Sexual Assault: States Provide for Survivors to Access Free Forensic Exams but Total Costs are Unknown

Para la versión de esta página en español, ver a GAO-24-107417.

What GAO Found

States and territories have laws or policies that provide for survivors to receive sexual assault forensic exams (exams) free of charge. GAO found that 47 out of 56 states and territories, including the District of Columbia, have laws that specify that survivors are not to be billed for the cost of exams. The remaining nine states and territories certify to the Department of Justice (DOJ) that they or another government entity incur the full out-of-pocket exam costs. Exam costs for American Indian and Alaska Native individuals who are citizens or descendants of federally-recognized Tribal Nations are covered by the Indian Health Service, investigating law enforcement agencies, health care providers, or designated state and county payers.

Coverage for related medical treatments varies in states, counties, and on tribal lands. State- and territory-level payers in all 56 states and territories that responded to GAO's survey reported that they cover the cost of at least one treatment for survivors of sexual assault, either because they are required to by state law or policy or they choose to cover the cost. Most-commonly covered were the cost of the medical facility, emergency room personnel, and testing for sexually transmitted infections and pregnancy. Least-commonly covered were the cost of dental care and diagnostic imaging (see figure).

Related Medical Treatments that Payers in 56 States and Territories Most and Least Frequently Reported Covering the Cost, Fiscal Year 2022

Note: For more details, see figure 2 in GAO-24-106036.

Similarly, coverage for related medical treatments also varied among the Tribal Nations and county payers GAO interviewed.

State-level payers reported spending at least $93 million in federal and state funds in fiscal year 2022 for exams and related medical treatments. However, the total amount spent by all payers is unknown for several reasons, such as limited data collection and a lack of a standardized medical billing code specifically for sexual assault forensic exams, which makes efforts to track payment inconsistent.

Why GAO Did This Study

According to federal data, sexual assaults in the U.S. increased by an estimated 64 percent from 2021 to 2022. Survivors may seek an exam and related medical treatments from a health care provider. According to federal law, sexual assault survivors have the right to not be charged for exams.

The Violence Against Women Act Reauthorization Act of 2022 includes a provision for GAO to report on states' and territories' coverage for exams and related medical treatments. Among its objectives, this report examines (1) information on state and territory requirements for covering the cost of exams and related medical treatments, (2) what medical treatments related to sexual assaults are covered by payers in states and territories, and (3) how much payers in states and territories reported spending in fiscal year 2022 for exams and related medical treatments.

GAO reviewed state and territory laws and policies; analyzed the survey responses provided by payers in 50 U.S. states, the District of Columbia, and five territories (100 percent response rate); and interviewed officials from the Departments of Justice, Health and Human Services, and the Interior. GAO also interviewed officials from two selected Tribal Nations, officials from organizations that serve another four selected Tribal Nations, and county-level payers from two counties in each of three states.

For more information, contact Gretta Goodwin at (202) 512-8777 or GoodwinG@gao.gov.