Waiver Services – CAP Cayuga/Seneca

Please fill out the below fields to request a Screener contact you to determine eligibility. We will contact people in the order in which they submit the screening.

Please note that a screening takes about 20 minutes per household member.

Call Screening

Name
This field is for validation purposes and should be left unchanged.
Name*
First Last
Birthday:*
MM slash DD slash YYYY
Medicaid CIN Number*
Phone
What is the best days and times to call?
Email
What insurance do you have?*
- Fidelis Medicaid
- Excellus Medicaid
- United Healthcare Medicaid
Please list names and Date of Birth for all other household members. If you live alone, write N/A*

Call Screening

Quick Links

Agency Headquarters

Seneca Office