III.B. Overview of the State
Demographic Information
Illinois is a large, diverse state. It is currently the sixth most populous state in the nation and was home to 12.7 million residents in 2021. The Chicago metro area is home to 9.6 million people, 2.7 million of whom reside within the city. Chicago is the largest city in Illinois and the third largest in the country. From 2020-2021, Illinois lost almost 1% of its population; during this same time period, the only other state to experience similar population loss was New York. Notably, other large states, like Texas, Georgia, and Florida experienced increases in population during that time. Only eleven out of the 102 counties in Illinois recorded population increases from 2021-2022.
In 2021, there were 2.5 million women of reproductive age (ages 15-44) who resided in Illinois. In 2021, there were approximately 132,000 births to Illinois residents, with 55% born to White women, 16% to Black women, 21% to Hispanic women, 6% to Asian women, 0.3% to American Indian/Alaska Native women, and 1.4% to non-Hispanic women of other races (includes Native Hawaiian or other Pacific Islander, other race, and multiple-race women). In 2021, nearly 1 in 4 (22.1%) Illinois residents were under age 18 — approximately 2.8 million children. Approximately 6% of the total population, around 700,000 children, is under the age of 5. The fertility and birth rates in Illinois are slightly lower than the national averages, but higher than several other large states, such as California.
Geographic Considerations
Illinois’ population is concentrated in Cook County (which includes the city of Chicago) and the surrounding collar counties. In addition to the diverse and urban city of Chicago, Illinois is home to many small and mid-sized cities. Fifteen cities in the state, including Joliet, Naperville, and Aurora, have more than 75,000 residents.
By land mass, Illinois is largely rural. More than two-thirds of its 102 counties are classified as non-metropolitan, and approximately 1.4 million Illinoisans live in rural communities. Reflecting a larger long-term national trend, the rural areas in Illinois have decreased in population since 2010 by approximately 6%. Rural communities in Illinois are largely concentrated in the southern and western parts of the state.
In planning for the care and well-being of Illinois’ maternal and child health population, the IL Title V program and its partners must balance the needs of a large and diverse urban center, several mid-sized cities with unique populations and care delivery systems, and a large rural area with limited geographic access to services.
Education
In 2021, approximately 87% of Illinois adults were high school graduates and 37% were college graduates. Educational achievement is not evenly distributed in the state. Illinois also suffers from racial disparities in educational achievement. Twenty-five percent (25%) of non-Hispanic Blacks and 18% of the Hispanic population have graduated from college, compared with 41% of non-Hispanic Whites. The rates of high school and college graduation are slightly higher in Illinois than in the U.S.
Racial and Ethnic Diversity
In 2021, the racial/ethnic makeup of Illinois residents was as follows: 60% identify as non-Hispanic White, 18% identify as Hispanic/Latino, 14% identify as non-Hispanic Black, 6% identify as Asian, <1% identify as American Indian/Alaska Native, <1% identify as Native Hawaiian or other Pacific Islander, and 2% identify as multi-racial. Cook County is more racially diverse than the state overall. In 2019 Cook County had the following breakdown of resident, 41% of the population identify as non‐Hispanic White, 23% identify as non-Hispanic Black and 26% identify as Hispanic/Latino. Within the city of Chicago, 31% of residents identified as non‐Hispanic White, 29% identified as non-Hispanic Black, 30% identified as Hispanic/Latino, and 7% identified as Asian.
Illinois has a significant population born outside the United States. In 2021, approximately 14% of Illinois residents identified as foreign born. Most of these foreign‐born residents (47%) are not U.S. citizens. Foreign-born Illinoisans come primarily from Latin America, with a sizeable Asian population as well. Reflecting this large immigrant population, more than 23% of Illinoisans speak a language other than English at home, with Spanish being the most common other language. Cook County has a higher percentage of foreign‐born residents and non‐English speakers than the rest of the state.
Employment and Income
From 2016-2021, 65% of Illinois adults were in the civilian labor force — either currently working or actively looking for work. Due to the COVID-19 pandemic, the non-adjusted employment rate in Illinois rose from 4.1% in June 2019 to 14.6% in June 2020. Since then, Illinois has experienced some economic recovery, with unemployment rates reaching 4.7% as of 2022. Despite this encouraging recovery, there is still concern for how the past few years will continue to affect the economic security of women, children, and families.
