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Thank you for taking the time to complete this short survey.  Medicaid Matters New York, the statewide coalition representing the interests of people who are served by Medicaid in New York, is interested in raising the importance of Medicaid to state officials, the media, and the public.  We hope you will share information about why Medicaid matters to you to help us put human faces to our work.  There is an option below to upload a photo of yourself that we may use.  If you prefer to email your information or photo to us directly please send it to lkassel@medicaidmattersny.org.  Again thank you!  We are excited to learn why Medicaid matters to you and to share your story!

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* 1. What is your name?

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* 2. Where do you live?

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* 3. Why does Medicaid matter to you?

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* 4. Please upload a forward facing photo of yourself.

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* 5. What is the best way to contact you if we have a question?  Please select call, text or email below, and enter your contact information in the comment box.

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* 6. Do we have your permission to use your information and photo in our materials? Here is an example of how we may use your information and photo (scroll to the bottom of the flyer): https://medicaidmattersny.org/wp-content/uploads/2021/05/2020-enrollment-one-pager-MMNY-2.16.21.pdf

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