This January, the Oregon Health Plan starts covering the cost of reassignment surgery for transgender people. It also helps cover the cost of hormone therapy and puberty suppression.
Some politicians question the use of tax payer money, but people in the transgender community call it ground breaking.
When Alexis Paige was born 26 years ago, as far as doctors and family were concerned, she was a boy. But by 11, she began to grow breasts and wanted to be a girl, making school very difficult.
"It kind of culminated in an instance in which I was actually pressed against a wall by someone who groped my breast to see if they were real and wanted to check if I was actually a male or female," she said.
By 16 her hips began to spread. She says she always felt different -- as if she wasn't in the right body -- and it drove her to try suicide.
"I was riding my bicycle when I noticed a car coming, just in that moment, I decided I'd purposely ride out in front of it and I was hoping that it would kill me," she said.
By last year, Paige went through therapy and saw a doctor who prescribed estrogen.
"Suddenly for the first time I had energy, I wasn't feeling sad all the time," she said. "I actually stopped getting sick. I stopped feeling sore. This was who I was supposed to be."
At that time, Paige had a job and insurance to cover medical expenses. But then she lost that job and was terrified she'd have to end the therapy.
She says knowing that the Oregon Health Plan will now cover her hormones if she losses her job again, is invaluable.
"I know there will be some people who will question that and question whether that's right or it's wrong," she said.
"There's people who argue back and forth about whether it's innate to be trans or it's psychological. And the thing is, so what? I mean, you don't look at someone with cancer and go, 'Oh your cancer wasn't caused by a genetic reason, it was environmental, so we're not going to treat you.'"
Oregon joins California, Massachusetts, Washington D.C. and Vermont as jurisdictions where Medicaid covers medical treatments for gender dysphoria.
By looking at medical billing data, the state estimates at least 175 people will use the new coverage this year.
But there are those who question its validity and expense.
"To a large degree I think the jury is still out on these procedures and whether or not they're legitimate," said Roseburg Republican, state Senator Jeff Kruse.
He's on the Legislature's Senate Committee on Health Care and Human Services. He says the gender reassignment medical procedures are "elective" and "dubious at best."
Oregon's Health Evidence Review Commission decided to look into coverage for gender dysphoria last year -- after a psychiatrist pointed out that the state had lumped it with conditions like pedophilia.
"People with gender dysphoria that did not receive treatment had a much higher rate of hospitalizations or ER visits or doctor visits for depression and anxiety," said commission director, Dr. Ariel Smits.
"And they had a pretty significantly high suicide attempt rate -- some studies found about 30 percent. But folks when they received the treatment that they felt was adequate for their gender dysphoria, had an almost normal rate of depression and anxiety compared to the general population."
Their suicide rate also dropped significantly.
But what about the cost?
"It may cost somewhere in the $100,000 to $200,000 range although these numbers are very vague," said Smits.
"There's also the possibility that it'll be less, or even cost savings, because hopefully these folks will no longer be going to the ER or being hospitalized for their severe depression or suicide attempts."
While the coverage begins this month, Basic Rights Oregon says it may take the state a while to line up services.