The per capita income in Illinois in 2021 was $39,571, compared to a national average of $38,332. Incomes are generally higher in Cook County, with a per capita income of $41,990. Illinois’ per capita income was higher than that in Pennsylvania, Florida, and Texas, but lower than that of New York and California.
Poverty and Housing
In 2021, 12.1% of all Illinoisans lived below the federal poverty line (FPL). Children are more likely to live in poverty. Sixteen percent (16%) of children under 18 years old and 17.7% of children younger than 5 years old lived in poverty. Poverty in Illinois is more common in Cook County, and specifically in the city of Chicago. In Cook County in 2021, 14% of the total population and 19% of children lived in poverty; in Chicago, 17% of the total population and 24% of children lived in poverty. Of all Illinois households in 2021, 14.1% received food stamps and 3% received cash assistance.
Living in a female‐headed household is strongly associated with poverty in Illinois. While 9% of all families were impoverished, 23% of female‐headed households in 2021 had incomes below the FPL. This increases for households with children; 32% of female‐headed households with children under 18 years old and 37% of female‐headed households with children under 5 years old were impoverished. Nearly half (41.9%) of unmarried women who gave birth in the last 12 months lived in poverty, compared to 10.1% of married new mothers.
In Illinois in 2021, 68% of housing units were owner‐occupied. This is a higher rate than in many other large states. However, there is a large racial disparity in home ownership; in the Chicago metropolitan area, 49% of White householders own their home, while only 22% of Black householders do. For those families that rent a home, the high cost of rental housing is a concern. In 2021, 44.4% of families renting a home spent more than 30% of their income on rent. Low‐income families are especially at risk for rental costs that consume large proportions of their household income.
Key Health Indicators
According to America’s Health Rankings for 2022 (https://www.americashealthrankings.org/), Illinois ranked 26th out of the 50 states on combined measures of health determinants, behaviors, and outcomes. Illinois ranked high among all states for adequate water fluoridation (3rd), supply of dentists (6th), low rate of people experiencing frequent mental distress (7th), and a low prevalence of adverse childhood experiences (11th). However, Illinois did poorly compared to other states for measures of premature death racial inequality (36th), physical inactivity (40th), and residential segregation (44th). For birth outcome indicators, Illinois consistently ranked in the middle, coming in at 31st for infant mortality and 27th for low birth weight. The report also indicates some positive trends in Illinois, including a 55% increase in mental health providers over the last five years, and a 23% decrease in smoking in the last four years. Unfortunately, there have also been some trends in the negative direction, including a 22% increase in premature deaths since 2019, and a 28% increase in drug deaths over the last two years.
Maternal and women’s health in Illinois present both strengths and challenges. Most Illinois women are accessing important health care services; about 3 in 4 women of reproductive age received at least one preventative visit in the last year and 3 in 4 pregnant women received prenatal care beginning in the first trimester. In recent years, the maternal mortality and severe maternal morbidity rates have improved slightly overall, however, they continue to show increasing racial disparities. Compared to non-Hispanic white women in Illinois, non-Hispanic Black women are about twice as likely to experience a severe pregnancy complication at delivery and about twice as likely to die from a pregnancy-related cause and more than four times as likely to die as non-Hispanic White mothers.
Illinois has worked hard to improve the health of infants and perinatal women over time. Illinois women are more likely than ever to deliver in a risk-appropriate care setting; more than 86% of Illinois’ very low birth weight infants are born in a hospital with a level III neonatal intensive care unit (NICU). There has been modest, steady progress on some infant mortality outcomes in Illinois. Over the last five years, there was a small reduction in perinatal mortality and preterm-related mortality in Illinois overall. However, neonatal mortality and infant mortality have fluctuated during the last five-year period with no substantial change. A stark Black-White racial disparity continues to persist; infants born to non-Hispanic Black women have 2-3x greater risk of infant mortality compared to infants born to non-Hispanic White women.
