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Covered California and Obamacare related questions from consumers, employers and agents are answered by Phil Daigle with the best information available at the time. Archived entries may no longer be accurate as the Covered California and Obamacare knowledge-base is evolving quickly. TO REQUEST A PERSONAL RESPONSE INCLUDE EMAIL ADDRESS.


Agents Submitting Medi-Cal Applications?

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Question: I have signed up some clients with incomes that qualify them for Medi-Cal. Since we will receive a $58 commission, I have continued the application process. When I look on my individual listing for these clients they show as “ineligible”. Does this mean they are ineligible for a subsidy? Also, will the application be forwarded to Medi-Cal?

Answer: Yes. If the applicant’s income makes them Medi-Cal eligible the application will be handed-off to the county for further processing. The “ineligible” tag you see in your CC agent account means the applicant is ineligible for Covered California coverage. If your client designated you as agent of record you “should” eventually get your one-time $58 sign-up fee.

42 Comments

Online Medi-Cal Enrollment for Los Angeles https://www.dpssbenefits.lacounty.gov/ybn/Register.html

Hello, can someone direct me to the right person to be able to answer my questions: when do I get pay on all of the Medical clients I helped since the beginning of the Obamacare. is the $58 per family or per person? I have not received a penny from spending numerous time helping clients, hours of on hold on phone and zillion times got disconnected and frustration.

I have received four or five checks now representing less than 50% of the Medi-Cal applications I submitted for CY 2014. I realize that I won’t be paid for all that I’ve submitted because anyone who was ever issued a Medi-Cal ID number in the past doesn’t count as a new enrollment. $58 is for “new enrollments” only.

Unfortunately, none of us who have been paid have any idea how many applications we are eligible to be paid for, or how many of those have actually been paid. As far as I know, we can’t even tell if they’ve paid all they are going to pay for 2014 and whether or not they will pay anything for 2015.

I don’t even know if there is actually anyone at CoveredCA who cares enough to find answers to any of those questions. But if you’ll email me, I can give you the email address for Kirk Whelan, who is supposed to be at the top of the Sales chain and our intermediary with the Executive Director.

Has any agent actually been paid their Medi CAL commission from Covered CA? I have never been paid for Medi CAL enrollments from spring of 2014 and I stopped doing them in July or August because of non payment. Just wondering what the experience of others has been.

AgentAnon …

Assuming you have achieved “Certified Insurance Agent” status, we all feel your pain and the empty space in your pocket.

Are you asking about calendar year 2014 pr 2015 enrollments? If you are asking about 2015 … you, like the rest of us, will have to wait until they finish making payments for 2014 first. Which means several more months of waiting.

As for getting paid for 100 enrollments … don’t hold your breath. In the 2014 Medi-Cal year, I did in excess of 120 enrollments, and have been paid for about 45 or 50 — I’ve given up hope of trying to account for them.

No payments are issued if any enrollment involves a person who previously was “enrolled” in Medi-Cal, even if their enrollment resulted in a denial of benefits and they never received a penny of assistance. If they have an “ID” number in the Medi-Cal record system, that’s the end of any payments to agents, CACs, or Navigators for that person and his/her entire household (including children who were never previously enrolled).

Beyond that, there is absolutely no accountability for any of our enrollments. With our first round of payments last October, we were issued a statement that vaguely referenced the individuals whose enrollments we were being paid our $58. But in the second and third rounds of payments … nada.

Just remember this: CoveredCA took out close to $2 million for its 2014 “administrative expense” related to disbursement of the balance of its $24 million fund for this purpose long before it issued a single payment to agents. The rest is fiscal irresponsibility at the highest levels. And because they are a quasi-state agency, they have qualified immunity from most civil litigation issues — including failure to pay commissions on a timely basis.

As of May 2015, our office has submitted over 100 applications for Medi-Cal and have not been paid the promised $ 58.00 on one of these. Any suggestions? We have contacted the Depart of Health Services and Covered CA and so far nothing.

I got my remittance letter, but it only has Case ID# not names.

Max, the humorous bit was contained in your earlier post regarding CC payment of medi-Cal commissions, with the update “Functionality for emailing remittance letters has been put on hold until a working process is put in place”. Now come on, that’s funny.

