Please complete and submit this form to tell us about your interest in joining or leading a
team of concerned citizens to advocate with the governor of your state for Medicaid expansion.
State where you vote and plan to act
Check all the options that apply to your willingness to visit the governor of your state in support of Medicaid expansion
If you have or are willing to organize/lead a team, please describe who would comprise your team.
(e.g. sisters, healthcare professionals, etc.)