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The New York State Department of Health has affirmed the right of a gender-nonconforming transgender patient to Medicaid coverage for breast-reduction surgery in what advocates are calling a historic decision.

The state health department overturned on May 11 a decision by an administrative judge that had upheld Medicaid insurer Healthfirst's denial of coverage for a mammoplasty procedure for a 27-year-old transgender person, saying the operation was not medically necessary. The administrative law judge had ruled in June 2017 that the regulation guaranteeing nondiscriminatory coverage for Medicaid patients for gender reassignment surgery did not apply to nonbinary individuals, but only for those transitioning from male to female or female to male.

The administrative judge's decision was appealed with assistance from the Legal Aid Society, the Sylvia Rivera Law Project and the firm Willkie Farr & Gallagher, acting pro bono.

In a statement announcing the DOH decision, Heidi Bramson, staff attorney with the Legal Aid Society's health law unit, said, “The Legal Aid Society is hopeful that this historic, precedent-setting decision will inform insurance plans, health care providers, judges and gender non-conforming individuals that health care discrimination on the basis of gender identity is illegal and it has no place in New York.”

In a statement, Wesley Powell, partner at Willkie Farr, said, “We are pleased with the Department of Health's decision in this important case, which should further cement the rights obtained in Cruz v. Zucker—that transgender, non-binary, and gender non-conforming New Yorkers have access to medically necessary, gender affirming health care.”

In an interview Friday, Powell said, “I think the case is particularly important coming now when there has been more of a public conversation that the experience of gender is not binary. This is a critically important decision.”

The Legal Aid Society, Sylvia Rivera Law Project and Willkie Farr filed Cruz in 2014 challenging a state regulation that banned Medicaid coverage for sex reassignment-related procedures and treatments. The federal lawsuit decided by U.S. District Judge Jed Rakoff in July 2016 in the Southern District of New York led to a repeal of the ban, and an amended regulation effective December 2016 that required Medicaid to cover medically necessary procedures for individuals with a diagnosis of gender dysphoria.