Accessible and high-quality preventive care is essential to the health and well-being of Illinois’ children and adolescents. Title V program has ample opportunity to improve overall child health. Traditionally, Illinois has been a national leader in childhood insurance coverage with only about 4% of Illinois children in 2022 being uninsured. In recent years, however, Illinois has lost ground. Illinois is ranked 17th out of the 50 states on this measure. Access to services is a challenge among both insured and uninsured children. Nearly half of children in 2018-2019 with a diagnosed mental or behavioral health condition did not receive any treatment for their condition. Mental health and suicide prevention remain a top priority in the state. The adolescent suicide rate has steadily risen since 2014 and, in the 2020 estimate, Illinois’ adolescent suicide rate is about the same as the national rate (8.6 vs 8.9 per 100,00).
The State’s Unique Strengths and Challenges
Illinois has many resources that strengthen and support its capacity to impact the health status of women and children. When all the services provided through IDPH and other state agencies are considered, Illinois has a robust set of services for women and children, including CYSHCN. These interventions are supported by an appropriate set of state statutes and regulations. Illinois also has seven colleges of medicine and a college of osteopathy, three dental schools, and numerous colleges for allied health sciences. These institutions are accompanied by large systems of care, including outpatient settings. Illinois also has nine children’s hospitals and many family practice, pediatric primary care, and specialty care providers. Finally, the University of Illinois Chicago (UIC) School of Public Health has one of the United States’ 13 Centers of Excellence in Maternal and Child Health (CoE-MCH). The state’s Title V program has an intragovernmental agreement with the UIC CoE-MCH to provide ongoing epidemiological and data support, and IDPH routinely hosts student interns from this program.
Even with these resources, Illinois faces challenges in the improvement of women’s and children’s health. Most of Illinois outside of Cook County and the counties that surround it are health provider shortage areas for primary, dental, and mental health services.
Poverty and inequity have resulted in racial and ethnic disparities in health status. It is important to acknowledge racism as a driving force of the social determinants of health and as a barrier to achieving health equity and optimal health for all people. The impact of racism on health outcomes is particularly important for Illinois as it is a racially and ethnically diverse state but remains very segregated. Per a Brookings Institute report, Chicago is consistently one of the most racially segregated cities in the United States. For Black-White segregation, Chicago is the 3rd most segregated city in the United States, after Milwaukee, WI and New York, NY. For Latino-White segregation, Chicago is the 6th most segregated city in the United States, and the most segregated city in the Midwest.
Illinois Department of Public Health Roles and Responsibilities
The Illinois Department of Public Health (IDPH) is one of the longest standing state agencies, established in 1877 as the State Board of Health. It now has headquarters in Springfield and Chicago, seven regional offices, three laboratories, and more than 1,200 employees. IDPH houses more than 200 public health programs covering the spectrum of diseases/conditions and the entirety of the life course. IDPH’s vision is that "communities of Illinois will achieve and maintain optimal health and safety" and the mission is to “protect the health and wellness of the people in Illinois through the prevention, health promotion, regulation, and the control of disease and injury.”
The Office of Women's Health and Family Services (OWHFS) is one of eight programmatic offices with IDPH. The deputy director reports directly to the IDPH Chief Operating Officer. OWHFS houses three divisions: Division of Maternal, Child, and Family Services, Division of Women's Health, and Division of Population Health Management. These divisions work together closely to support women’s and family health across the lifespan. The IL Title V program sits within the Division of Maternal, Child, and Family Health Services, with the Title V MCH director also serving as the division chief.
Illinois’ System of Care
Population Served
The Title V program serves all women of reproductive age, as well as infants, children, adolescents, and CYSHCN. Three state agencies oversee the utilization of Title V block grant in IL: IDPH, UIC‐DSCC, and DHS. IDPH administers the MCH Block Grant and oversees all Title V funded MCH programming across the state; UIC-DSCC focuses on statewide CYSHCN programming; and DHS leads many of the direct service MCH programs (e.g., the Special Supplemental Nutrition Program for Women, Infants, and Children [WIC], home visiting).
