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Tucked away in the 750-page revised budget Gov. Ralph Northam presented last month is a single line that his administration says would guarantee that transgender enrollees in Virginia’s expanded Medicaid program have access to gender-affirming care.

“This is an important equity issue and a critical part of making our commonwealth welcoming and inclusive of all,” Northam’s spokeswoman, Alena Yarmosky, said in an email.

If the General Assembly agrees to the language, Virginia would become at least the 19th state to explicitly affirm that transgender care is covered by its Medicaid program, according to statistics gathered last year by UCLA School of Law.

Another 12 states have adopted laws or regulations expressly banning coverage of gender-affirming care for transgender Medicaid enrollees, UCLA’s review found. (At least two of those states, West Virginia and Alaska, are currently facing lawsuits challenging the policies. )

Virginia is one of 20 states with no express policy on the issue.

Leaders of the state’s Medicaid program said the care, which can range from counseling to hormonal therapy and gender reassignment surgeries, is already covered by all six of the health insurance providers that administer Virginia’s Medicaid program.

But they said making the state’s policy on the issue clear and unambiguous is an important step forward.

“Transgender individuals face a tremendous amount of stigma in society,” said Dr. Chethan Bachireddy, the chief medical officer overseeing Virginia’s Medicaid program. “An affirmative policy not only says, ‘This is what we’re doing,’ in a way that’s explicit and public. But it’s also helping to reduce some of the stigma that might be associated with seeking care related to gender dysphoria.”

There are an estimated 34,500 transgender people living in Virginia, 2,000 of whom are on Medicaid, according to UCLA, though the researchers and Bachireddy cautioned that those numbers likely undercount the population of transgender adults the state is serving because not all are comfortable openly sharing the information.

To those who might oppose the budget amendment on political grounds — GOP lawmakers overwhelmingly voted against legislation making it easier for transgender people to change their birth certificates earlier this year — Bachireddy said he could only view the issue through a medical lens. And on that front, he said the language would merely bring Virginia in line with standards of care agreed upon by the national and international medical community.

“To me it’s not a political issue, it’s an issue of health and health care,” he said.

Northam’s proposed budget includes several other initiatives aimed at increasing access to sexual and reproductive health services for low-income Virginians.

That includes $2.4 million to provide doula services to Medicaid-enrolled pregnant women, services studies have shown improve health outcomes for both mothers and their children and Northam has previously linked to a broader effort to reduce high maternal mortality rates among Black women.

Northam also proposes including $4 million in additional funding for long-acting contraceptives and language that would allow pharmacies to dispense 12-month supplies of other prescription pharmaceuticals.

Bachireddy called both proposals “no brainers,” citing studies have shown that not requiring people to pick up birth control prescriptions every month results in fewer unintended pregnancies.