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 2020. The Chicago metro area is home to 9.5 million people, 2.7 million of whom reside within the city of Chicago. Chicago is the largest city in Illinois and the third largest in the country. From 2010-2019, Illinois lost almost 2% of its population; during this same period, the only other state to experience population loss was West Virginia. Notably, other large states, like Texas, California, and Florida experienced increases in population during that time. Only four of the 102 Illinois counties recorded population increases from 2019-2020.
In 2020, nearly 1 in 4 (22.5%) Illinois residents were under age 18 — a total of approximately 2.8 million children. Approximately 7% of the total population, more than 900,000 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 Florida.
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. Twelve cities in the state, including Aurora, Joliet, Naperville, and Rockford, 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 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 2020, approximately 90% of Illinois adults were high school graduates and 35% were college graduates. Educational achievement is not evenly distributed in the state. Only 86% of adults in Chicago are high school graduates, indicating the need for increased educational focus in this city. Illinois also suffers from racial disparities in educational achievement. Twenty-three percent (23%) of non-Hispanic Blacks and 16% of the Hispanic population have graduated from college, compared with 40% 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 2020, the majority (58%) of the Illinois population was non‐Hispanic White. Non-Hispanic Blacks comprise 14% of the population and Latinos of all ethnicities account for 18%. Cook County is more racially diverse than the state overall. In 2019 in Cook County, only 65% of the population was non‐Hispanic White, while non-Hispanic Blacks comprised 24% and Latinos comprised 26%. Within the city of Chicago, this diversity is even more pronounced: 48% were non‐Hispanic White, 29% were non-Hispanic Black, 29% were Latino, and 7% were Asian. So, while Illinois is more racially homogenous than other large states, the concentration pockets of racial minorities in the Chicago area presents unique challenges for culturally competent health care delivery.
Illinois has a significant population born outside the United States. In 2020, approximately 14% of Illinois residents were foreign born. Most of these foreign‐born residents (48%) 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 2016-2020, 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 March 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 2020 was $37,306, compared to a national average of $35,384. Incomes are generally higher in Cook County, with a per capita income of $40,042. 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 2020, 12.9% of all Illinoisans lived below the federal poverty level (FPL). Children are more likely to live in poverty. Sixteen percent (16%) of children under 18 years old and 17.6% 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 2019, 14% of the total population and 31% of children lived in poverty; in Chicago, 18% of the total population and 31% of children lived in poverty. Of all Illinois households in 2019, 17.8% received food stamps and 2% received cash assistance.
Living in a female‐headed household is strongly associated with poverty in Illinois. While 12% of all families were impoverished, 13% of female‐headed households in 2018 had incomes below the FPL. This increases for households with children; 35% of female‐headed households with children under 18 years old and 40% of female‐headed households with children under 5 years old were impoverished. Nearly half (43%) of unmarried women who gave birth in the last 12 months lived in poverty, compared to 8% of married new mothers.
In Illinois in 2016-2020, 66% 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, 74% of White householders own their home, while only 39% of Black householders do. For those families that rent a home, the high cost of rental housing is a concern. In 2017, 45% 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 2020, Illinois ranked 25th out of the 50 states on combined measures of health determinants, behaviors, and outcomes. Illinois ranked high among states for adequate water fluoridation (3rd), low prevalence of adverse childhood experiences (5th), supply of dentists (8th), and a low rate of people experiencing frequent physical distress (15th) or mental distress (15th). However, Illinois did poorly compared to other states for measures of premature death racial inequality (36th), excessive drinking (43rd), and residential segregation (47th). For birth outcome indicators, Illinois consistently ranked in the middle, coming in at 31st for infant mortality and 29th for low birth weight. The report also indicates some positive trends in Illinois, including a decrease in severe housing problems over the last four years (19% vs. 17%), and a 31% decrease in smoking in the last eight years. Unfortunately, there have also been some trends in the negative direction, including a 26% increase in suicides over the last nine years, and a 28% increase in frequent mental distress over the last four 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. In Illinois, non-Hispanic Black mothers are about twice as likely to experience a severe maternal morbidity 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 82% of Illinois’ very low birth weight infants are born in a hospital with a level III neonatal intensive care unit (NICU). There has also been a modest, steady progress on infant mortality outcomes in Illinois. Over the last five years, there has been a small reduction in perinatal mortality, neonatal mortality, and preterm-related mortality. However, infant mortality has fluctuated during the last five-year period with no substantial change, and there has been a slight increase in post neonatal mortality.
Accessible and high-quality preventive care is essential to the health and well-being of Illinois’ children and adolescents. While 90% of children in Illinois are reported by their parents to be in excellent or very good health, this is the 13th lowest rate in the country, demonstrating that the 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 2019 being uninsured. In recent years, however, Illinois has lost ground. Illinois is ranked 18th 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 2012 and, in the 2020 estimate, Illinois’ adolescent suicide rate is the ninth highest in the country.
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 medicine, 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. Chicago is consistently ranked as one of the most racially segregated cities in the United States.
Illinois Department of Public Health Roles and Responsibilities
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 1,100 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.”
In 2016, IDPH became the eighth state health department to receive accreditation by the Public Health Accreditation Board (PHAB). The Title V Needs Assessment was cited as an area of excellence by PHAB. Specifically, PHAB stated that "Extensive community engagement was elicited through the Title V Needs Assessment Activity coordinated through the Office of Women's Health and Family Services, helping to shape statewide maternal‐child health policy development. This activity serves as a model for other programs in the department for community engagement to support and inform policy." IDPH received PHAB re-accreditation during 2020 and Title V staff were involved in leading and participating in several workgroups that prepared re-accreditation materials.
OWHFS is one of six programmatic offices with IDPH. The deputy director reports directly to the IDPH director (State Health Officer). OWHFS houses three divisions: Maternal, Child, and Family Services; Women's Health; and Population Health Management. These divisions work together to support women’s and family health across the lifespan. The Title V program is located within the Division of Maternal, Child, and Family Health Services, with the Title V MCH director 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 Illinois: 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 Title V program provides approximately $4.5 million 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 as closely aligned with the state’s overall Title V priorities.
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, 105 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.
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, Wis., Madison, Wis., Iowa City, Iowa, St. Louis, Mo., and Indianapolis, Ind. 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 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-child care, 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 ages 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 FPL are eligible for traditional Medicaid coverage and children in families with incomes up to 313% 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 FPL. 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 2020, 93.2% of the civilian non-institutionalized population was insured. Among children ages 18 and under, this proportion was 96.9%. Across race/ethnicity, insurance coverage was lowest among Hispanics and Latinos (84.6%). Foreign-born residents who are not citizens (69%) had a lower insurance coverage rate than naturalized citizens (91.9%). Across all ages, women are slightly more likely than men to have insurance coverage (94.1% vs. 92.2%), although nearly 13% of women ages 19-44 were uninsured in 2020.
Nearly 71% 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 60.9% of children under age 6 and 64.9% of children ages 6 to 18 covered by a private insurance plan. One third of Illinois residents (33.7%) are covered by a public insurance plan, and for 20.5% of Illinois residents public insurance is their only form of health insurance coverage (includes Medicare, Medicaid, and VA benefits). Notably, 36.6% of Illinoisans aged 18 and younger, and 19.9% of women aged 19-44 were enrolled in public health insurance in 2020.
Public insurance also reaches many of Illinois’ poor residents; 67.2% of residents below 138% of the federal poverty level use a public insurance plan. As of FY21, 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.
FY21 State Statutes and Regulations Related to Maternal and Child Health Block Grant and Programs
- Section 43 of Public Act 102-0103 allows pharmacists to dispense hormonal birth control over the counter.
- 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.
- 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.
- 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.
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