Indiana law requires the state to cover the costs of performing forensic medical exams on victims of sexual assault, but a recent transfer of nearly $1.5 million has officials conceding the program is underfunded.
In June, at the end of fiscal year 2019, the Indiana State Budget Agency shifted $1.44 million from the Departmental and Institutional Emergency Contingency Fund to the Indiana Criminal Justice Institute. The money was put into the institute’s Victims of Violent Crime Administration Fund and used to pay for the medical exams.
This shortfall came up during the July 19 meeting in Bloomington of the Indiana State Budget Committee. Sen. Karen Tallian, D-Ogden Dunes, and Rep. Greg Porter, D-Indianapolis, pressed state budget director Zachary Jackson for an explanation.
“This has been a program that has typically needed some assistance from the budget agency at year end to make sure that we’ve caught up on all the payments through the year end,” Jackson said. “… I wouldn’t be surprised if at the end of this fiscal year, again, we need to cobble together resources. It’s something that whenever we were building the budget, we probably should have done a better job to add more money.”
However, Jackson said all the fiscal year 2019 claims deemed eligible for reimbursement had been paid.
Indiana law mandates the state, not the victims of sex crimes, pay for the forensic medical exams. The statutory system requires the health care provider to perform the exam, then file an application to be reimbursed for the costs. Under Indiana Code Section 16-21-8-6, providers are prohibited from charging the victim for services even if the reimbursement is delayed.
Kristen Pulice, chief operating officer at the Indiana Coalition to End Sexual Assault, said any budget shortfalls or slowdown in processing claims would not impact the victims.
“No one is going to go without an exam,” Pulice said. “We would never let that happen.”
During the reimbursement process, the money for the exams flows through the Indiana Criminal Justice Institute.
Each year, according to ICJI, about 2,400 to 2,700 claims are paid. When the claims exceed the funds available, ICJI will request a supplemental appropriation. Last fiscal year, the state allocated $2.8 million for the examinations.
After the members of the State Budget Committee were notified of the money transfer to ICJI, Porter wrote a letter to Jackson. The representative noted a similar shortfall in funding for a similar program administered by the ICJI had occurred about five years ago. He wanted to know why internal controls were not implemented to prevent another disruption.
Jackson responded to Porter in a letter he wrote on the ride back to Indianapolis after the committee meeting. Also, the director gave an explanation during the meeting, pointing out the building of the state’s current budget occurred when the victims’ fund did not experience a funding shortfall.
“It just happened that as we were building the budget, we had just concluded FY ‘18, and that was the one year in probably the past five years where everything was fine,” Jackson said. “They did not need any extra money at the end of FY ‘18, and so as we were starting to build the budget literally the next month, it didn’t dawn on us that they would need extra money in ‘19 and probably most years going forward.”
However, Porter said the shortfall in funding was discovered April 22 and 23 when the Legislature was still in session. If the budget committee had been made aware of the problem, he said, it could have appropriated additional money to the Victims of Violent Crime Administration Fund as part of the budget, especially since the state had a $2 billion surplus.
Just as Jackson acknowledged, June 2019 was not the first time funds had to be transferred to ICJI. According to minutes from the State Board of Finance, at least three other times money had to be shifted between accounts to pay claims to victims of sexual assault and to reimburse the costs of the medical exams.
The transfers approved include:
• $2.81 million transferred in June 2017 from the Department of Correction’s Medical Services Payment Fund;
• $850,000 transferred in June 2015 from the County Jail Maintenance Contingency Fund, and;
• $1.83 million transferred in June 2013 from the South Bend Juvenile Correctional Facility Fund.
Porter is uncertain why the extra money was needed. He wondered if the shortfall was caused by a managerial problem or by a spike in claims. And he worried the budget process was being sidestepped since the transfer of funds removed accountability and transparency.
Pulice speculated the shortfall might be related to the cost of HIV drugs victims are given, or to the varying rates that health care providers are charging the state. She said Indiana, unlike some other states, does not cap the amount of the reimbursement.
However, not all states pay for the exams as Indiana does, Pulice said. Hoosiers do not have to file with their insurance or cover partial costs, which gives victims an extra layer of privacy because the bill for services will not be linked to them. Sexual assault survivors are still stigmatized, she said.
There has not been a concerted grassroots effort to get the state government to put more money into the victims fund, according to Pulice. Pondering the shortfall, she questioned where the additional appropriation could come from, then she sighed and said, “There is so much out there that needs to be done.”•