Demographic Information

Population Size and Changes

Illinois is a large, diverse state. It is currently the sixth most populous state in the nation and was home to 12,741,080 residents in 2018. The Chicago metro area is home to 9.5 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.  In recent years, both Illinois and the city of Chicago have experienced a population decline; 0.7% of the state population left from 2016-2018, and Chicago lost 0.23% of its population from 2017-2018. 

In 2017, nearly one in four (22.6%) Illinois residents were under age 18 — a total of approximately 2.9 million children. Approximately 6% of the total population, 767,348 children, is under the age of 5.

The fertility rate in Illinois during 2017 was 59.0 births per 1,000 women ages 15-44; the birth rate was 1.73 per 1000 population. The fertility and birth rates in Illinois are lower than the national average of 60.3 and 1.77 respectively, but higher than several other large states such as Florida and California.

Geographic Considerations

Illinois’ population is concentrated in Cook County (includes city of Chicago) and the surrounding collar counties.  More than 65% of the state’s population, 8.4 million people, live in these counties.  In addition to diverse and urban Chicago, Illinois is home to many small and mid-sized cities. Twelve cities in the state, including Joliet, Rockford, and Aurora, have more than 75,000 residents.

By landmass, Illinois is largely rural. More than two-thirds of its 102 counties are classified as non-metropolitan, and approximately 1.5 million Illinoisans live in rural communities.  Reflecting a larger long-term national trend, all rural areas in Illinois have decreased in population since 2012.  Rural communities in Illinois are largely concentrated in the southern and western parts of the state.

In planning for the care and wellbeing of Illinois’ maternal and child health population, the Title V program and its partners must balance the needs of 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 2017, approximately 89% of Illinois adults are high school graduates and 33.4% are college graduates. Educational achievement is not evenly distributed in the state. Only 83.8% of adults in Chicago are high school graduates, indicating the need for increased educational focus in this county. Illinois also suffers from racial disparities in educational achievement; 20.8% of non-Hispanic blacks and 13.9% of Latinos have graduated from college, compared with 37.4% 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

Illinois is diverse in terms of racial/ethnic make-up of the population.  In 2017, the majority (61.9%) of the Illinois population was non‐Hispanic white. Non-Hispanic blacks comprise 14.1% of the population, and Latinos of all ethnicities account for 16.8%.

Cook County is more racially diverse than the state overall. In 2017, Cook County, only 43% of the population was non‐Hispanic white, while non-Hispanic blacks comprised 23.4% and Latinos comprised 25.1%. Within the city of Chicago, this diversity is even more pronounced: 29% were non‐Hispanic white, 30% were non-Hispanic black, 29% were Latino, and 6% 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 2017, approximately 14% of Illinois residents were foreign‐born. Most of these foreign‐born residents (50.7%) are not US 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

In 2013-2017, 65.3% of Illinois adults were in the civilian labor force — meaning that they were working or wanted to be working. In 2018, Illinois had a seasonally adjusted unemployment rate of 4.6%. Reflecting national trends, this rate has fallen in recent years.  Compared to other large states, Illinois’ unemployment rate is high; New York, Florida, Texas, and California all have lower rates than Illinois.

Most Illinois residents were in occupations categorized as management / professional (38%) or sales / office (24%). The per capita income in Illinois in 2013‐2017 was $32,924, compared to a national average of $31,177. Incomes are generally higher in Cook County, with a per capita inform of $33,722.  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 2017, 12.7% of all Illinoisans lived in below the federal poverty line (FPL). Children are more likely to live in poverty; 17.0% of children under 18 years old and 18.8% of children under 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 2017, 14.4% of the total population and 20.1% of children lived in poverty; in Chicago, 18.6% of the total population and 27.3% of children lived in poverty. Of all Illinois households in 2017, 12.9% received food stamps and 2.2% received cash assistance.

Living in a female‐headed household is strongly associated with poverty in Illinois. While 9.0% of all families were impoverished, 26.2% of female‐headed households in 2017 had incomes below the FPL. This increases for households with children; 35.2% of female‐headed households with children under 18 years old and 40.3% of female‐headed households with children under five years old were impoverished. Mothers, and especially unmarried mothers, are very likely to live in poverty.  Nearly half, 45.2%, of unmarried women who gave birth in the last 12 months lived in poverty, compared to only 10.1% of married new mothers.

Poverty is also drastically different by race/ethnicity in Illinois. Among non‐Hispanic white residents, the poverty rate in 2017 was 9.6%, compared to 26.2% among non-Hispanic blacks and 15.0% among Hispanics. Among children, this disparity in poverty is even further demonstrated: 10.2% of non‐Hispanic white children under age 18 lived in poverty, compared to 37.5% of non-Hispanic black children and 20.2% of Hispanic children.

