The effects of a sexual assault can be long-lasting, but the medical bills shouldn’t be. Yet a new study finds that despite federal efforts to lift that burden from rape victims, a hodgepodge of state rules means that some victims may still be charged for medical services related to rape, including prevention and treatment of pregnancy or sexually transmitted infections.

“If you’re exposed to HIV as a result of the attack, that’s something the state should be paying for, especially if we can give you prophylaxis to prevent infection,” says Ilse Knecht, deputy director of public policy at the National Center for Victims of Crime. A 28-day course of antiretroviral drugs to prevent HIV infection costs up to $1,000.

When Congress reauthorized the Violence Against Women Act in 2005, provisions were added to ensure that victims who say they have been raped can’t be charged for medical forensic exams, sometimes called rape kits, whether or not they report the attack to police. Those costs are instead covered by victim compensation funds, which are financed primarily by fines and penalties paid by offenders. The act’s 2013 reauthorization, which takes effect in March 2015, goes a step further: It says that even victims who have insurance that would cover the exam can’t be required to pay for it upfront and seek reimbursement later. The exams, which can cost more than $1,000, must be free of charge.

Last month the Urban Institute published a study — carried out in conjunction with George Mason University and the National Sexual Violence Resource Center — looking at the law and its effects. It found that while in much of the country, rape victims receive exams free and without having to report what happened to the police, the patchwork of state laws governing what’s included in a forensic medical exam can present financial problems for some. The federal law says that an exam should include a patient interview and history, an examination for physical trauma, including penetration or force, and evidence collection.

The federal law doesn’t require states to cover tests for pregnancy or sexually transmitted infections as part of the exam, though many states do so, the study found. They’re less likely to cover treatment for those infections, for pregnancy or for injuries sustained during the rape.

Some states cap the amount that they’ll pay for the exam or for specific services, according to the study. In those cases, hospitals often absorb the extra costs of the exam, said Janine Zweig, a senior fellow at the Urban Institute and the study’s lead author. Patients may be billed for services that the state doesn’t consider part of the exam, however.

A victim’s health insurance may cover services not paid for by the state. But victims are sometimes reluctant to submit claims related to a rape, victim advocates say. They often fear that their parents or a partner will receive the insurance forms.

A 2012 analysis found that 15 states have laws related to using insurance in cases of rape. The legislative review by AEquitas, an organization that trains prosecutors in sexual assault cases, found that some states required insurers to be billed first for costs related to forensic medical exams while other states prohibit health-care providers from billing insurers for the exams. Others fall somewhere in the middle, permitting victims’ insurance to be billed but only with their consent, for example.

According to the Justice Department, states may ask or require victims to submit claims for the exams to their insurers. However, they must make sure that victims don’t have to pay co-payments or deductibles on those claims.

A good rape crisis center or sexual assault response team can often assist victims who are faced with medical costs not covered by the state . “The most important thing is to talk to a state advocacy group to find out what can be covered and what can’t,” says Christopher Mallios, an attorney adviser at AEquitas.

This column is produced through a collaboration between The Post and Kaiser Health News. KHN, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health-care-policy organization that is not affiliated with Kaiser Permanente. E-mail: