In a break with his party, Nevada’s Republican Gov. Joe Lombardo has signed a bill requiring all insurance companies and Medicaid to cover gender-affirming care, including surgery, for both kids and adults.

The law also bans insurance companies “from engaging in certain discrimination on the basis of gender identity or expression.” There are no religious exemptions for businesses or healthcare providers. All employers are required to adhere to the Standards of Care from the World Professional Association for Transgender Health (WPATH).