On June 11, 2025, the Trump administration announced immediate changes to the green card application process, a move that has sent ripples through immigrant communities and advocacy groups across the United States. The U.S. Citizenship and Immigration Services (USCIS) introduced a new requirement mandating a renewed medical examination form for every permanent residency application. This policy shift, framed as a measure to safeguard public health, has sparked debates over its implications for cost, accessibility, and bureaucratic efficiency. With the administration signaling a broader overhaul of immigration policies, this change is seen as a precursor to further restrictions. This article explores the details of the new rules, their impact on applicants, and the broader context of the Trump administration’s immigration agenda.
The New Green Card Eligibility Rules
The cornerstone of the updated policy is the mandatory submission of a fresh Form I-693, Report of Medical Examination and Vaccination Record, for every green card application. Previously, a medical examination form submitted with an initial application remained valid for subsequent filings, provided it was unexpired (typically valid for two years from the date of the civil surgeon’s signature). Under the new rules, applicants must obtain a new medical examination for each application, regardless of prior submissions or validity periods.
The Form I-693 requires applicants to undergo a comprehensive medical evaluation conducted by a USCIS-designated civil surgeon. The examination includes tests for communicable diseases such as tuberculosis, syphilis, and gonorrhea, as well as verification of vaccination records for diseases like measles, mumps, rubella, and COVID-19. The administration justifies this change as a necessary step to ensure that all green card recipients meet stringent public health standards, citing concerns about emerging health threats and the need for up-to-date medical data.
In addition to the medical examination requirement, the administration has tightened scrutiny on other eligibility criteria. Applicants must now provide more detailed documentation of their financial stability, including recent tax returns, employment verification, and proof of health insurance coverage. The public charge rule, which assesses whether an applicant is likely to rely on government assistance, has been reinstated with stricter enforcement. These changes align with the administration’s broader goal of reducing immigration levels and prioritizing applicants deemed to contribute economically to the U.S.
Impact on Green Card Applicants
The new rules have significant implications for green card applicants, particularly those navigating employment-based, family-based, or diversity visa pathways. The requirement for a new medical examination adds both financial and logistical burdens. The cost of a medical exam varies but typically ranges from $200 to $500, depending on the civil surgeon and the applicant’s location. For families or individuals filing multiple applications, these costs can quickly accumulate, posing a barrier for low-income applicants.
Moreover, the availability of USCIS-designated civil surgeons is limited in some areas, particularly rural regions or communities with fewer healthcare providers. Applicants may face long wait times to secure appointments, potentially delaying their application process by weeks or months. For those applying through adjustment of status, where timing is critical to maintaining legal presence in the U.S., these delays could have serious consequences, including lapses in work authorization or deportation risks.
South Asian communities, which represent a significant portion of green card applicants, particularly through employment-based visas like the H-1B program, have expressed particular concern. Advocacy groups such as the South Asian Americans Leading Together (SAALT) have criticized the policy as disproportionately affecting their communities, many of whom already face lengthy backlogs due to per-country visa caps. For example, Indian nationals, who account for a large share of employment-based green card applicants, often wait decades for visa availability. The added requirement of repeated medical examinations exacerbates an already arduous process.
Broader Context of the Trump Administration’s Immigration Policies
The changes to green card eligibility rules are part of a broader immigration agenda under the Trump administration, which has prioritized reducing both legal and illegal immigration. Since taking office in January 2025, the administration has reinstated several policies from its first term, including expanded border enforcement, restrictions on asylum processes, and revisions to legal immigration pathways. The reinstatement of the public charge rule, which was temporarily relaxed under the Biden administration, signals a return to a merit-based immigration framework that emphasizes self-sufficiency.
The administration’s focus on public health as a justification for the new medical examination requirement reflects a recurring theme in its immigration rhetoric. During its first term, the Trump administration implemented policies such as the travel ban on several Muslim-majority countries and heightened vetting procedures, often citing national security or public safety concerns. The current policy echoes this approach, framing immigration control as a matter of protecting American citizens from perceived risks.
