State should pay for sex assault exams in Minnesota

Opinion editor's note: Editorials represent the opinions of the Star Tribune Editorial Board, which operates independently from the newsroom.

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The emergency medical exam that sexual assault survivors undergo assesses injuries, guides treatment and collects evidence that can be crucial in prosecuting perpetrators.

The last thing a victim and medical provider should worry about during this delicate procedure is "Who will pay for this care?"

While Minnesota counties must pick up the cost, the regrettable reality is that there has long been confusion about who should foot the bill for exams, with inconsistencies heaping further injustice on victims. A 2016 report conducted by the Minnesota Coalition Against Sexual Assault (MNCASA) found that "more than half of professionals interviewed for the study ... said they knew of patients being charged for exams,'' according to Star Tribune coverage of the group's findings.

It's an outrage that this happens and that a legislative remedy is still needed seven years after MNCASA reported its shocking findings. Fortunately, a bill offering a sensible solution, HF 1279/SF 1249, is gathering momentum at the State Capitol this session. It merits lawmakers' strong support to ensure that sexual assault survivors are treated with the compassion they deserve, not further victimized by the medical billing system.

The legislation, whose chief authors are Rep. Heather Edelson, DFL-Edina, and Sen. Judy Seeberger, DFL-Afton, is commendably pragmatic. It would set up a standardized process by shifting payment responsibility from the counties to the state.

For example, many hospitals serve patients from a wide area, particularly medical centers outside the metro. Questions can arise when the sexual assault occurs in one county, but the hospital where the exam takes place is in another. Billing the state is more straightforward, reducing the time billing departments need to comply with individual county requirements.

The legislation, if passed, would also reduce stress on Minnesota counties' already strained budgets and help ensure that hospitals are fairly compensated for the costs of providing this care. Counties currently shoulder the expenses for sexual assault exams out of their budgets, according to a state Department of Public Safety spokeswoman. They do not receive federal or state funds to pay for these exams.

For large metro counties, this financial responsibility likely isn't burdensome. For smaller counties, the expense can be daunting. While the exam's cost varies, Edelson's legislation would set reimbursement at a maximum of $1,400, which will be adjusted annually for inflation.

MNCASA's Jude Foster told an editorial writer that most states have already made this change. Minnesota is one of just a handful of states still relying on county billing. Passing the bill would align the state with what is considered best practice, she said.

In Minnesota, a total of 1,875 rapes were reported in 2022, according to the Minnesota Bureau of Criminal Apprehension's Crime Data Explorer website.

Abby Honold, a Minnesota sexual assault survivor and activist who has collaborated with the state's congressional delegation to improve training for law enforcement working with victims, said it is important to reduce barriers to care. The possibility that their insurance may get billed can dissuade some women from getting medical help, she said.

Current law allows counties to seek reimbursement through a victim's insurance if the victim consents, according to a Department of Public Safety spokeswoman. If the victim does not authorize consent, the county is required to pay.

Mistakes, however, can still happen. "That said, a victim's insurance may occasionally be billed for exams. This issue is primarily attributable to intake/admittance procedures at hospitals, along with a lack of familiarity with the statute, especially for small hospitals who do not deal with sexual assault exams on a regular basis," the DPS spokeswoman said.

The Star Tribune Editorial Board's only suggested improvement to Edelson's bill would be adding a penalty for hospitals that mistakenly bill a victim's insurance. Even without that, this bill is good policy, with the caveat that lawmakers back up the reform with adequate funding to cover the exams. This reform should have been enacted years ago. Passing it swiftly this session will help make up for that lost time.