Incarcerated Members

In general, adults who are incarcerated in detention or correctional facilities are not eligible for PrimeWest Health.

PrimeWest Health members, regardless of age, are ineligible for coverage while they reside in the following correctional facilities:

  1. City, county, State and Federal correctional and detention facilities for adults, including, inmates who are:
  1. In a work release program that requires they return to the facility during non-work hours
  2. Admitted to an acute care medical hospital for medical treatment or to give birth, but are required to return to the facility when treatment or convalescence is completed
  3. Sent by the court or penal institution to a chemical dependency (CD) residential treatment program while serving a sentence and are required to return to the correctional facility after completing treatment
  1. Secure juvenile facilities licensed by the Department of Corrections (DOC) that are for holding, evaluation, and detention purposes
  2. State-owned and operated juvenile correctional facilities
  3. Publicly-owned and operated juvenile residential treatment and group foster care facilities licensed by the DOC with more than 25 non-secure beds

Children who are placed by a juvenile court in certain juvenile programs may be eligible depending on the type of facility.

Counties are responsible for updating the status of PrimeWest Health members when they are notified that a member is incarcerated. Notification that a member is incarcerated may not be received by PrimeWest Health until after the member’s eligibility is determined.

When an incarcerated member is covered by other health insurance, the health care provider must bill that insurance before submitting the bill to the appropriate county or DOC for reimbursement. If the member is enrolled in PrimeWest Health on the date of service, bill the Minnesota Department of Human Services (DHS) for inpatient services. Review the Billing section of Hospital Services for details on billing these services. Providers should contact the appropriate county jail or correctional facility regarding how to bill for any outpatient services that were provided.

PW_03-19_096
Updated_03/12/2019