Maryland has officially become the third state in the nation to provide insurance coverage for transition-related care,The Baltimore Sun reported Tuesday.

The policy shift, which went into effect July 1 but was only announced publicly this week, means that any state employee, retiree, or dependent will be able to access mental health services, hormone therapy, and a range of surgeries associated with gender reassignment without having to pay entirely out of pocket. California and Oregon are the only other states that provide similar insurance coverage for their transgender employees.

The change was made as a result of a discrimination complaint brought by 31-year-old Sailor Holobaugh, a clinical research assistant in at the University of Maryland School of Medicine, who was denied reimbursement for a transition-related mastectomy in 2012. Holobaugh appealed the decision with the Maryland Insurance Administration and the Maryland Attorney General’s Office, and was eventually awarded nearly $4,500 from his state-provided insurance plan to cover $6,000 in surgery costs.

Rather than agreeing to only reimburse Holobaugh, however, state officials decided to shift Maryland’s entire health care policy for its transgender employees.

“It’s a pretty sweeping change,” Jer Welter, managing attorney at Free State Legal, told The Baltimore Sun. “It is going from care for gender transition being completely, categorically excluded in all of the plans, to being fully covered under all of the plans.”

It’s not just Maryland where transgender individuals are gaining ground. The state’s policy change reflects a wave of growing understanding and acceptance for what used to be considered a disorder. In the most recent version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), counseling, cross-sex hormones, gender reassignment surgery, and legal transition to the desired gender are all listed as treatment options for gender dysphoria — a condition in which there is a marked difference between a person’s expressed or experienced gender and the gender others would assign him or her. Earlier this year, the American Medical Association wrote that “the only effective treatment of [gender dysphoria] is medical care to support the person’s ability to live fully consistent with one’s gender identity.”

California, Colorado, Connecticut, Oregon, Vermont, and Washington, D.C., all prohibit private insurers from excluding coverage for gender dysphoria treatments, The Boston Globe recently reported. Additionally, Massachusetts, California, and Vermont have Medicaid programs guaranteeing gender dysphoria treatment for lower-income and disabled people.

Federal and state nondiscrimination laws are also changing with the times. On Monday, President Obama signed an executive order barring federal contractors from discriminating on the basis of sexual orientation or gender identity. He also expanded workplace protections to transgender employees of the U.S. government. And earlier this year, Maryland passed a law protecting transgender people from labor, housing, public accommodation, and employment discrimination.