Who pays for sexual assault exams?
Until the 2005 reauthorization of the Violence Against Women Act (VAWA), some states required sexual assault victims seeking medical forensic exams—the “rape kit”—to report the crime to police in order for the exam to be free-of-charge. In other words, if victims were unsure about reporting the assault to the police, or if they had already decided not to involve the authorities, then they were left to pay for the exam themselves.
What is important to understand here is that no other crime carries the expectation that victims might pay for evidence collection during the criminal investigation process. It is because the crime scene for a sexual assault is a victim’s body, and the process during which the evidence is collected is through a medical exam, that this expectation developed.
In the aftermath of what could be the most traumatic event of their lives, victims need access to a timely evidence collection process. But they also need time to process the assault without being rushed into the decision about whether or not to involve law enforcement. And, victims need both of these things without the added worry of paying for the exam.
And since the exam provides much more to victims than evidence collection—i.e., a connection to medical care for injuries, sexually transmitted diseases, and possible pregnancy, and often a connection to advocacy and counseling services—they should not be prevented from receiving it, regardless of their interest in involving the police. VAWA 2005 addressed this, mandating that states receiving federal funding to support violence against women services and criminal justice initiatives had to provide free exams without conditioning them on reporting the assault to law enforcement.
But how are states adhering to this requirement? Our team surveyed state-level sexual assault coalitions, state funding and grant administrators, and over 400 community-based sexual assault service providers to learn about how exams were conducted and who paid for them. In 19 jurisdictions across six states, we also interviewed health care-based exam providers, law enforcement, prosecutors, victims, and advocates.
Here’s some of what we found when it comes to payment:
- Victim compensation funds are by far the largest designated source of funds to pay for medical forensic exams across the United States. Thirty-four states use compensation funds to pay for all or part of the exams.
- Very few states use law enforcement or prosecution funds. By comparison, only 11 states paid for exams using funds that are typically used for evidence collection to build criminal cases.
- Funding for exams is precarious. Health care-based exam providers reported that exams often cost more than some state-mandated payment caps allow, putting hospitals in the position of absorbing the additional cost or billing it to the victims.
Victim compensation is intended to pay for services that directly benefit victims. These victims have most often been subjected to violent crimes, including sexual assault, as well as physical assault, domestic violence and stalking, homicide, child physical and sexual abuse, drunk driving, and robbery. Medical and dental services, mental health counseling, lost wages, and funeral or burial expenses are the most common types of expenses compensated.
It is clear that the medical services provided in an exam directly benefit victims and are in keeping with the mission of compensation. Plus, the exam can serve as an important link to additional medical services as well as referrals to counseling, advocacy, and other services that directly benefit victims.
But some have questioned—through this study and otherwise—whether compensation funds intended to benefit victims should be used to pay for forensic evidence collection intended to build a criminal case. Is forensic evidence collection a benefit to victims, or is it a benefit to the justice system? Victims who have had negative experiences with the justice system might say that it is no benefit to victims at all.
Medical examiners do not bill victim compensation programs for autopsy services, so why should compensation pay for evidence collection in sexual assault cases? Moreover, when compensation funds are tight and every dollar spent on forensic evidence collection cannot be spent on services that directly benefit victims, the issue moves beyond the philosophical to the very practical.
We also learned that in some communities, payment is not the issue, but access to the exam is. We’ll elaborate on these findings in a second post.