While the Virginia legislature voted Wednesday to expand Medicaid and provide health coverage to an additional 400,000 low-income residents, ending a years-long battle among state lawmakers, the Democrats’ victory was tainted by a work requirements provision made possible by a Trump administration policy unveiled earlier this year, which permits such rules for the first time in the program’s history.

With Democratic Gov. Ralph Northam, a pediatrician and Army doctor by trade, planning to sign the measure into law, Virginians and advocates for Medicaid expansion welcomed the development but emphasized the dangers of the caveat, which, as research from the Center on Budget and Policy Priorities has shown, “will almost certainly cause many low-income adults to lose health coverage.”

Once Northam signs the bill, Virginia will join the 32 other states plus D.C. that have expanded Medicaid under the Affordable Care Act (ACA), according to the Kaiser Family Foundation (KFF), which tracks state actions on the program. Northam told a local radio station he expects the expansion to take effect in January.