While I can see how some would look at this as humorous, to me it is appalling! I had to contend with a steady stream of phone calls from Medi-Cal applicants wondering when they were going to be approved. I spent hours on hold, trying to make sure applications had been forwarded from CoveredCA to DHCS and/or the counties. It was anything by funny to me.

In the latest round of CoveredCA snafus, I have clients who aged into Medicare in November and December, whose “participation” in health insurance through CoveredCA could not be terminated because those numbskulls disabled the function and took more than two months to reenable it. In the meantime, my clients have been receiving premium due/past due notices from the insurance companies. That’s not funny either.

If only the Board realized how much happy smoke Peter V. Lee is blowing up their noses.

Max, Freelancer, If I were a comedian, I wouldn’t want Covered California to get their act together. They provide an almost constant stream of hilarious material.

Hot off the digital press at CoveredCA as of 6pm tonight (1-5-15)

New! Department of Health Care Services (DHCS) Update: Certified Enrollment Entities and Certified Insurance Agents Medi-Cal Enrollment Application Payments

At the end of 2014, DHCS issued remittance letters to Certified Enrollment Entities and Certified Insurance Agents for completed Medi-Cal applications submitted through July 2014. A remittance letter is a detailed payment statement sent separately from a check that includes supporting information about payment(s) issued. Note that the payments that correspond with these remittance letters were mailed in the first half of December 2014.

If you have not already received a remittance letter for a Medi-Cal application that was submitted by the end of July 31, 2014, please check your mailboxes over the coming week.

===============================================

* BUT * immediately following that information above was this little tidbit:

Update: Functionality for emailing remittance letters has been put on hold until a working process is put in place.

===============================================

As usual, someone speaks before they know what they’re saying. If the “functionality” tracks along the same timetable as the payments did, we should get the “remittance letters sometime in September or October. LMAO!

Freelancer …

I did not keep track of Medi-Cal enrollments after the first 30 or 40 I did. All of the applications are in my “book of business” and I could easily find the application dates, if I needed to.

All those same names were sent in an Excel file by CoveredCA—something I suggested to the CC Director of Sales after I spoke at the CC Board meeting in September (as recommended by several agents who contacted me prior to my trip to Sacramento). But that Excel file does not include application dates either.

There are multiple problems associated with this, however. There is no way to tell for certain who was or was not “approved” for Medi-Cal at the local county level — at least not without calling every single person in the list. LA County DPSS, for example, was taking up to 5 months to approve applications. There are no payments for persons not approved, nor for any “split” households (parents on health insurance, children on Medi-Cal), nor for anyone who was previously on Medi-Cal. So trying to keep track of anything is futile.

The larger issue is that CoveredCA provides no accountability for any of this, in keeping with most of their other “standard practices.” As others have commented, we were not issued any statements identifying who we were or were not paid for. For all I know, the powers to be at CoveredCA simply said, “Pay one out of every five.” And, if that’s true, it could be that if an agent did not write at least five Medi-Cal applications, he/she might not be paid at all.

APPARENTLY IT’S A BIG SECRET. SO MUM’S THE WORD.

Frank …

I recommend that you not hold your breath waiting for more 2014 Medi-Cal enrollment payments.

Do you agents have records of your own as to the dates of the MediCal enrollments you submitted? That might help you sort out what has been paid and what is still in the queue for future payment.

This is just the first round of payments according to Covered CA. The rest of the payments for other enrollments are in the coming months as long as there is $$$.

Anon …

In December, most of us received payments of 20 cents on the dollar — in increments of $58 — for our Medi-Cal applications. Having had more than 100 such applications approved, I was somewhat disappointed by my check for a total of only 24.

If that disturbs you, welcome to life in the big city of [mostly] empty promises. Just another insult added to the injuries we agents have all suffered thanks to the PPACA.

I rec’d payment for 3 Medi-Cal applications. I think I had around 20. There was no commission statement, so I don’t know which ones I got paid on.

Is there any new information about when agents will be paid the $58 per application for Medi-Cal enrollments or who to contact regarding same? Thanks.

No Certified Insurance Agent has been paid a single $58 enrollment fee to the best of my knowledge. I doubt that any of us ever will. My guess … all of the $24 million that they have already received will simply disappear into the CoveredCA coffers to balance the 2014 books to make it look like they are functioning as required by law. The rest of us have been lied to and defrauded.