Additionally, the IL Title V program provides “mini block grant” funding annually to the Chicago Department of Public Health’s Maternal, Infant, Child, and Adolescent Health Bureau to implement comprehensive, effective, and innovative programming within the city of Chicago. These programs are closely aligned with the state’s Title V priorities overall, but CDPH has flexibility in how to use funds across multiple program areas.
Health Services Infrastructure
Perinatal Levels of Care
Perinatal regionalization is a strategy to organize risk-appropriate services for pregnant women and neonates according to their medical complexity and needs. Currently, 93 Illinois hospitals have a designation for a perinatal level of care, granted by IDPH, which outlines the populations of infants that can be cared for by the facility and the resources and personnel necessary to provide this care. Each birthing hospital is assigned to one of 10 administrative perinatal centers (APC), which provides ongoing training, technical support, and consultation on complex medical issues, as well as helps to coordinate and assure the transport of women or neonates between facilities. Illinois Title V program supports the APCs and regulates perinatal designations according to Illinois’ Perinatal Administrative Code.
Monitoring the changing availability of obstetric services throughout the state and potential impact on maternal and infant outcomes is a priority of IL Title V and the Illinois Perinatal Advisory Committee. Between January 2016 and December 2022, there were 29 obstetric hospitals closures in the state of Illinois (6 full facility closures, and 23 facilities that closed their obstetric unit). During this time, there were also 3 new hospitals that opened to provide obstetric services, resulting in a net loss of 26 obstetric hospitals in Illinois during a seven year period. We continue to monitor obstetric hospital closures and to seek to understand the driving factors behind these closures. More information is available in Section III.C (Needs Assessment Update).
Children’s Hospitals
Illinois has a large network of children’s hospitals and pediatric specialists. There are nine children’s hospitals in Chicago and additional children’s hospitals in Peoria and Springfield. Through partnerships with UIC‐DSCC, children’s hospitals in neighboring states also play a key role in promoting the health of Illinois MCH population. Specifically, there are children’s hospitals in Milwaukee, WI., Madison, WI., Iowa City, IA, St. Louis, MO., and Indianapolis, IN. that also work with UIC-DSCC.
Integration of Services
Behavioral Health: The federal Center for Medicare & Medicaid Services (CMS) approved a series of behavioral health demonstration projects under a 1115b demonstration waiver to implement Integrated Health Homes as a part of HealthChoice Illinois, the state’s Medicaid managed care program.
Financing of Services
Women and children in Illinois are eligible for publicly subsidized health insurance through Illinois’ Medical Assistance program, which is administered by Illinois Department of Health and Family Services (HFS). The Medical Assistance Program includes both Title XIX and Title XXI.
Necessary medical benefits, as well as preventive care for children, are covered for eligible persons when provided by a health care provider enrolled with HFS. Eligibility requirements vary by program. Most individuals enrolled are covered for comprehensive services, such as doctor visits and dental care, well-childcare, immunizations for children, mental health and substance abuse services, hospital care, emergency services, prescription drugs, and medical equipment and supplies. Illinois is a Medicaid expansion state. Under the Affordable Care Act (ACA), eligibility for Medicaid coverage was expanded to adults aged 19-64 who were not previously covered. Individuals with income up to 138% of the federal poverty level are eligible.
In Illinois there are several insurance options for children and families. Children in families with incomes up to 142% of federal poverty level are eligible for traditional Medicaid coverage and children in families with incomes up to 318% FPL are eligible through the Children’s Health Insurance Program (CHIP) program. Specifically, All Kids is an Illinois' program for children who need comprehensive, affordable, health insurance, regardless of immigration status or health condition. The insurance plans under All Kids, include All Kids Assist, All Kids Share, All Kids Premium Level 1 and 2, and Moms and Babies. Children and pregnant women must live in Illinois and are eligible regardless of citizenship or immigration status.
