The Trump administration has swiftly implemented changes to the green card application process, announcing on Wednesday that all new applicants must now submit an up-to-date medical examination form. The United States Citizenship and Immigration Services (USCIS) declared that its earlier policy—allowing indefinite use of the medical exam form—posed potential risks to public health and will no longer be valid.
Previously, immigrants applying for permanent residency were permitted to reuse an I-693 medical form that had been signed by a certified civil surgeon, even after long intervals. However, under the new rule, effective June 11, 2025, that flexibility has been eliminated. Every new green card application must now be accompanied by a freshly signed medical report, regardless of whether a similar form had been used in a prior, withdrawn, or denied application.
The change could significantly affect individuals currently seeking adjustment of status, who until now had a deadline of June 10 to submit forms signed under the old guidelines. These abrupt changes offer little to no time for applicants or their legal representatives to adjust, a departure from previous USCIS practice, which typically allowed a grace period for transitioning to new policies.
The medical examination form in question, known as the I-693 or “Report of Immigration Medical Examination and Vaccination Record,” is a key part of the green card application process. It is designed to identify health-related grounds of inadmissibility to the U.S., such as infectious diseases or missing vaccinations. While these forms were previously valid indefinitely if signed after November 1, 2023, the new directive revokes that policy.
Under the revised guidelines, once an application is withdrawn, any corresponding I-693 form becomes invalid. This forces the applicant to undergo a new medical exam and secure a freshly signed form. This change is expected to affect thousands of immigrants who are in the midst of preparing their Form I-485, which is used to apply for lawful permanent resident status.
“This is pretty typical of the kind of changes we’ve been seeing. Time was that they would at least give you some grace period, some lead up, but this means that things that were in the mail this week are going to be invalid potentially,” said Matt Cameron, an immigration attorney with the law firm Cameron Micheroni and Silvia in Boston, in an interview with Newsweek.
The implications of this shift are not only procedural but also financial. Immigration medical exams, which include general physical assessments, vaccination record verification, and disease screening, generally cost between $100 and $500. Cameron highlighted the concern that applicants could end up paying for the process multiple times. With the new rule, every new filing will necessitate another round of testing, which could place additional financial burdens on immigrants.
Before December 2024, filing the I-693 was a requirement only for applicants who needed to show they were not inadmissible on medical grounds. Now, every applicant for a green card must file this form, and even those applying for other types of visas might be required to do so, at USCIS’s discretion.
This regulatory tightening reflects a broader trend under the Trump administration, which has intensified its scrutiny of both temporary and permanent visa applicants. These efforts align with the administration’s goal of cracking down on perceived abuses of the immigration system.
A similar abrupt change in March caused considerable confusion among applicants. A wave of modifications to several immigration forms at that time prompted a lawsuit from immigration attorneys, who argued that the changes were too sudden and left applicants unprepared. In response, USCIS had to provide a two-week buffer before implementing those modifications.
The new rules come amid a more aggressive stance by the Trump administration on immigration enforcement, which includes taking actions even against green card holders. In one prominent case from March, federal agents detained Mahmoud Khalil, a green card holder, Columbia University graduate, and participant in pro-Palestinian protests. Although he held lawful permanent resident status, the administration argued that his actions contradicted U.S. foreign policy and pursued his removal from the country.
Instances like Khalil’s, where green card holders have been detained domestically or refused entry upon returning from international travel, are becoming more common. While not entirely new, these occurrences were rare prior to the administration’s more hardline stance following January 20.
The federal government continues to emphasize that a green card does not equate to U.S. citizenship and can be revoked for a range of reasons, including violations of immigration law, criminal activity, or national security concerns.
Commenting further on the recent policy change, Matt Cameron told Newsweek, “They usually would give this until the end of the month or something, so the applications that are just about to be filed can be honored. It’s not a radical change, but I think it’s very much of a piece of the trend here in just making everything more difficult. Across the board [they] have made every kind of contact with the immigration system more difficult.”
Elissa Taub, an immigration attorney at Siskind Susser in Houston, Texas, also offered her perspective. “Previously, I-693s all had an expiration date, so we had clients needing to get multiple exams done while their I-485s were pending over many years due to backlogs,” she said.
“Currently, I-693s don’t expire, and it sounds like they are clarifying that if you withdraw that application or it’s denied, you can’t reuse the same unexpired I-693 with a new application. I don’t think this is too earth-shattering, and I’m happy that this policy change is relatively narrow and that they didn’t decide to create a new pre-filing expiration period,” Taub added.
USCIS explained its rationale in a statement accompanying the new directive: “We have since determined that the April 4, 2024, policy is overly broad and could potentially threaten public health in the United States. By limiting the validity period to only the current immigration benefit application or request, we ensure that aliens get timely and proper medical examinations and treatment, which safeguards public health.”
While the latest update may seem like a technical adjustment, it carries significant implications for applicants navigating an already complex and often costly immigration system. The decision underscores the Trump administration’s consistent approach: increasing the stringency of immigration processes under the premise of safeguarding national interests.