Any add’l news on this? Anyone receive anything yet?

Here’s the latest news concerning those $58 per Medi-Cal enrollment payments for Certified Insurance Agents that we were told would be coming from DHCS. If you’ve been holding your breath, now it’s time to grab your buttocks and take a deeper breath.

The following statement came to me at 3:19 this afternoon in an email from Crystal Haswell, Chief, Outreach and Enrollment Unit, Medi-Cal Eligibility Division, after responding to my complaint that a large number of my Medi-Cal enrollees in Los Angeles County (and a few others elsewhere) — with applications dated back to December and January — still have not been formally approved for Medi-Cal and that I believe the reason for this is county eligibility workers deliberately stonewalling the process. I also asked what the status of those $58 payments was. She asked if I was a Certified Insurance Agent, and I responded, “Absolutely.”

Here’s what Crystal had to say about the payments (Crystal.Haswell@dhcs.ca.gov):

“Paying Certified Insurance Agents for enrolling individuals in Medi-Cal is a new policy that was not in place at the time you signed your agreement with Covered California. As a new function that must be built into the system, Covered California is working to implement this change as soon as possible. Beyond adding this functionality to our IT systems, Covered California also has to get approval from their Board of Directors as well as the Office of Administrative Law before Agents and Covered California can enter into an amended agreement for these payments.” # # #

This “new policy” was announced in late October 2013. SEVEN MONTHS have elapsed since then and the CoveredCA Board has not yet approved this “new policy”? What else do those folks have on their meeting agendas that can’t be put aside for all of five minutes to vote to approve a “new policy” to benefit the persons who are most responsible for the “success” of CoveredCA enrollments to date?

CoveredCA happily announced months ago that they were going to take a nearly $2,000,000 cut from the $24,000,000+ they HAVE ALREADY RECEIVED for administrative expenses! In the meantime, I could be using the $4000-$5000 I should have been paid by now. And I’m sure a few of you out there are in the same situation.

This is just another shining example of what happens when our state legislature creates a new bureaucracy with absolutely no transparency and no accountability to anyone inside or outside state government. That $24,000,000 in combined state and federal funding … will surely evaporate long before any agent sees one penny of it — if it hasn’t already.

As a licensed agent, if I treated my fiduciary responsibility for client money in that same manner, I would be prosecuted for theft.

Elizabeth …

Don’t hold your breath waiting to be paid for Medi-Cal apps. CoveredCA has only enough money, after taking $2 million for themselves, to pay about 450,000 applications. Those payments are most likely going to the CECs first, and that means $0 or nearly $0 for agents.

We’ve all been sold a bill of goods by CoveredCA, and many of us are unlikely to participate again in 2014 open enrollment come October.

Payments, if any, will not be processed until after open enrollment ends on March 31, from what I’ve been told.

After reading the comments, do agents get paid to enroll client onto to Medi-Cal or not?

The bigger issue now is when are the agents going to get paid.

I know of a person who signed up three hundred people and has not been paid.

Some agents cannot wait two more months to be paid. We have bills to pay and need money to live.

I have spent many hours helping people, but I need to be compensated too. What can we do to get paid? Do we rally the agents to make a statement. Please advise!

Steve … The most appropriate way to “help” is to complete an online enrollment/eligibility application. Once CoveredCA determines eligibility for Medi-Cal they turn the information over directly to the county Medi-Cal agency. That agency either approves the applicant on the basis of the application or will contact the applicant for additional information or an in-office interview to complete their enrollment in Medi-Cal.

I assume the local agencies will be as overwhelmed with all the new applications and may not get them all processed before the end of December. But Medi-Cal will pay qualified medical expenses incurred as much as 90 days prior to a person’s enrollment date, so even if the enrollment is not completed by 12-31-2013, it will probably still be effective on 1-1-2014 as long as the application was submitted on line by 12-15-2013.

“Here’s how a client can designate an agent from within the Covered Cal portal. 1. Log in at the /v.calheers.ca.gov/ portal (This assumes the account has already been created). 2. Click the “Find Help Near You” link on the upper right 3. Click the “Find Agents” button (center of the page; may have to scroll down to see the button) 4. Ask your client to use the “Search by Name” function on the right to find you 5. Click the link to the agent name (ex. “Max Herr”)”

Finally, an answer that makes sense and works.

