Just an update, I talked to his office, turns out the wait would only be in the months, the receptionist told me to go ahead and get all the letters before they schedule the consult, due to the way Apple Health works, that would make it easier.
So, 3 letters, 1 from your PCP, and 2 from therapists, apparently electrolysis on the genital region would be required but, I was told that Apple Health will cover this if they say it is necessary for the surgery. Hopefully this month I will have the 3rd letter and be able to schedule things. I will keep everyone updated on how it all works, so far I haven't seen anything that explains how to navigate SRS on Medicaid in Washington in detail, so I suppose I will write it 😛