In Illinois in 2017, 66.2% 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 Chicago, metropolitan area 74% of white householders own their home, while only 39.1% of black householders do. For those families that rent a home, the high cost of rental housing is a concern. In 2017, 45.2% 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 2018, Illinois ranked 28th out of the 50 states on combined measures of health determinants, behaviors, and outcomes. Illinois demonstrated strength on measures such as vaccinations for children (6th), supply of primary care physicians (10th), and a low rate of people experiencing frequent mental distress (10th).  Illinois did poorly when compared to other states on indictors such as rate of Chlamydia infections (41st), poor air quality (47th), and excessive alcohol use (45th).  For birth outcome indicators, Illinois tended to rank in the middle of the states, coming in at 30th for infant mortality and 28th for low birth weight.  The report also indicates an increase in the obesity rate in Illinois over the last six years, to 31.1% of adults, a decreasing in the adult smoking rate to 15.5% of adults, and a 45% increase in pertussis infections from 2017-2018.

Maternal and women’s health in Illinois present both strengths and challenges.  Illinois has made steady progress on some outcomes, such as its teen birth rate -- in 2017, the rate was 17.4 births per 1,000 women ages 15-19 which represented a 64% decline since 2000 and a 29% decline in only 5 years.  More than three quarters of pregnant women receive a prenatal care visit in their first trimester, and nearly 70% of Illinois women have had a preventive medical visit in the past year. 

Almost 90% (88.6%) of children in Illinois are in excellent or very good health, an encouraging finding, although most states (46/50) have even high proportions than Illinois.  Only 2.5% of children in Illinois were uninsured in 2016, one of the lowest rates in the country.  The asthma hospitalization rate has been lowering by an average of 10.5% over the last five years to a rate of 18.5 per 10,000 children in 2016.  Adolescent mortality related to suicide (8.0 per 100,000 teens) and motor vehicle accidents (9.8 per 100,000) are relatively low compared to other states but have been steadily worsening and are of concern in the central and southern parts of the state.

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 and pediatric primary care and specialty care providers. Finally, the UIC School of Public Health has one of 13 Maternal and Child Health Centers of Excellence in the U.S. The state’s Title V has an ongoing intragovernmental agreement with this program 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. The recent implementation of managed care in Illinois’ Medicaid program may pose challenges for ensuring that the entire MCH population (including CYSHCN) have timely access to the preventive, primary, and specialty care they require.

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

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 over 1,100 employees. IDPH houses over 200 public health programs covering the spectrum of diseases/conditions and the life course. The vision of IDPH is: "Communities of Illinois will achieve and maintain optimal health and safety" and the mission of IDPH 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 only 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, who wrote in the final accreditation report: "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 is preparing to apply for re-accreditation in the coming years.

The Office of Women's Health and Family Services (OWHFS) is one of six programmatic offices with IDPH, with a Deputy Director that reports directly to IDPH Director (State Health 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 and are united by a common vision and mission to support women’s and family health across the lifespan. The vision of OWHFS is "a future free of health disparities, where all Illinoisans have access to continuous high-quality health care" and the mission of OWHFS is to: “improve health outcomes of all Illinoisans by providing preventive education and services, increasing health care access, using data to ensure evidence‐based practice and policy, and empowering families.” The Illinois Title V Program sits within the Division of Maternal, Child and Family Health Services, with the Title V MCH Director also serving as Division Chief.

Illinois’ System of Care

Population Served

Illinois’ Title V program covers the full range of the “MCH population,” including women of child‐bearing age, pregnant women, infants, children, adolescents, and CYSHCN. Responsibility for the MCH Program in Illinois is spread across three agencies: IDPH, IDHS, and UIC‐DSCC.

Illinois’ 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 aligned with the state’s Title V priorities for residents of the state’s largest city, Chicago.  

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, 116 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 ten administrative perinatal centers (APC), which provides on-going training, technical support, consultation on complex medical issues and helps to coordinate and assure the transport of women or neonates between facilities.  Illinois’ Title V block grant supports the APCs and regulates perinatal designations according to Illinois’ Perinatal Administrative Code. 

Children’s Hospitals

Illinois also has a large network of children’s hospitals and pediatric specialists. In the greater Chicago area, these include the UIC Children’s Hospital, Advocate Children’s Hospital, the Alexian Brothers Women’s and Children’s Hospital, the University of Chicago’s Comer Children’s Hospital, the Ann and Robert H. Lurie Children’s Hospital, La Rabida Children’s Hospital, the Ronald McDonald Children’s Hospital of the Loyola University Medical Center, Rush University Children’s Hospital, and Shriners’ Hospital for Children. Downstate, there are children’s hospitals located in Peoria (the Children’s Hospital of Illinois) and Springfield (St. John’s Children’s Hospital).