Thanks!

“Max states that there is nowhere on the paper application”

PLEASE! Do not misquote me or put words in my mouth!

I have never said anything about the “paper” application. All I have been talking about is the CoveredCA ONLINE enrollment process, which is the only thing I am using.

And so far, all I have done is create accounts and submit basic information and documents for folks, the majority of which are Medi-Cal eligibles.

The initial online enrollment process is not the health insurance application process — so I think we’re talking apples and oranges. When the online enrollment determines a person in INELIGIBLE for health insurance because they are ELIGIBLE for Medi-Cal, there is nothing beyond that point to do — the enrollee’s “application” (aka: initial online enrollment/eligiblity “application” form) is automatically referred to the local county Medi-Cal agency.

In the initial online enrollment/eligibility “application” form, there is no place to designate an agent — only a place to designate a personal representative.

That’s why I have no idea how successful this business about being paid $58 per approved Medi-Cal beneficiary will actually be. How will CoveredCA determine me to be the “agent of record” when there is no place to identify me as an “agent”?

Here’s how a client can designate an agent from within the Covered Cal portal.

  1. Log in at the /v.calheers.ca.gov/ portal (This assumes the account has already been created).

  2. Click the “Find Help Near You” link on the upper right

  3. Click the “Find Agents” button (center of the page; may have to scroll down to see the button)

  4. Ask your client to use the “Search by Name” function on the right to find you

  5. Click the link to the agent name (ex. “Max Herr”)

  6. On the top of that page there will be a message, “Agent Selection

Selecting an agent as your representative allows them to: Access your account, see your information,and make changes on your behalf.”

Click the “continue” button in the same box as the message.

  1. I think you can follow the instructions from there. When I get to that step, the system give me a pop up that says that I’ve already designated someone else as an agent (sorry) so I can’t give fresh instructions from there.

I do know that from the home page, I can scroll down to “Resources” and click the link to “Manage Delegates” and find a way to remove the agent I already designated.

Obviously from the client end of things, I can’t know what the agent is able to see on their own interface, but it’s clear on my system that an agent has been designated. I actually designated the agent after selecting a plan.

I would agree that the site is poorly designed and navigation is hard to fathom — but there is definitely a way for a consumer who is entering information on their own to designate their agent online.

Steve … Are you doing anything online via CoveredCA? Or are you strictly processing everything on paper?

You may be using a state form, but it’s not available as part of the eligibility determination process on Covered CA. There is NOWHERE in the account creation/enrollment/eligibility process at CoveredCA (v.calheers.gov) for anyone to designate an agent. PERIOD. Eligibility for Medi-Cal at CoveredCA is simply a test of income vs FPL. (People are told to find an agent listed on the CoveredCA website if they need additional help completing their application.)

From that point, the application gets handed off to the local Medi-Cal agency in the appllcant’s county of residence for final determination.

I’m keeping an Excel spreadsheet of all my applicants, their case numbers, and other information so that I can follow up on any payments I may be due. I believe it’s going to end up being my responsibility to request payment for Medi-Cal enrollments — all because of the poor design of the online process.

What else is there for any of us as agents to do?

I somehow feel that the comments about being the personal representative are incorrect. That we should be agents. What version of the application are we talking about? I’m using STATE OF CALIFORNIA Health Insurance Application (09/13) | CCFRM604 and it has a spot for Certified Agents on page 18 as numbered on the application.

Well, I guess that’s good news for me, because I am enrolling more Medi-Cal eligibles than others. We’ll see if we actually get paid. Good thing I have been making myself their personal representative, because there is no way to go back into the application and do that after it is submitted.

While this reference will not be conclusive enough for some, I appreciate that you provided it. I was sure I had seen it in print but couldn’t remember where.

Here is a link confirming the $58 medi-cal compensation for agents

http://www.healthexchange.ca.gov/BoardMeetings/Documents/October%2024,%202013/PPT%20-%20Covered%20California%20Program%20Reports.pdf

The California Health Benefit Exchange Board announced a “Key Update” on 10/24/13.

“Agents will receive a $58 payment for each successful Medi-Cal enrollment.

