III.E.b.v.a. Public and Private Partnerships

State Agencies

Illinois’ health care delivery system is multi-faceted and has a number of programs and initiatives. The Illinois Department of Healthcare and Family Services (HFS) is Illinois’ largest insurer. It administers the All Our Kids medical assistance program that is jointly financed by state and federal funds. The program also provides critical health care coverage to birthing persons and children in Illinois.

In 2011, Illinois enacted significant health care reform including the Saving Medicaid Access and Resources Together (SMART) Act (Public Act 97-0689). Among the 62 items in the act was the goal of enrolling at least 50% of all Medicaid beneficiaries in a "care coordination" or managed care plan by January 1, 2015. This has led to a rapid expansion of Medicaid managed care within the state. Currently, five managed care plans are serving the “Family Health” population (children, pregnant women, and childless adults eligible for Medicaid under the Affordable Care Act) statewide, and two other plans are serving beneficiaries in Cook County only.

In 2017, HFS convened a workgroup to design an Integrated Health Home model for the state. This is an outcome-based initiative that incorporates non-medical interventions and will help to increase the likelihood of successful pregnancies, Shannon Lightner, OWHFS interim deputy director, was part of the workgroup and represented the Title V and public health issues at large. The Integrated Health Homes model was projected to launch in early 2020, along with a quality incentive program for managed care organizations to increase the number of women who can deliver full-term babies. Unfortunately, due to the COVID-19 pandemic, the launch of the program was delayed.

Illinois became the first state to extend full Medicaid benefits from 60 days to 12 months postpartum, following the federal CMS approval in April 2021. HFS submitted a Medicaid 1115 demonstration waiver to permit continuous eligibility through 12 months postpartum. CMS’ approval of the waiver enabled federal matching dollars to implement this Medicaid expansion. This development will improve continuity of care for women.

In 2021, HFS implemented its Comprehensive Medical Programs Quality Strategy (Quality Strategy), which is designed to improve outcomes in the delivery of health care at a community level. In addition, the strategy demonstrates HFS’ commitment to addressing social and structural determinants of health, empowering customers to maximize their health and well-being, and maintaining the highest standards of program integrity on behalf of Illinoisans. This quality strategy has a framework that focuses on five areas (pillars of improvement): (1) MCH, (2) Adult Behavioral Health, (3) Child Behavioral Health, (4) Equity, and (5) Community-Based Services and Supports. Each area has specific improvement goals.

As most relevant pillars to Title V are MCH and Child Behavioral Health, HFS is committed to improving maternal and infant health outcomes by reducing pre-term birth rate and infant mortality, improving the rate and quality of postpartum visits, improving well-child visits rates for infants and children, and increasing immunization rates for infants and children. For child behavioral health, HFS is committed to improving the behavioral health services and supports for children with mental illness by improving the integration of physical and behavioral health, improving transitions of care from inpatient to community-based services, reducing avoidable psychiatric hospitalizations through improved access to community-based services, and reducing avoidable emergency department visits by leveraging statewide mobile crisis response. The equity and adult behavioral health pillars are also of interest to Title V. The equity pillar focuses on preventative care, such as increased access to breast cancer and cervical cancer screenings and services focused on controlling high blood pressure control. The adult behavioral health pillar is of particular interest because of HFS’ commitment to improve care coordination and access to care for individuals with substance use disorders.

HFS and IDPH have taken additional steps to strengthen their working relationship. The agencies have teamed up to do the two-year Maternal and Child Health Policy Innovation Program (MCH PIP) offered by the National Academy of State Health Policy (NASHP). HFS and IDPH are developing policy initiatives to improve access to care for Medicaid-eligible pregnant and parenting women. Specifically, the state team will strive to: (1)  improve Medicaid managed care coordination processes for pregnant and postpartum Medicaid enrollees to address key drivers of adverse maternal morbidity and mortality outcomes as identified by IDPH and Title V, (2) implement new prenatal and postpartum quality metrics to monitor and drive improvement in health outcomes for prenatal and postpartum Medicaid managed care enrollees, and (3) enhance data sharing to better inform interventions and improvements in maternal health outcomes for the targeted MCH population.

Federal Opportunities

In addition to working with state agencies, IDPH and Title V have taken advantage of various federal opportunities to strengthen the health care delivery systems that service Illinois’ MCH population. IDPH continues its work under the five-year grant it received through the Enhancing Reviews and Surveillance to Eliminate Maternal Mortality (ERASE-MM) program funded by CDC. Also, IDPH has partnered with the University of Illinois at Chicago (UIC) Innovations to ImPROve Maternal OuTcomEs in Illinois (I PROMOTE-IL), which is a five-year grant from HRSA to improve maternal health and to create a state Maternal Health Task Force. The Title V director previously served as a co-chair of the task force, and currently, is an active member. Title V was also engaged in the Chicago Collaborative for Maternal Health (CCMH). CCMH was funded through the Safer Childbirth Cities program launched by Merck for Mothers in 2018. The collaborative consisted of a partnership between the city of Chicago, EverThrive Illinois, and AllianceChicago.

Other Partnerships

Other notable partnerships involved strengthening the health care delivery system through clinical practice improvements and provider education. Title V and I PROMOTE-IL provide funding and support to the Illinois Perinatal Quality Collaborative (ILPQC) to implement the Birth Equity Initiative. This initiative aims to support hospital capacity to facilitate systems and culture change to promote birth equity. Title V and ILPQC also partner to provide training to all birthing hospitals on obstetrical hemorrhage and hypertension. I PROMOTE-IL is assessing protocols for pregnant and postpartum persons seeking care in emergency departments and designing emergency department provider training. There may be an opportunity for Title V, ILPQC and I PROMOTE-IL to partner on this endeavor in the near future.