Critics argue that the new rules are less about public health and more about creating additional barriers to immigration. Immigrant advocacy organizations, such as the American Immigration Council, have pointed out that existing medical examination protocols were already robust, with stringent requirements for communicable disease testing and vaccinations. They contend that the policy change is designed to deter applicants and reduce the number of green cards issued annually.
Reactions from Stakeholders
The policy has elicited a range of reactions from stakeholders, including immigrant communities, legal experts, and policymakers. Advocacy groups have vowed to challenge the new rules in court, arguing that they violate administrative procedures and impose undue burdens on applicants. The American Civil Liberties Union (ACLU) has indicated plans to file a lawsuit, claiming that the policy discriminates against low-income and minority applicants by increasing financial and logistical barriers.
On the other hand, supporters of the administration’s policies argue that the changes are a necessary step to modernize the immigration system. Conservative think tanks, such as the Center for Immigration Studies, have praised the administration for prioritizing public health and economic self-sufficiency. They argue that requiring updated medical examinations ensures that green card recipients do not pose health risks to the broader population, particularly in the wake of global health crises like COVID-19.
Lawmakers are also divided on the issue. Republican leaders in Congress have expressed support for the administration’s efforts to tighten immigration controls, viewing the policy as part of a broader strategy to address border security and legal immigration backlogs. Conversely, Democratic lawmakers have condemned the changes, accusing the administration of using public health as a pretext to restrict legal immigration. Some have called for congressional oversight to review the policy’s implementation and its impact on vulnerable communities.
Economic and Social Implications
The new green card eligibility rules could have far-reaching economic and social consequences. The U.S. economy relies heavily on immigrant labor, particularly in industries such as technology, healthcare, and agriculture. Employment-based green card holders, many of whom are highly skilled professionals, contribute significantly to innovation and economic growth. By increasing the cost and complexity of the application process, the new rules may deter talented individuals from pursuing permanent residency, potentially driving them to other countries with more streamlined immigration systems, such as Canada or Australia.
Socially, the policy risks exacerbating tensions within immigrant communities already grappling with uncertainty and discrimination. The heightened scrutiny of financial stability and health insurance requirements may disproportionately affect marginalized groups, including refugees and asylees, who often face economic challenges upon arriving in the U.S. Advocacy groups warn that the policy could deepen inequalities, making permanent residency accessible primarily to wealthier applicants.
Looking Ahead: Challenges and Opportunities
As the Trump administration continues to reshape the U.S. immigration system, the new green card eligibility rules are likely to face legal and political challenges. Courts may scrutinize the policy’s compliance with the Administrative Procedure Act, which requires federal agencies to follow transparent processes when implementing significant rule changes. Previous immigration policies under the Trump administration, such as the public charge rule, faced successful legal challenges, suggesting that the new medical examination requirement could be contested on similar grounds.
For applicants, navigating the new rules will require careful planning and resources. Immigration attorneys are advising clients to anticipate longer processing times and budget for additional medical examination costs. Community organizations are stepping up efforts to provide support, including legal clinics and financial assistance for low-income applicants. However, the capacity of these organizations is limited, and many applicants may struggle to access the help they need.
The policy also raises questions about the future direction of U.S. immigration policy. The Trump administration has signaled plans for further reforms, including potential changes to the diversity visa program and family-based immigration categories. As these policies unfold, they will likely continue to spark debates over the balance between national security, public health, and the contributions of immigrants to American society.
In Summary
The Trump administration’s immediate changes to green card eligibility rules mark a significant shift in the U.S. immigration landscape. By mandating new medical examinations and tightening financial scrutiny, the policy introduces additional hurdles for applicants, raising concerns about accessibility and fairness. While the administration frames these changes as necessary for public health and economic stability, critics argue that they are designed to restrict legal immigration and disproportionately harm vulnerable communities.
As the policy takes effect, its impact will be felt by millions of aspiring permanent residents, from highly skilled professionals to family-based applicants. The broader implications for the U.S. economy, social fabric, and global competitiveness remain to be seen. For now, the new rules underscore the ongoing tension between immigration control and the nation’s legacy as a land of opportunity for those seeking a better life.