Community Supports: Member Service Change Request Form

This form is for TotalCare members to request changes to the Community Supports (CS) services they are getting.

Some reasons you might fill out this form include:

• You want to ask for a new CS provider.
• You would like to change the type of meals you are getting (prepared meals, grocery/produce boxes).

Need help with this form? Call Member Services at 833-530-9015 (TTY: 800-735-2929 or 711).