Saint Louis University Journal of Health Law & Policy

Document Type



Sexual assault continues to be a major public health problem in the United States. Compounding the problem, survivors of sexual assault all too often face challenges of obtaining and paying for sexual assault forensic exams (SAFEs), commonly referred to as a “rape kit,” and related medical services. Sexual assault survivors who do seek medical care in the emergency department (ED) are often turned away for several reasons, such as EDs determining that sexual assault is not an emergency medical condition, failing to carry SAFEs, or refusing to treat survivors who lack proof of insurance. Denial of care can further traumatize survivors, deter medically necessary treatment, result in loss of forensic evidence, and cause non-physically apparent medical needs to be overlooked. Federal laws, such as the Violence Against Women Act (VAWA) and the Emergency Medical Treatment and Labor Act (EMTALA), offer only limited remedies to compel and cover care for survivors of sexual assault. Consequently, federal and state legislative, regulatory, and enforcement action is needed to ensure that sexual assault survivors receive appropriate care and that such care is covered.

This article provides overviews of sexual assault in the United States and the appropriate follow-up health care services that survivors need. It also identifies the barriers to accessing and affording appropriate health care services following a sexual assault and applicable laws governing provision and payment for such services. It analyzes potential remedies for survivors who are denied access to SAFEs and related services, and it provides recommended actions at both the state and federal levels that will better ensure access to and coverage of SAFEs and related services.