  • The payment structure will follow Enrollment Assistance Program rules

  • If the application is a mixed program family no $58 payment

  • Agents do not need to be Enrollment Counselors to receive payment”

This is what an applicant agrees to when Designating an Agent. And Cov CA still needs to have an Agent authorized as “personal Representative”? GEEZ: +] What should I know before I designate an Agent? Designating an Agent to represent you is a decision that should be considered carefully.

Agents act on your behalf just as insurance agents do in the physical world. You’ll be entrusting your Agent to understand your needs in choosing health insurance - whether you need to select plans to offer your employees or choose plans to cover you and your family. The Agent will be able to use your account to make health insurance purchasing decisions just as you would if you were acting on your own.

The first step is to find a Agent using Agent search. You then review a list of Agents, read more about them, and then select one that you can designate to act on your behalf. You may also want to call the Agent or search for the Agent on the public internet to find out more.

Once you designate an Agent, he or she can access your account, read and edit your personal information, select health insurance plans for you, and even purchase them and bill you for the purchase. So designate a Agent only after you do enough research and thinking. You need to be sure you’re comfortable with the Agent who works with you.

Selecting an agent as your representative allows them to: Access your account, see your information,and make changes on your behalf.

Agent to be Designated: I grant this Agent permission to access, enter, and update information in my online application. I further grant permission to the Agent to submit my completed application, including activating an eSignature on my behalf. I understand that I may end my partnership with this Agent at any time through my account dashboard or by calling 1-800-300-1506. I grant permission to the Agent to enter payment information in my online account. I understand that the insurance premium that I am quoted will be charged to my account.

In the initial account set up process, there is a page on which to fill out the “Personal Representative” information and to indicate if that person should receive email communication.

CAUTION! If this is not filled out during the initial account set up, there is no way to go back and change it later. If you are letting your clients do the enrollments on their own, don’t expect to be named their personal representative — they have to input your name, address, phone numbers, etc. It’s a real flaw in the Covered CA site design.

There are some other quirks concerning documentation required — doesn’t seem to be consistent, and they apparently don’t need everything they ask for because I needed to upload a couple of late documents, and lo and behold, the applicant already had been determined eligible for Medi-Cal. Go figure.

But that doesn’t stop them from demanding proof of income for a 2-1/2 year old child.

Well, I am doing this “Personal Representative” designation automatically for all the Medi-Cal enrollments I have done in the past couple of weeks, and I’m not getting any emails, even though the Eligibility Determinations are popping up in their “secure mailboxes”.

And the Eligibility Determination letter is a real piece of work — It starts out by saying You’re not eligible for an enhanced silver plan. Then goes on to say, but it looks like your eligible for Medi-Cal. I don’t understand the logic of this.

Just don’t plan on getting much done on the Covered CA website between 10 am and 5 pm.

I have been designated as CIA through some online applications as well as on paper ones submitted via Fax. While after 2-3 weeks of little access I can now view some client inputted information for the online apps. However today I called CovCA as nothing that shows online gives any clear indication of where the case is in processing. However because I was not “An Authorized Representative”, the Cov CA CSR could not tell me anything. I am their designated CIAgent; I have access to the file- addresses, income, DOBs, etc. She said sorry could not tell me anything. How can we help clients if we are cut out of the loop? And this being “An Authorized Rep”- I do believe that is completely different than being an Agent/CIA….As to the Faxed in applications, lord only knows if/when there will ever be “in the loop” access on those as far as processing status. CovCA wants us agents as allies in all this ACA stuff but in my experience they are CLUELESS as to what a client /Agent relationship is. They started CLUELESS by combining IFP with small group training. They continue CLUELESS by NOT having easily accessible /knowledgable/ reliable CSR in IFP. There is NO accountability.One CSR’s advice on general ? is the opposite of another’s. And the processing time; I seem to recall in training they mentioned a 15 day turnaround. A CSR I spoke with today said 45 days is more likely….I think it is quite unlikely that anyone who applied for 1-1-14 effective date coverage now thru CovCA would know if in fact they have coverage by then…. Mostly venting on this ; welcome any wise input.

The speed bumps do not seem to have been reduced even with the past weekend’s upgrades to the CoveredCA website. In “chatting” with “Lucinda” using the online chat feature (I started as #73 in the queue with an estimated wait time of 23:43, which was pretty close to accurate) her words were “We are experiencing some instability on our system right now… . Try again later.”

Thanks for the help, “Lucinda”.

