a Trump-era proclamation. As of now, the concessions hold only for Harvard-affiliated individuals, while students at other institutions remain unaffected.

Furthermore, USCIS announced the termination of the CHNV parole programs for Cubans, Haitians, Nicaraguans, and Venezuelans following a Supreme Court ruling. Global mobility teams are thus advised to review and prepare for possible CHNV parolee work authorizations revocations to avoid compliance risks.

An intriguing amendment is the fine waiver for undocumented individuals who opt for self-deportation via the CBP One Home App. The waived fines, otherwise totaling nearly $1,000 per day after a final removal order or for late voluntary departures, could lead to an increase in voluntary departures among undocumented workers.

In conclusion, the Trump administration’s tougher stance on immigration enforcement continues. In particular, the revocation of green cards belonging to those viewed as having violated immigration laws has come under increased scrutiny. Furthermore, the administration has emphasized that green cards do not equate to citizenship, and can be revoked on national security grounds or due to immigration law violations or criminal convictions.

The process for becoming a U.S. citizen involves a mandatory medical examination which can be cost-prohibitive for applicants, particularly in areas like Kansas City where there are limited options. The exam, not covered by most insurance policies, must be performed by physicians qualified by Immigration Services. The test includes a review of a patient’s medical history, a physical examination, a chest x-ray, and blood tests. In Kansas City, 17 locations have the necessary civil surgeons to perform the exam; however, with the city’s growing immigrant population, waiting lists are long. The exam cost reportedly varies with prices reaching up to $1,400, a hefty sum for many immigrants.

This situation led Priyanka Raeburn, an immigrant from New Delhi, India, to seek a low-cost alternative at community health center KC CARE, where the exam’s base cost is $250. Dr. Craig Dietz, KC CARE Health Center’s chief medical officer, noted that the exams’ purpose is to screen for communicable diseases and ensure vaccine records are current. His clinic, started about a year ago, sees between 500 to 600 patients, many of whom are immigrants. Despite concerns over how President Trump’s policies might impact immigration, Dietz doesn’t see the demand for the services his clinic offers declining.

In June, the Trump administration reversed a policy related to green cards, causing every new permanent residence application to require a renewed medical examination form – effective immediately. This rule includes applications already pending or filed after June 11, 2025, and affects those applications linked to Form I-693 (Report of Immigration Medical Examination and Vaccination Record). The change means applicants must pay for the medical exam, performed by a civil surgeon, more than once if their application is denied or withdrawn.

Furthermore, President Trump also announced the introduction of a “gold card” system aiming to allow successful applicants to purchase a green card for $5 million. This move is believed to be part of his plans to replace the EB-5 visa program, which provides green cards to individuals who invest in the U.S. However, any changes to the EB-5 program would require congressional approval.