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While past research has examined investigative and prosecutorial decision making for sexual assault cases, little is known about the extent to which medical forensic exams lead to case outcomes such as arrest, charges, and conviction. With funding from the National Institute of Justice, the Urban Institute is examining the role of sexual assault medical forensic exams and other case characteristics in achieving investigative and prosecutorial outcomes in sexual assault cases in two counties in one northeastern state. In addition to conducting comprehensive case reviews to identify which evidence and case characteristics predict outcomes, we conducted qualitative interviews with key stakeholders in each jurisdiction (law enforcement, prosecutors, medical forensic examiners, and advocates) to learn more about sexual assault case processing. Drawing on our findings from these interviews, this presentation will discuss the barriers to and facilitators of the investigative process, focusing on the evidence gathered during the sexual assault medical forensic exam and how the evidence can influence case progression and outcomes. Further, we will explore how the medical forensic exam supports case processing, including the timeliness and completeness of the exam results, how the evidence is documented and tracked, and how the exam results are shared with the appropriate stakeholders.