UIC‐DSCC also works closely with children’s hospitals in neighboring states, including the Children’s Hospital of Wisconsin in Milwaukee and the American Family Hospital in Madison, Wisconsin; the University of Iowa Hospitals and Clinics in Iowa City, Iowa; the Cardinal Glennon Children’s Hospital, the St. Louis Children’s Hospital and the Shriners’ Hospital for Children in St. Louis, Missouri; and Riley Children’s Hospital in Indianapolis, Indiana.

Integration of Services

CYSHCN: UIC‐DSCC approaches care coordination comprehensively, assessing needs, developing care plans, and linking CYHSCN and their families to physical, mental, and social health care services.

Behavioral Health: The federal Center for Medicare and Medicaid Services (CMS) approved a series of behavioral health demonstration projects under an 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 the Illinois Department of Healthcare 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 healthcare provider enrolled with HFS. Eligibility requirements vary by program. Most people who enroll are covered for comprehensive services, including, but not limited to; 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. Some programs, however, cover a limited set of services.

Under the Affordable Care Act (ACA), adults age 19-64 who were not previously eligible for coverage under Medicaid can now receive medical coverage. Individuals with income up to 138 percent of the federal poverty level are eligible. Illinois is a Medicaid expansion state.

The “Family Health Plans,” including All Kids and FamilyCare, are comprised of five plans: FamilyCare/All Kids Assist; All Kids Share; All Kids Premium Level 1; All Kids Premium Level 2; and Moms and Babies. Children are eligible through 18 years of age. Adults must be either a parent or caretaker relative with a child under 18 years of age living in their home or be a pregnant woman. 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. Children and pregnant women must live in Illinois and are eligible regardless of citizenship or immigration status. Families may apply for All Kids online through both an English and Spanish Web-based application. Both English and Spanish applications are also available for download by persons who want to apply for All Kids by mail.

Moms and Babies provides a full range of health benefits to eligible pregnant women and their babies up to one year of age. To be eligible, pregnant women must have countable family income at or below 213 percent of the FPL. Babies under one year of age are eligible at any income if Medicaid covered their mother at the time of the child’s birth. Moms and Babies enrollees have no co-payments or premiums and must live in Illinois.

Over time, insurance coverage and access in Illinois has been an area of steady improvement.  In 2017, 91.5% of the civilian non-institutionalized population was insured.  Among children ages 18 and under, this proportion was 96.7%.  Rates of insurance were lower among Hispanics and Latinos (81.0%), and foreign-born residents who are not citizens (63%). Women are more likely than men to have insurance coverage, although almost 10% of women ages 19-44 were uninsured in 2017.

Nearly 70% of people in Illinois use private insurance, either alone or in combination with other insurance carriers. Children are less likely than adults to be covered by private insurance, with 59.2% of children under six and 63.8% of children ages 6 to 18 covered by a private insurance plan. More than a third of Illinois residents (34.2%) are covered by a public insurance plan, and for 21.2% of residents a public insurance carrier is their only insurance coverage.  Medicaid plans are particularly important for child populations with 37.5% of children using Medicaid in 2017.  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. In 2017, Illinois’ Medicaid program covered 1.4 million children and the Children’s Health Insurance program covered 324,282. In combination, nearly 1.8 million children were covered, representing a 3% decline from the covered number in 2016.

The Illinois’ Breast and Cervical Cancer Program (IBCCP) provides breast and cervical cancer screenings and diagnostics for uninsured and underinsured women at any income level. Women found in need of treatment are referred to HFS for Medicaid. In 2016, 13,455 women received screenings through IBCCP. This represents a decline of 34% from the previous year, due in part to funding challenges.  

The implementation of Medicaid managed care is discussed in the “Health Care Delivery System” sub-section.

