Share Your Story!

Your voice matters! By sharing your health care story, you are joining other Idahoans who want a say in the policy decisions that affect their health. Idaho Kids Covered invites you to share your experiences with Medicaid or going uninsured. Everything is confidential and never shared without your permission. Thank you for taking the time to fill out our story survey.

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* 1. Name

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* 2. Age

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* 3. Zip Code

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* 4. Which race/ethnicity best describes you?

American Indian or Alaskan Native

Asian / Pacific Islander

Black or African American

Hispanic

White / Caucasian

Prefer not to answer

Multiple ethnicity / Other (please specify)

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* 5. Email

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* 6. Phone number

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* 7. Preferred method of contact (check box)

text

call

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* 8. Do you or someone you're assisting have Medicaid?

I have Medicaid coverage

I had Medicaid coverage in the past

A family member has Medicaid coverage

I'm assisting someone who has Medicaid coverage

None of the above

I am uninsured

Share Your Story!

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* 1. Name

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* 2. Age

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* 3. Zip Code

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* 4. Which race/ethnicity best describes you?

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* 5. Email

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* 6. Phone number

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* 7. Preferred method of contact (check box)

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* 8. Do you or someone you're assisting have Medicaid?

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* 9. Please tell us a little about yourself or the person you are assisting.

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* 10. How has having access to Medicaid as health insurance impacted you/your family?