Regulators in Oregon and California have directed several health insurance companies to stop denying coverage for transgender patients because of their gender identity.

The new regulations apply to companies insuring about a third of people in Oregon and about 7% of those in California.

Officials in Oregon and California have told some private insurance companies that they must pay for a transgender person’s hormone therapy, breast reduction, cancer screening or any other procedure deemed medically necessary if they cover it for patients who aren’t transgender.

Advocacy groups said the action is a major step forward in their long battle to win better health care coverage for transgender Americans.

“It’s just a matter of fairness,” said Ray Crider to the Associated Press, a 28-year-old trans man from Portland, Oregon. “I just never felt that I was like anybody else. I see everybody else being taken care of without having to fight the system.”

Officials in both states said the new regulations aren’t new policies but merely a clarification of anti-discrimination laws passed in California in 2005 and in Oregon two years later.

The Transgender Law Center in San Francisco said it was unaware of insurance regulators in any other states taking similar action.

Many US health insurance policies broadly exclude coverage of gender identity dysphoria or classify it as a pre-existing condition. Transgender patients are often denied coverage for medical procedures unrelated to a gender transition.

“This is a very historic bulletin, and it really indicates that the tide is turning on this issue,” said Tash Shatz, a transgender justice community manager at Basic Rights Oregon, an advocacy group.

Trans campaigners say gender confirmation, through hormone treatment or surgery, is medically necessary, and they’ve long fought insurance companies that argue that the procedures are cosmetic.

They hope the new state regulations will mean fewer procedures are refused and can make it easier to appeal a denial.