The Trump administration has swiftly followed through on its promise Thursday to grant approval for states to impose work requirements on their Medicaid programs, giving Kentucky a green light Friday afternoon.

Nine other states have similar waiver requests sitting before Trump’s Department of Health and Human Services, and more approvals are expected in the coming weeks.

It’s the first time in the program’s 50-plus-year history that such a requirement has been allowed, and lawsuits are expected to follow close on the heels of the announcement.

Kentucky applied for the waiver back in the summer of 2016, asking for permission to make Medicaid only available to non-disabled adult residents who work at least 20 hours per week, volunteer, study, or take care of a family member. Additionally, Kentucky has gotten the ability to charge low-income Medicaid recipients health care premiums, implement a six-month lockout period for people who fail to re-enroll in time, and eliminate full coverage of dental care, vision services, and over the counter medications for many adults. Former foster care youth, pregnant women, and full-time students are exempt.

As the governor himself stated in the waiver application, a full third of Kentucky’s population is on Medicaid, and a main goal of the new work requirement and other restrictions is to cut down that number. “This is an expense Kentucky cannot afford,” Bevin wrote.

A chart included in the waiver application shows the state expects enrollment to drop by tens of thousands of people over the course of five years due to the new rules.

The National Health Law Program said in a statement to TPM that the waiver approval violates federal law, and that litigation will soon be filed.

“The action appears designed to achieve significant cuts in Medicaid enrollment rather than Medicaid’s stated purpose of furnishing medical assistance to low-income people,” NHeLP Legal Director Jane Perkins said.