In medical image classification, data privacy constraints and the high cost of expert annotations pose significant challenges to building generalizable models. Federated semi-supervised learning (FSSL), which combines the privacy-preserving nature of federated learning with the label efficiency of semi-supervised learning, offers a promising direction. However, in real-world deployments, client data often exhibits highly non-independent and identically distributed (Non-IID) characteristics. This distributional heterogeneity undermines the reliability of pseudo-labels generated by global models, ultimately limiting model generalization. A key limitation of existing FSSL approaches lies in their reliance on a static labeled set fixed prior to training. Such strategies lack the ability to adaptively correct pseudo-label noise or address class imbalance throughout training, particularly under Non-IID settings. To address this, we propose FSSAL, a novel framework that introduces an active learning component into the FSSL pipeline. By continuously identifying informative and representative samples during training, our method adaptively refines the labeled set and enhances the model’s robustness to distribution shifts. FSSAL employs client-private models for pseudo-label generation to reduce global bias, applies a class-aware dynamic thresholding mechanism to ensure more reliable and balanced label selection, and incorporates a sample selection strategy guided by both feature diversity and model uncertainty. Extensive experiments on four public medical image classification datasets demonstrate that FSSAL consistently outperforms competitive FSSL methods in accuracy and F1-score, especially under highly Non-IID conditions, highlighting its robustness and practical potential.