
The coverage extends to all D.C. residents with group or individual health insurance — including the roughly one-third of city residents receiving Medicaid benefits — whose doctors diagnose the condition and for whom treatment is deemed medically necessary.
"This action places the District at the forefront of advancing the rights of transgender individuals," Mr. Gray said at his ceremonial office at City Hall. The District joins California, Colorado, Connecticut, Oregon and Vermont in requiring the coverage, which the federal government will not be made to offer to its employees

Transgender activists applauded the move, saying it guarantees coverage for treatments such as gender reassignment surgery that can cost tens of thousands of dollars and which have been denied by insurance companies that deemed the procedures cosmetic.
"This isn't about who's paying for things. This is about whether or not it's medical care and who gets to decide that," said Mara Keisling, executive director of the National Center for Transgender Equality. "Nobody in America wants their health care decisions made by the insurance companies."
The National Center for Transgender Equality estimates that 2,000 transgender people live in the District, though it's unclear know how many might seek treatment under the coverage.
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