Services During Coronavirus Questionnaire
This survey is meant to collect information about services being provided to Mainers with disabilities who receive those services under MaineCare sections 21 and 29. Thank you for your participation!

Please answer the following about your services (or the services of the family member/person you support) since the COVID-19 outbreak:
What is your (the person receiving services) zip code and/or town/city? (this is for statistical purposes only - your answers will remain anonymous)
Your answer
Case management:
Section 29 waiver - Day Program - Check all that apply
Sections 21/29 waiver - Home Supports - check all that apply
Sections 21/29 - Shared Living - please check all that apply
Section 21 - Residential - check all that apply
Please tell us why you are not receiving your usual services
Please tell us about the information that you are receiving about your services.
Are there things you or your family need, but can't get? What are they?
Your answer
Is there anything else you'd like us to know about your services right now?
Your answer
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