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* 1. I am a(n) (check all that apply)

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* 2. My location in Illinois is:
a. County
b. Zip code

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* 3. Are you aware of the changes to dental care for adults insured by Medicaid which will start on July 1, 2012?

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* 4. What type of insurance coverage for dental care now exists for you/your family member/your client(s)?

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* 5. Where do you/your family member/your client(s) currently go to get dental care?

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* 6. This question is for people with Medicaid coverage only - what are your plans to get dental care after July 1, 2012 when adult dental benefits are reduced?

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* 7. Based on your specific disability-related and/or medical needs, do you need any of the following accommodations in order to get dental care (check all that apply)?

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* 8. What else would you like us to know about your special needs and paying for dental care?

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* 9. If you have a current dentist, did you talk with him/her about the changes to your dental benefits?

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* 10. Please share your name, telephone number and email address if you would like us to contact you regarding this survey. If you want to get daily updates about disability services in Illinois, join The Arc of Illinois by calling 815-464-1832 or visiting our website at www.thearcofil.org.

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