In response to the COVID-19 lockdown, the Temporary MHLA Enrollment/Renewal Form Via Telephone Only (TERF) program was created to allow applicants to safely enroll or renew from home.  This choice to begin, renew, and modify an application by telephone will now be permanent and be renamed the Remote MHLA Enrollment/Renewal Form with new requirements.

Just like before, enrollers must enter the information from the form into One-e-App and ensure its accuracy. The applicant has 30 days to provide required documentation by email, phone, fax, mail, or in person.

New Requirements:

1. For renewals, applicants must submit all required documents (such as proof of identity, residency, and income) regardless of change or no change. The two check boxes for renewal (for declaring changes or no changes) will be eliminated and will be replaced with one renewal check box for both.
2. Enrollers must enter family member’s name, DOB, birthplace, employment status, SSN, active Medi-Cal status, and CIN # (if applicable).
3. For modifications, enrollers must check a box for the reason.

Please familiarize yourself with this new form and call the SME Line at (833) 714-6500 with any questions.