1. What would changes mean to me or my family?

This survey is important for adults and children with disabilities, older adults, their families, and their care providers to complete to help us understand how people use Medicaid programs in Wisconsin.

In Wisconsin, Medicaid funds health care, long term care services, and other critical supports that are not available or accessible on the private market to older adults, people with physical disabilities, people with intellectual/developmental disabilities, people with mental health conditions, and low-income working adults. One in five Wisconsin residents rely on some type of Medicaid program.

Policymakers in Wisconsin and Washington, D.C. are proposing big changes to Medicaid, including Medicaid Block Grants. These changes could happen quickly and could be harmful to people. We want to know about the Medicaid services and supports that you or your loved ones use to help you live your life and stay healthy, and how important these supports are to your life.

After you share this information, we’ll keep you updated about proposed changes to your supports or program and let you know how you can take action. Also be sure to mark your calendars for Disability Advocacy Day in Madison on March 21. Check the Survival website at http://www.survivalcoalitionwi.org/ for updates on how to register for this free event, which provides info on the issues and sets up visits with your legislators in the Capitol.

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* 1. Name

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* 2. Age

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* 3. Address

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* 4. City

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* 5. State

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* 6. Zip Code

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* 7. Phone Number

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* 8. Email Address

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* 9. I am a

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20% of survey complete.

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