Statutory Base Related to Maternal and Child Health

• In the 2015, Section 2310-677 of the Department of Public Health Powers and Duties Law (20 ILCS 2310) was enacted, creating the Neonatal Abstinence Syndrome (NAS) Advisory Committee. This committee is charged with advising and assisting IDPH with identification, treatment, reporting, and improving the outcomes of pregnancies where NAS is a factor.
• The Prenatal and Newborn Care Act (410 ILCS 225) and the Problem Pregnancy Health Services and Care Act (410 ILCS 230) establish programs to serve low‐income and at‐risk pregnant women.
• 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 HIV Prevention Act (410 ILCS 335) sets forth the requirements related to HIV testing and counseling of pregnant women by the health care professionals caring for them
• 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.
• The Illinois Family Case Management Act (410 ILCS 212) authorizes the Family Case Management (FCM) program.
• The WIC Vendor Management Act (410 ILCS 255) "establish[es] the statutory authority for the authorization, limitation, education and compliance review of WIC retail vendors…"
• Section 5/3-3016 of the Counties Code (55 ILCS 5) requires that an autopsy be performed on children under two years of age who die suddenly and unexpectedly and the circumstances concerning the death are unexplained and that all deaths suspected to be due to Sudden Infant Death Syndrome (SIDS) be reported to the Statewide Sudden Infant Death Syndrome Program within 72 hours.
• The Early Intervention Services System Act (325 ILCS 20) "provide[s] a comprehensive, coordinated, interagency, interdisciplinary early intervention services system for eligible infants and toddlers …"
• Section 5/27-8.1 of the Illinois School Code (105 ILCS 5), requires:
  • Children enrolled public, private, and parochial schools entering kindergarten or 1st grade, 6th grade, and 9th grade to have a health examination and a tuberculosis skin test if they live an area designated by IDPH as having a high incidence of tuberculosis, (105 ILCS 5/27-8.1(1));
  • Children enrolled in public, private, and parochial schools in kindergarten, 2nd, 6th, and 9th grade shall have a dental examination (105 ILCS 5/27-8.1(2)); and
  • Children enrolled in public, private, and parochial schools in kindergarten shall have an eye examination (105 ILCS 5/27-8.1(3)).
• 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 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.”
• 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 one year of age to early adolescence; and programs providing health services for adolescents.
• The Public Water Supply Regulation Act (415 ILCS 40/7a) requires the “owners or official custodians of public water supplies” to follow the recommendations on optimal fluoridation for community water levels as a means of protecting the dental health of all citizens, especially children.
• The Child Hearing and Vision Test Act (410 ILCS 205) requires children to be screened for vision and hearing problems as early as possible, but no later than their first year in any public or private education program, licensed day care center, or residential facility for children with disabilities. It also requires periodic screening thereafter.
• The Lead Poisoning Prevention Act (410 ILCS 45) requires physicians and health care providers who see or treat children 6 years of age or younger to test children for lead poisoning when they live in an area defined as high risk by IDPH.
• The Substance Use Disorder Act (20 ILCS 301) requires:
  • Establishment and support of programs and services for the promotion of maternal and child health;
  • Establishment of substance abuse prevention programs; and
  • The creation of a list of all providers licensed to provide substance use disorder treatment to pregnant women in Illinois.
• The Suicide Prevention, Education, and Treatment Act (410 ILCS 53) authorizes IDPH to carry out the Illinois Suicide Prevention Strategic Plan and to fund up to 5 pilot programs that provide training and direct service programs relating to youth, elderly, special populations, high-risk populations, and professional caregivers.
• Section 17 of the Children and Family Services Act (20 ILCS 505) requires the development of the Comprehensive Community Based Youth Services program to ensure that youth who do or may interact with the child welfare and juvenile justice systems have access to needed community, prevention, diversion, emergency, and independent living services.
• Section 16.1 of the Probation and Probation Officers Act (730 ILCS 110) authorizes the Redeploy Illinois program, which is intended to encourage the deinstitutionalization of juvenile offenders and offer alternatives, when appropriate, to avoid commitment to the Department of Juvenile Justice.
• The Juvenile Court Act of 1987 (705 ILCS 405) establishes juvenile probation services with the goal of allowing youth to remain with their families whenever possible to maintain the youth’s moral, emotional, mental, and physical welfare.
• The Emancipation of Minors Act (750 ILCS 30) allows homeless minors to be emancipated from their parents.
• The Specialized Care for Children Act (110 ILCS 345) designates the University of Illinois Division of Specialized Care for Children as the agency to administer federal funds to support Children and Youth with Special Health Care Needs (CYSHCN).
• The Illinois Domestic Violence Act of 1986 (750 ILCS 60) defines abuse, domestic violence, harassment, neglect, and other terms, and authorizes the issuance of orders of protection. The Domestic Violence Shelters Act (20 ILCS 1310) requires the Department of Human Services to administer domestic violence shelters and service programs.
• The Reduction of Racial and Ethnic Disparities Act (410 ILCS 100) requires IDPH to establish and administer a grant program to “stimulate the development of community-based and neighborhood-based projects that will improve the health outcomes of racial and ethnic populations." The grant program was envisioned to “function as a partnership between State and local governments, faith-based organizations, and private-sector health care providers, including managed care, voluntary health care resources, social service providers, and nontraditional partners.”
• The Reproductive Health Act (IL Public Act 101-0013) sets forth “the fundamental rights of individuals to make autonomous decisions about one's own reproductive health, including the fundamental right to use or refuse reproductive health care.”