The commissioners of the Minnesota Department of Health and the Minnesota Department of Commerce issued a joint bulletin to health insurance providers on Monday.

“The purpose of this Bulletin is to advise entities delivering or issuing individual and group health insurance policies in Minnesota that discrimination against an individual because of the individual’s gender identity or expression is prohibited,” health commissioner Edward Ehlinger and commerce commissioner Mike Rothman wrote.

The bulletin notes that both Minnesota law and the Affordable Care Act prohibit denial of insurance coverage or claims based on gender identity.

Minnesota is the 15th state to have either a state law mandating equitable health insurance coverage for transgender people or has issued guidance stating that insurance companies cannot discriminate.

Minnesota joins California, Colorado, Connecticut, Delaware, Illinois, New Hampshire, New Jersey, Maryland, Massachusetts, Nevada, Oregon, Rhode Island, Vermont, Washington, and the District of Columbia in either prohibiting discrimination on the basis of gender identity in statute or have issued guidance to insurance companies outlining the ban on discrimination.

Nevada and Rhode Island are the most recent states reminding insurers that discrimination is illegal. Nevada issued such guidance in June, and Rhode Island followed suit last week.

The Minnesota commissioners noted that their departments “are committed to ensuring that Minnesotans do not face discrimination in accessing medically necessary health care benefits, including those based on transsexualism, gender identity disorder, and gender dysphoria.”

The commissioners continued, “Commerce and Health currently disapprove policy forms filed by insurers if there are exclusions on coverage for medically necessary treatment for gender dysphoria and related health conditions, including gender confirmation surgery (previously known as sex reassignment surgery). Commerce and Health will also continue to conduct independent 2 reviews for denials of coverage on the basis that services are not medically necessary via the Departments’ external review programs. Determination of medical necessity and prior authorization protocols for gender dysphoria-related treatment must be based on the most recent, published medical standards set forth by nationally recognized medical experts in the transgender health field.”

Though the commissioners note that private health insurers cannot discriminate under Minnesota law, public health programs in the state do discriminate.

Minnesota law specifically forbids the state’s Medicaid program from covering gender confirmation health care for transgender people. The state covered such procedures until 2005 when legislators passed, and Republican Gov. Tim Pawlenty signed, a health and human services omnibus bill that blocked the coverage. Currently, Medical Assistance, General Assistance Medical Care, and MinnesotaCare do not provide equitable health care for transgender Minnesotans.

A bill introduced in 2015 and up for consideration in 2016 would change that.