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AHCCCS/Medicaid & Federal Programs Impact Survey

Thank you for taking the time to share the importance of AHCCCS/Medicaid and other federal programs for you, your family, your organization and your community by completing this brief survey.

We are collecting stories to help shine a light on the potential impacts of loss of federal funds to Arizonans like you. Your story will help our fight to protect vital services for children and families. We do not know which programs may be affected and are looking for a variety of impacts to prepare for multiple scenarios.

Note that the information in this survey will be used only for the purpose of protecting against cuts to Medicaid and similar programs. Completing this survey will not add you to further mailing lists.
1.First name(Required.)
2.Last name(Required.)
3.Email address(Required.)
4.Phone Number(Required.)
5.Address
6.City
7.Zip code(Required.)
8.Are you answering for you, your family, on behalf of an organization, or as a concerned community member (answer for your primary role only)?(Required.)
9.Organization (if applicable)
10.Is your organization at risk of needing to reduce or eliminate services if federal funding is reduced or eliminated?
11.Are you at risk of losing your job if federal funding is reduced or eliminated?
12.Are you at risk of losing benefits if federal funding is reduced or eliminated?
13.If health care cuts are made, please select the program(s) that will have the biggest impact on you, your family or the people you serve (please select no more than 3):(Required.)
14.Are you willing to (check all that apply):