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AHCCCS/Medicaid & SNAP Impact Survey

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

We are collecting stories to help shine a light on how federal cuts to Arizona’s Arizona Health Care Cost Containment System (AHCCCS) and the Supplemental Nutrition Assistance Program (SNAP) is impacting Arizonans like you. Your story will help our fight to mitigate and document the consequences for children and families in Arizona.

Note that the information in this survey will be used only for the purpose of documenting cuts to federal programs like Medicaid and SNAP. 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 due to Medicaid or SNAP cuts?
11.Are you at risk of losing your job due to Medicaid or SNAP cuts?
12.Are you at risk of losing benefits due to Medicaid or SNAP cuts?
13.Which federal health care cuts has had or 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):