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.