Iowa will resume reimbursement for sexual assault victims for contraceptives, but not for abortions

The policy is one of half a dozen that Bird announced during a press conference where she announced her office’s completion of a 17-month investigation and 28-page report into state victim assistance programs.

“I agree that Plan B birth control prescriptions should be reimbursed,” Bird said. “However, Iowa will not use public funds to pay for abortions for victims of assault.”

Under Bird’s predecessor, Democratic Attorney General Tom Miller, Iowa’s health care providers — primarily hospitals and pharmacies — were compensated for contraceptives and abortions administered to victims of sexual violence. The cost of these services was covered by the state’s Crime Victim Compensation Program, which is funded by fines, penalties and restitution paid by criminals, as well as federal funds and other sources of the criminal justice system. The program is not funded by state tax sources.

After defeating Miller in the 2022 election and becoming attorney general in 2023, Bird, a Republican and vocal anti-abortion activist, halted reimbursement for contraceptives and abortions for victims of sexual assault while her office reviewed victim assistance programs.

During the 17-month review, Bird’s office said there was one claim for an abortion from a victim of sexual assault in Iowa and 362 claims for contraceptive reimbursement totaling $14,904.35. Bird said those outstanding claims for contraceptive reimbursement will be reimbursed, as will any future claims.

Victims were able to obtain contraceptives and abortions during the study period; only reimbursements to providers were suspended.

“I want to make it clear that not a single victim was denied benefits because of the audit. Not a single victim was denied benefits late because of the audit,” Bird said.

According to the US Food and Drug Administration, Plan B contraception delays or stops ovulation and thus prevents pregnancy.

Victim advocates, including the Iowa Coalition Against Sexual Assault and the Iowa Coalition Against Domestic Violence, had urged Bird to continue using the program’s funds to cover emergency contraception and abortion costs, saying costs should never be a barrier to rape victims seeking medical care.

A spokesman for the Iowa Coalition Against Domestic Violence said Friday afternoon that the organization is reviewing the report and Bird’s new policy. The Iowa Coalition Against Sexual Assault did not immediately respond to a request for comment.

Planned Parenthood Advocates of Iowa, the organization that provides reproductive health services, including abortion, issued a statement criticizing the new policy.

“For months, Attorney General Bird needlessly denied compensation to hundreds of victims of sexual violence, turning them into political puppets,” Mazie Stilwell, public affairs director for Planned Parenthood Advocates of Iowa, said in the statement.

“The politicization of victims of sexual violence is absolutely reprehensible and disgusting. They are real people who are vulnerable and deserve to be treated with dignity and respect. Even though the government is again providing emergency contraception, those who need abortion care now have to cover the costs. This is the last thing victims should be worrying about. It is not right and we need to demand more from the people elected to represent us.”

Democratic State Auditor Rob Sand issued a statement accusing Bird of pursuing politically motivated policies.

“For a year, Iowa’s attorney general has inflicted more trauma on rape victims purely for political reasons,” he said in his statement. “We know this because her report does not provide a single legal or financial reason to withhold payments for emergency contraception.”

Jacinda Bunch, a sex crimes investigation nurse with the Johnson County Sex Crimes Task Force, said the last 17 months have been frustrating and have caused anxiety among patients and doctors.

“I’m just glad we’ve finally come to a resolution and can move on. And we know we’re going to get our money back,” she said.

She noted that it is “very rare” that a victim needs or wants an abortion. “I’m just glad that we can provide most of the care that is needed,” she said. “That’s why emergency contraception is so important to avoid getting to later stages where an abortion might be necessary.”

Katy Rasmussen, coordinator of Johnson County’s Sexual Assault Response Team, said she was relieved to hear that state payments for emergency contraception would be reinstated.

“Offering our patients the option of emergency contraception is an integral part of the screening and all of our patients have a right to this option without having to worry about how they will cover the costs,” she said.

Rasmussen said the 17-month pause had placed “an enormous burden” on programs that had no other ways to cover costs.

“We were very concerned about how we were going to find funding for these costs,” Rasmussen said. “Fortunately, Johnson County was willing to provide some money, but not every program had that support. Hopefully the changes they make based on the audit were worth the effort.”

Polk and Johnson counties provided funds to cover these costs in their region while the state program remained in question.

So far, about $2,500 has been spent in Johnson County.

At first, hospitals and pharmacies either agreed to cover the costs or waited for the outcome of Bird’s audit before submitting reimbursements. But after a year, the University of Iowa Hospitals and Clinics decided to bill Johnson County for the costs it had withheld so far.

Some hospitals are still sending bills to the Attorney General’s Office. Some have agreed to cover the costs for patients. And many victim advocates are exploring ways to raise funds to cover the costs.

Before Friday’s press conference, the Attorney General’s Office did not respond to questions from the Gazette about the scope of the audit, how it was conducted, the reasons for the long duration, the reasons for the delay in publishing the report and the timing of the decision.

The Gazette had requested a copy of the audit report and other documents related to the review more than two months ago. The attorney general’s office provided those documents on Friday and said it was refusing to release them because the findings and report were not yet finalized. Iowa Code precludes the release of preliminary documents.

Bird announced other new measures, including what she described as improvements to victim reporting systems, increased incentives for nurses specializing in sex crimes, and improved tracking of rape kits.

Bird said her office’s review found:

• A shortage of sex crimes investigation nurses, or SANE nurses, is leading to long wait times for victims — as much as eight hours in Polk County. Bird recommends doubling investigation fees for SANE nurses and reimbursing them for travel expenses.
• Prosecutors were unable to update the status and location of sexual assault evidence, known as rape kits. The Attorney General’s Office has updated the program to ensure prosecutors can update the kits’ status.
• A notification system designed to warn victims when their abuser receives a protection order and when it is about to expire stopped working. Bird said she hired a staff member to implement a new protection order notification system.
• A notification system designed to notify victims when their abuser is released from custody had been issuing incorrect alerts. Bird said her office has been working with partners to correct the messages and ensure the alerts are accurate.

Rasmussen said working as a sex crimes investigation nurse requires additional training and ongoing education that is often unpaid and potentially costly to the training nurse.

“I think a raise will help ease the burden of these training costs while also showing that our work is valued,” she said.

The full report can be viewed on the Iowa Attorney General’s website.