Sexual Assault Medical Forensic Exams and VAWA 2005: Payment Practices, Successes, and Directions for the Future

Research Report

Sexual Assault Medical Forensic Exams and VAWA 2005: Payment Practices, Successes, and Directions for the Future

Abstract

The Violence Against Women Act of 2005 requires that sexual assault victims must not be required to file law enforcement reports in order to receive free exams. This study aimed to examine how states are meeting these goals. We found victim compensation funds are by far the largest funder of exams across the country. In the 19 jurisdictions included in case studies, victims generally received free exams without having to report if they did not want to. However, barriers to even accessing the exam prevent some victims from seeking help.

Overview

Since the Violence Against Women Act of 2005, sexual assault victims have been able to receive free exams without filing a report. But who pays?
Key findings

  • Victim compensation funds are by far the largest designated source of funds to pay for MFEs across the United States, but sufficient funds are a major concern.
  • Most victims are able to receive free exams without having to report to law, with very few exceptions.
  • Barriers to even accessing the exam are real and prevent some victims from seeking help; this is especially true for individuals identifying as non-English speakers, immigrants, or American Indians
  • Among the few victims who get exams but do not report at the time of the exam, few file an official report to law enforcement at a later date.

Victim compensation funds are the most commonly designated source of funds to pay for MFEs. These fund administrators are most likely to pay compensation funds and other special MFE-designated funds. STOP (Services*Training*Officers*Prosecutors) programs were least likely to cover MFEs and the least likely to pay MFE bills despite state eligibility for the program depending on VAWA compliance.
In the states analyzed, victims generally received free exams with no upfront charges. Providing the exams, however, costs more than state victim compensation programs typically give. Faced with a net loss, providers often sacrificed the special equipment or specially trained staff that provides higher quality care to victims. Exam coverage does not usually include the additional services needed, leaving victims with the bill.
Some victims are faced with barriers when they try to access exams. Victims living in rural areas or on tribal lands might live too far away from the hospitals and community centers that have sexual assault nurse examiners (SANEs), the primary providers, on staff. Non-English speaking victims and Native Americans also had difficulty accessing the exams due to language and cultural barriers.
Most victims who get MFEs report the assaults to the police at the time of the exam. It is more likely that victims who do not report their assaults to the police have not gotten exams. This means that victims who do not report to police miss out on receiving other necessary medical, advocacy, and counseling services.
Policy recommendations

  • Ensure funding levels are adequate for designated payers and routinely examine if payment levels or caps imposed on payments to providers are sufficient.
  • Consider broadening definitions of what should be paid for as part of the MFE process.
  • Continue efforts to make trained examiners available throughout states and train first responders to appropriately respond to individuals in historically marginalized groups.
  • Consider public awareness campaigns on access to free exams regardless of reporting
  • Link advocates to victims during the exam process.
  • Allow victims, if they choose, the chance to talk with law enforcement “off the record” as part of their reporting decisionmaking process.

Increase victim confidence in the criminal justice system response.

Research Area: 
To reuse content from Urban Institute, visit copyright.com, search for the publications, choose from a list of licenses, and complete the transaction.