Using information from the Urban Institute and the International Association of Forensic Nurses evaluation of the SAFE Protocol, this report identifies the designated public payers for sexual assault medical forensic exams (SAMFEs) in states and jurisdictions and examines which parts of the exam process are paid for by these designated payers and stakeholders' perceptions of the extent to which survivors receive exams free of charge and without the condition of reporting to law enforcement as per mandates in the Violence Against Women Act. Released in 2013, the second edition of the National Protocol for Sexual Assault Medical Forensic Examinations, or SAFE Protocol, is a voluntary guide developed by the Department of Justice that local and state jurisdictions can use to inform their responses to sexual assault. It institutionalizes best practices around survivor care and evidence collection, particularly for sexual assault nurse examiners (SANEs) completing medical forensic examinations. One provision of the SAFE Protocol is guidance around payment for sexual assault medical forensic exams (SAMFEs). In 2018, the Urban Institute and the International Association of Forensic Nurses were funded by the Office on Violence Against Women to evaluate the SAFE Protocol with the aim of understanding the extent to which its provisions had been implemented across the United States. Our mixed-methods study incorporated the perspectives of multiple stakeholders in the sexual assault response system at the state and local levels.