The Medicaid “Moms and Babies” plan provides a full range of health benefits to eligible pregnant women and their babies, with eligibility up to 213% of the federal poverty line. The program pays for both outpatient and inpatient hospital services for women while they are pregnant and postpartum. Until recently, the postpartum coverage period was 60 days. During the current the public health emergency for COVID-19, under the maintenance of effort (MOE) requirement, all Medicaid recipients were granted continuous eligibility for the duration of the public health emergency. Thus, pregnant persons had continuous insurance coverage without having to re-verify income eligibility and were not discontinued at 60 days postpartum. Once the public health emergency is over, Illinois’ efforts in extended coverage will continue. In April 2021, Illinois became the first state to receive approval for the extension of continuous Medicaid eligibility for 12 months postpartum through an 1115 waiver. This waiver approval will allow Illinois to continue receiving federal match for postpartum Medicaid claims up to one year postpartum, including allowing women to enroll at any time during the first year postpartum if they become eligible at that time. Babies may be covered for the first year of their lives provided the mother was covered when the baby was born. Moms and Babies enrollees have no co-payments or premiums and must live in Illinois.
Along with All Kids, Medicaid also has a program called “FamilyCare,” which offers health care coverage to parents living with their children 18 years old or younger as well as relatives who are caring for children in place of their parents. For all plans, non-pregnant adults must live in Illinois and be U.S. citizens or legal permanent immigrants in the country for a minimum of five years.
There are approximately 1.6 million children enrolled in All Kids. Families may apply using English or Spanish web-based applications that may be submitted online or downloaded and submitted through the U.S. Postal Service.
Over time, insurance coverage and access in Illinois has been an area of steady improvement. In 2021, 93.0% of the civilian non-institutionalized population was insured. Among children ages 18 and under, this proportion was 96.8%. Across race/ethnicity, insurance coverage was lowest among Hispanics and Latinos (84.2%). Foreign-born residents who are not citizens (68.5%) had a lower insurance coverage rate than naturalized citizens (92.1%). Across all ages, women are slightly more likely than men to have insurance coverage (94% vs. 92%), although nearly 8% of women ages 19-44 were uninsured in 2021.
Nearly 69.4% of people in Illinois utilize private health insurance, either alone or in combination with other insurance types. Children are less likely than adults to be covered by private insurance, with 61.5% of children under age 6 and 65% of children ages 6 to 18 covered by a private insurance plan. One third of Illinois residents (35%) are covered by a public insurance plan, and for 21.2% of Illinois residents public insurance is their only form of health insurance coverage (includes Medicare, Medicaid, and VA benefits). Notably, 37.4% of Illinoisans aged 18 and younger, and 20.3% of women aged 19-44 were enrolled in public health insurance in 2021.
Public insurance also reaches many of Illinois’ poor residents; 67.5% of residents below 138% of the federal poverty level use a public insurance plan. As of FY2021, nearly 1.5 million children were covered by either Illinois’ Medicaid program or the Children’s Health Insurance Program (CHIP).
The implementation of Medicaid managed care is discussed in the “Health Care Delivery System” sub-section.
Selected State Statutes and Regulations Related to Maternal and Child Health Block Grant and Programs
- MCH Program Authority. The Maternal and Child Health Services Code (77 Ill. Admin. Code 630) makes the planning, programming, and budgeting for MCH programs the responsibility of IDPH and requires IDPH to give the University of Illinois, Division of Specialized Care for Children “at least the amount of federal Maternal and Child Health Services Block Grant funds required by Title V” for services for children with special health care needs. It also authorizes IDPH to award funds for programs providing health services for women of reproductive age, programs providing health services for infants in the first year of life, health services for children from 1 year of age to early adolescence, and programs providing health services for adolescents.
- CSHCN Program Authority. Specialized Care for Children Act (110 ILCS 345/). This act designates the University of Illinois as “the agency to receive, administer, and to hold in its own treasury federal funds and aid in relation to the administration of its Division of Specialized Care for Children,” and created the Advisory Board for Specialized Care for Children to advise the University. Program Content and Guidelines for Division of Specialized Care for Children Code (89 Ill. Admin Code 1200) is the Administrative Rule guiding DSCC Core Program.
- Perinatal Program. The Developmental Disability Prevention Act (410 ILCS 250) authorizes regional perinatal health care and establishes the Perinatal Advisory Committee (PAC). The Regionalized Perinatal Health Care Code (77 Ill. Admin. Code 640) establishes the administrative rules related to perinatal levels in Illinois, including resource and personnel requirements for perinatal levels of designation, data submission, and the designation/re‐designation site visit process. The Perinatal Code is in the process of being revised by the Perinatal Advisory Committee and IDPH Office of Women’s Health and Family Services.
