The U.S. Supreme Court gave the Trump administration permission this week to go ahead with a rule that would make it tougher for low-income immigrants to get green cards — a move that immigration and health care advocates in Minnesota expect will lead to a new era of confusion.

The controversial proposal would expand the government's authority to deny green cards for certain categories of legal immigrants who are a "public charge," or those receiving federal assistance for housing, nutrition and health care.

Alarm and confusion over the convoluted details of the law since it was proposed in 2018 have affected far more people than the immigrants to which it actually applies, immigrant advocates said.

"Every time that something new happens, it just heightens that fear," Portico Healthnet President Meghan Kimmel said.

She anticipates an increase in clients who will call with questions and requests to disenroll in health coverage and cancel appointments. When people don't have insurance, Kimmel added, they are less likely to use primary and preventive care and may go to the emergency room.

"Even for those who do have insurance, there is a greater hesitation to see the doctor because they are afraid and they just don't understand what the rules are and also what could change," Kimmel said. "And that unknown, I think, is what has been the scariest part for many of the clients that we work with."

The U.S. has long had a law making someone who is likely to become a public charge ineligible to become a legal permanent resident, but the new rule expands that definition. The law primarily affects those seeking permanent resident status through family member petitions, and many types of immigrants are exempt, including refugees and asylees.

"I am tired of seeing our taxpayer paying for people to come into the country and immediately go onto welfare and various other things," President Donald Trump said of the rule.

Anne Quincy of Mid-Minnesota Legal Aid said the law does not apply to 95% of the people who have called the organization about the public charge rule or attended the organization's presentations on the issue, including people whose U.S. citizen children are receiving benefits. Low-income people receiving MinnesotaCare will also not be affected by participating in the state program.

She said it's disheartening to see the Trump administration acknowledging that people are now disenrolling from benefits for which they are eligible. Discouraging people from applying for benefits "is not a good goal, it's not a lawful goal, and I think in fact it will turn out to be a serious problem in the case for them," Quincy said.

The Minnesota Department of Human Services said it is providing outreach to county, tribal and community partners to share updates about the rule, and Commissioner Jodi Harpstead said in a statement that the agency continues to be concerned that the rule will create fear and confusion among noncitizens.

Hennepin Healthcare Dr. Rachel Sandler Silva said there's often fear around accessing medical care, particularly preventive services such as cancer screenings and immunizations. She works with many families of mixed immigration status, with someone who isn't affected by the public charge rule but doesn't access medical care out of concern for a family member who they think could be penalized.

"If people aren't accessing health care, we do run the risks of outbreak for diseases like measles and hepatitis A, where vaccination can be a key part of prevention," Silva said.

This is Medicaid, a coalition seeking to protect the program from funding cuts, is trying to bring together medical professionals in the next few days to look at what the ruling will mean for immigrants. Spokesperson Laura Mortenson added that advocates are reminding people that they shouldn't assume they can't receive certain types of benefits.

Veena Iyer, executive director of the Immigrant Law Center of Minnesota, said she believes the public charge rule will not be permanent because it is legally baseless, but in the meantime, she's concerned that the temporary implementation of it "will exacerbate the fears that have been in place ever since the rule was first announced."