Medi-Cal enrollments are not compensated. This is strictly prohibited by federal law. Medicare enrollments are not applicable to Covered California. The $58 one-time payment is made only to Certified Enrollment Counselors for completed enrollments in a health insurance plan, not Medi-Cal.

Insurance agents earn commissions based on contractual agreements with each insurer. Agents must be appointed by the insurer to receive commissions. Agents not appointed with an insurer must be appointed within 14 days of the insurer receiving the application [CIC 1704.5. (a)].

Most insurance companies are paying agents commissions at or near 4% of annualized premium. $58 is the equivalent of 4% of a premium of about $121 per month ($1450 per year). Coverage for two or more persons at the bronze level is well in excess of that amount. Commissions are paid irrespective of premium tax credits applicable to a household.

Small business plans applied for through the SHOP exchange will result in the SHOP compensating agents 6% of annualized premiums for the life of the contract if first effective in 2014.

Covered California told me that currently there is no incentive or commission to agents for filing medi-cal or medicare applications. CoveredCA is on the way to settle one time lump sum incentive for agents for filing such application. You say it is one time $58 incentive. Please double check and display the updated information. Thanks

Max, I do web site management for a living. The 10am-5pm problem you are describing is clearly a server load issue. It may not be confined to the Covered California web site - the web site has multiple API functions that create connections with other web sites (such as to verify income via IRS), so issues related to those communications probably add to load.

I am not impressed with the design of the Covered Cal interface for actually buying insurance. There are a lot of issues that I can spot with my web design experience and server management experience that just look sloppy and ill conceived. So basically there are a lot of issues with design and implementation of the site.

I’m not an agent so I don’t know how your day shapes out, but given your experience, I’d suggest that you structure your work day so that you can be working with the site during off peak hours as much as possible. Perhaps you can take paper applications from clients and enter the web site later- that might be good practice down the line anyway. (Digital data can disappear, but paper usually doesn’t evaporate.) I’m a little worried about the insurance billing process - so I think for those who are buying coverage through Covered Cal, it might be a good idea to maintain paper records to document application submission dates. The part that worries me is the stage where the insurance company is supposed to receive data from Covered Cal. and invoice the customer. (A Covered Cal agent told me not to worry, they’d be sending my info to Blue Shield on Dec 5th, and I’d be fine as long as I paid my premium by December 26th. Somehow I did NOT find that reassuring.)

I have spent two days this week and two days a couple of weeks ago enrolling clients of a substance abuse clinic in Medi-Cal and/or health insurance. I am doing that as part of my public responsibility as a licensed agent.

There is no place in the application process to “designate” anyone as an agent. There is only a place to designate a person as a “personal representative”. I fail to see how I would be compensated for a Medi-Cal enrollment.

In fact, my understanding is that no one gets compensated for Medi-Cal enrollments. The $58 compensation paid to Enrollment Counselors is for enrolling persons in health insurance, and is not a “commission” from an insurance company as I would receive when I enroll someone in health insurance from one of the carriers with whom I am appointed. If I enroll someone in a health plan from a company I am not appointed, I have to contact that company to request an appointment (they have to appoint me within 14 days of submitting an application according to the Insurance Code) in order to be paid.

All that being said, my experience with the CoveredCA website these two weeks is rather interesting. My days at the clinics begin at 5am. The website runs fast and efficiently between then and about 10am. Beginning about 10am, the website becomes problematic — pages timeout and have to be redone and documents cannot be uploaded without multiple retries, and even them I sometimes just give up. After about 5pm, things miraculously speed up.

I don’t know if this is by design or because the website cannot handle too much traffic at one time. It’s annoying.

Additionally, the documentation requests frequently make no sense. Some persons are required to submit “proof of citizenship or legal presence” even though the application indicates US Citizen and not a naturalized citizen. Some people with no income are required to submit proof of income — beats me how you do that.

But the strangest one of all is the request for “Proof of Minimum Essential Coverage” and the acceptable documents are: = Notice of action of discontinuance from Medi-Cal = Notice of action of discontinuance from Medicaid = Confirmation of disenrollment from employer-sponsored health insurance plan = Confirmation of disenrollment from health insurance plan

How exactly does a person with no health insurance and no income provide that information? Makes absolutely no sense to me.

$58 for medi-cal app? I heard from our local group that it was $20-$25 per person.

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