The administration of U.S. President Donald Trump has instructed American consulates worldwide to factor in applicants’ chronic illnesses when evaluating visa requests. According to a directive signed by Secretary of State Marco Rubio, consular officers must now explicitly assess the health status of visa seekers.

The Washington Post reports that the list of conditions that may warrant a denial includes cardiovascular and respiratory diseases, cancer, diabetes, metabolic and neurological disorders, as well as mental health conditions. The document notes that treatment for such illnesses can require medical expenditures amounting to hundreds of thousands of dollars.

The guidance also specifies that officers should consider applicants’ obesity due to its links to sleep apnea, hypertension, and clinical depression. Additional criteria include whether the applicant is at or beyond retirement age and how many dependents they support.

White House spokesperson Anna Kelly stated that for nearly a century, State Department policy has allowed denials when an applicant poses a potential “financial burden on taxpayers.” She added that the Trump administration is “finally implementing this policy in full.”