There is much variability in the structure of medical evaluation programs for children suspected of experiencing child abuse and neglect and in the financial support for these programs. Although many are components of medical schools and hospitals, many are State supported or connected to child advocacy centers. These programs provide a valuable and critical service for the State and for the children who are victims of violence and abuse. However, to date, there is no uniform standard about the content or process for forensic evaluations nor standard evaluation measures or quality assurance efforts. Four programs are highlighted because they represent innovative, diverse, and potentially reproducible methods of increasing sustainable support. Specific processes that are able to be generalized in other States and locales are detailed. In Maine, the program director has been able to develop a $1,400 Medicaid contract for the comprehensive evaluation that includes social services and a psychological assessment. In New Jersey, one of the program directors has worked directly with the State legislature to obtain an annual line-item allocation of $2.1 million to secure the availability of core diagnostic services and allow for contractual reimbursement for the program’s medical and health services. In Virginia, funds from the legislature support forensic evaluations and in Oklahoma, an additional fee for lawsuits helps support child abuse services. This article presents the administrative details of 75 child abuse evaluation programs and highlights innovative approaches to increase funding and stabilize the funding for the programs. Information is presented on billing, contracts, costs of care, and State-based initiatives that can be reproduced by other programs and States. Tables, references