CHARLESTON, W.Va. (AP) — West Virginia’s Medicaid program must provide coverage for gender-confirming care for transgender residents, a federal judge ruled.

U.S. District Judge Chuck Chambers in Huntington made the ruling Tuesday in a lawsuit filed by LGBTQ interest group Lambda Legal over treatments for gender dysphoria. Chambers said the Medicaid exclusion discriminated on the basis of sex and transgender status and violated the Equal Protection clause of the 14th Amendment, the Affordable Care Act and the Medicaid Act.

Chambers certified the lawsuit as a class action, covering all transgender West Virginians who participate in Medicaid.

“Protecting and advancing health care for transgender people is vital, sound, and just,” Lambda Legal attorney Avatara Smith-Carrington said in a statement. “Transgender West Virginia Medicaid participants deserve to have equal access to the same coverage for medically necessary healthcare that cisgender Medicaid participants receive as a matter of course.”

The original lawsuit also named state employee health plans. It was filed on behalf of Christopher Fain, who was denied coverage for his testosterone prescription under Medicaid, and Zachary Martell, who is married to a state employee with health care coverage. Both Fain and Martell were denied coverage for a bilateral mastectomy.

Last September, two plaintiffs were added to the lawsuit. Transgender women Shauntae Anderson and Leanne James were denied coverage for gender-confirming care, according to the lawsuit. Anderson is enrolled in a Medicaid plan and James was enrolled in a Public Employees Insurance Agency health plan offered by the state.

A settlement with The Health Plan of West Virginia Inc. earlier this year led to the removal of the exclusion on gender-confirming care in that company’s PEIA plans. Remaining claims involving PEIA were dismissed after James died in February, Lambda Legal said.

“This decision is validating, confirming that after years of fighting to prove that gender-confirming care is medically necessary, we should have access to the same services that West Virginia Medicaid already provides to cisgender participants,” Fain said in the statement. “Transgender West Virginians should never feel as if our lives are worth less than others.”

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