- Maternal Levels of Care. Maternal Levels of Care Act (IL Public Act 101-0447) requires IDPH to establish levels of maternal care for hospitals in Illinois. These levels of care are to be complimentary but distinct from the perinatal levels of care system. IDPH, by rule, will develop criteria for the designation of hospitals based on their capabilities. IDPH will also collect additional data on maternal mortality and morbidity to lead any future changes to the maternal levels of care. Administrative rules are in the process of being written by the IDPH Office of Women’s Health and Family Services.
- Birthing Hospital Training. Hospital Hemorrhage Training Act (IL Public Act 101-0390) requires all birthing facilities to conduct annual continuing education that includes management of severe maternal hypertension and obstetric hemorrhage.
- Emergency Department Training. The Improving Health Care for Pregnant and Postpartum Individuals Act (Public Act 102-0665) sets forth the requirement that every birthing hospital have a written policy and conduct continuing education yearly for providers and staff of the emergency department and other staff who may care for pregnant/postpartum people on severe maternal hypertension and obstetric hemorrhage and other leading causes of maternal mortality.
- Birth Centers. The Birth Center Licensing Act (Public Act 102-0518) dictates that, except as provided by the act, no person shall open, manage, conduct, offer, maintain, or advertise as a birth center without a valid license issued by the Illinois Department of Public Health. The act speaks to many requirements including licensure, staffing, linkages, reimbursement, and reporting. Administrative rules are in the process of being written by the IDPH Office of Healthcare Regulation.
- Infant/Maternal Mortality among African-Americans. Task Force on Infant and Maternal Mortality Among African Americans Act (IL Public Act 101-0038) created a task force establishing best practices to decrease infant and maternal mortality among African Americans in Illinois and produce an annual report to the General Assembly detailing its findings and recommendations.
- Sudden Unexpected Infant Death (SUID). Section 5/3-3016 of the Counties Code (55 ILCS 5) requires that an autopsy be performed on children under 1 year of age who die suddenly and unexpectedly and the circumstances concerning the death are unexplained following investigation be reported to the IDPH SUID program within 72 hours. Effective 1/1/2020, IL Public Act 101-338 updated the Department of Public Health Powers and Duties Law (20 ILCS 2310) to requires IDPH to develop a coroner reporting form for SUID/SIDS and to publish information from the coroner reports. (
- Newborn Screening. The Newborn Metabolic Screening Act (410 ILCS 240), the Infant Eye Disease Act (410 ILCS 215), the Newborn Eye Pathology Act (410 ILCS 223), and the Early Hearing Detection and Intervention Act (410 ILCS 213) authorize health screening for newborns. The Genetic and Metabolic Diseases Advisory Committee Act (410 ILCS 265) created a committee to advise IDPH on screening newborns for metabolic diseases.
- School Health Centers. The School-Based/Linked Health Centers Code (77 Ill. Admin. 641) sets forth the standards for certification of school-based health centers in Illinois. The purpose of school-based health centers is to “improve the overall physical and emotional health of students by promoting healthy lifestyles and by providing available and accessible preventive health care when it is needed.”
- Provider Education. During late 2021 the Illinois legislation body adopted 20 ILCS 2105/2105-15.7) Sec. 2105-15.7. Implicit bias awareness training which states, “For license or registration renewals occurring on or after January 1, 2023, a health care professional who has continuing education requirements must complete at least a one-hour course in training on implicit bias awareness per renewal period”. https://www.ilga.gov/legislation/ilcs/ilcs5.asp?ActID=325
- Doula Certification and Coverage. In April 2021 the Governor signed amendment to the Illinois Public Aid Code to ensure coverage of doula by HFS. https://ilga.gov/legislation/102/HB/10200HB0158enr.htm The Amendment to the Public Aid Code ensures that the state supports the increased utilization and reimbursement of doula services for prenatal and postpartum care, which includes supporting the development of an educational infrastructure for the certification of community-based doulas across the state
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