South Dakota’s system for paying for sexual assault exams is creating problems for victims and making care uneven across the state, according to experts who met in Sioux Falls Monday.
The University of South Dakota studied this issue last August and found that the current system, where each county pays for these exams, leaves some victims with surprise medical bills.
“Some patients get unexpected bills or are told not to get these exams due to county budget concerns,” the USD report states. “These problems come from unclear laws and placing payment duties on counties.”
State Representative Kadyn Wittman, who joined the April 14 panel at the Sioux Falls rotary meeting, expressed concern about South Dakota’s high sexual assault rate, noting the state ranks in the top ten nationally with 50 cases per 100,000 people.
“There’s not enough of us to work against each other, so seeing that collaboration and open lines of communication between law enforcement and victim services and emergency departments, that was really heartening for me,” Wittman said, Dakota News Now reported.
The South Dakota Department of Health reports that the state’s rape rate is 55.8 per 100,000, much higher than the national average of 40 per 100,000. The Compass Center notes that South Dakota has 1.5 times the national average rate of forcible rapes.
South Dakota is one of just 11 states where counties pay for these exams. Nearby, Minnesota recently changed its system so that the state government pays instead of counties. A special state fund in Nebraska covers the exam, facility fee, and testing costs.
For sexual assault victims in rural counties with tight budgets, this system creates a troubling gap in care. The USD report found that counties with limited money tend to cover only basic exam costs, which may leave victims without full treatment.
Despite these problems, some progress is being made. In February 2024, the South Dakota Senate voted 30-3 to give $5 million to sexual assault, domestic violence, and children’s shelters across the state, South Dakota Searchlight reported.
However, the state’s basic funding for domestic abuse and sexual assault programs has stayed at $225,000 per year for over a decade — which is $25,000 less than when the fund started in 1993.
These local funding issues come as federal support also faces cuts. On April 1, the Department of Health and Human Services reduced staff for teams working on sexual violence prevention, NPR reported.
The USD researchers suggest, at minimum, that South Dakota make its laws clearer to ensure all counties handle billing the same way. This would reduce confusion and help patients understand what costs are covered.
For people in South Dakota, this payment issue isn’t just paperwork — it’s a public safety concern that affects healthcare access, justice for crime victims, and the safety of every community in the state.
