Insurance companies may no longer deny gender reassignment surgery to New Yorkers who need it. In a letter to insurers obtained by the Times, Governor Cuomo made it clear that if a doctor determines a patient needs the procedure, the companies must pay.

“This is an absolute sea change in the way that insurance for transgender people will cover their health care needs,” Michael Silverman, the executive director of the Transgender Legal Defense and Education Fund told the Times. “This essentially opens up an entire world of treatment for transgender people that was closed to them previously.”

New York is not necessarily a pioneer in this respect; eight other states, as well as D.C., all require insurers to pay for the surgery. A group of transgender patients sued the state this past summer, demanding that Medicaid also cover the procedure, a case they are likely to win.

Earlier this week the City Council passed a bill that makes it easier for transgender New Yorkers to change their birth certificates to reflect their actual identity.

State Senator Brad Hoylman told the Times that the wave of action meant it was time to pass a "transgender civil rights act," and lamented the fact that Medicaid currently doesn't cover the procedure. “Nobody should be in that position in order to embrace such a fundamental aspect of their personhood."