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Title page

Contents

Highlights 2

Letter 7

Background 12

Exams and Exam Providers 12

Entities that Pay for Exams and Related Medical Treatments 14

States and Territories Have Requirements Providing for Sexual Assault Survivors to Access Exams Free of Charge 18

Most States and Territories Have Laws or Policies that Survivors Must not be Billed for Exams 18

Most States and Territories Designate the Organization Responsible for Exam Payments 23

Payers Cover the Cost of a Range of Related Medical Treatments for Sexual Assault Survivors 25

Coverage for the Cost of Related Medical Treatments Varies in States, Counties, and on Tribal Lands 25

Payers Reported Challenges and Promising Practices for Providing Exams or Related Medical Treatments Free of Charge 30

Payers Reported Some Challenges Ensuring Survivors Receive Exams and Related Medical Treatments Free of Charge 30

Payers Reported Some Promising Practices for Ensuring Survivors Receive Exams and Related Medical Treatments Free of Charge 31

Payers Reported Spending at Least $93 Million in Fiscal Year 2022 for Sexual Assault Forensic Exams and Related Medical Treatments 32

Payers Reported Using Federal and State Funds to Pay for Exams and Related Medical Treatments 32

Payers Reported Spending At Least $93 Million in Fiscal Year 2022 on Exams and Related Medical Treatments, but Total Costs Are Unknown 34

Agency Comments 39

Appendix I: Objectives, Scope, and Methodology 41

Appendix II: Survey Instrument on Payment for Sexual Assault Forensic Exams and Related Medical Treatments 48

Appendix III: Requirements for Payment of Sexual Assault Forensic Exams and Related Medical Treatments as of March 2024 77

Appendix IV: Reported Coverage for Medical Treatments Related to Sexual Assault, Fiscal Year 2022 98

Appendix V: States' and Territories' Coverage for Sexual Assault Forensic Exams and Related Medical Treatments 102

ALABAMA 105

ALASKA 106

ARIZONA 107

ARKANSAS 108

CALIFORNIA 109

COLORADO 110

CONNECTICUT 111

DELAWARE 112

WASHINGTON, DISTRICT OF COLUMBIA 113

FLORIDA 114

GEORGIA 115

HAWAII 116

IDAHO 117

ILLINOIS 118

INDIANA 119

IOWA 120

KANSAS 121

KENTUCKY 122

LOUISIANA 123

MAINE 124

MARYLAND 125

MASSACHUSETTS 126

MICHIGAN 127

MINNESOTA 128

MISSISSIPPI 129

MISSOURI 130

MONTANA 131

NEBRASKA 132

NEVADA 133

NEW HAMPSHIRE 134

NEW JERSEY 135

NEW MEXICO 136

NEW YORK 137

NORTH CAROLINA 138

NORTH DAKOTA 139

OHIO 140

OKLAHOMA 141

OREGON 142

PENNSYLVANIA 143

RHODE ISLAND 144

SOUTH CAROLINA 145

SOUTH DAKOTA 146

TENNESSEE 147

TEXAS 148

UTAH 149

VERMONT 150

VIRGINIA 151

WASHINGTON 152

WEST VIRGINIA 153

WISCONSIN 154

WYOMING 155

AMERICAN SAMOA 156

GUAM 157

COMMONWEALTH OF THE NORTHERN MARIANA ISLANDS 158

COMMONWEALTH OF PUERTO RICO 159

ESTADO LIBRE ASOCIADO DE PUERTO RICO 160

U.S. VIRGIN ISLANDS (USVI) 161

Appendix VI: GAO Contact and Staff Acknowledgments 162

Tables

Table 1. Selected Department of Justice Grant Programs that Provide Grantees with Financial Assistance for Survivors of Sexual Assaults 15

Table 2. VAWA STOP Program Compliance Certification by States and Territories without Laws or Policies that Survivors Must not be Billed for Exams 19

Table 3. States' and Territories' Funding Sources in Fiscal Year 2022 for Sexual Assault Forensic Exams or Related Medical Treatments 33

Table 4. Total Reported Amount Spent in Fiscal Year 2022 for Sexual Assault Forensic Exams and Related Medical Treatments by State or Territory 34

Table 5. Officials GAO Interviewed Who Represent or Serve Each Selected Tribal Nation 45

Table 6. Laws or Policies Explicitly Stating that Survivors Must not Be Billed for Sexual Assault Forensic Exams or Requiring State or Territory Payment... 77

Table 7. Related Medical Treatment Costs States and Territories Reported Covering for Sexual Assault Survivors during Fiscal Year 2022 98

Figures

Figure 1. Laws and Policies Regarding Payment for Exams or Related Medical Treatments, by State or Territory 22

Figure 2. Sexual Assault Forensic Exams and Related Medical Treatments for which At Least One Payer in 56 States and Territories Reported Covering... 27

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