The Reduction of Infant Mortality in Illinois - Fiscal Year 2013

Illinois Department of Human Services

The Reduction of Infant Mortality in Illinois Annual Report for Fiscal Year 2013

January 2014

The Family Case Management Program and Special Supplemental Nutrition Program for Women, Infants and Children
2013 Annual Report

Dear Governor Quinn and Members of the General Assembly:

It is my pleasure to present The Reduction of Infant mortality in Illinois:  The Family Case Management Program and WIC Program Annual Report for Fiscal Year 2013.  These programs have contributed to a steady reduction in the state's infant mortality rate, which reached 6.9 per 1,000 live births as of calendar year 2009.

Illinois is unique in its effort to integrate the delivery of these two major programs for low-income women and children.  The Department has been able to blend the delivery, financing, monitoring and evaluation of these programs through innovation and performance management.  The comprehensive integration of maternal and child health programming is providing the foundation for future expansion and enhancement through the integration of additional service for this vulnerable population.

The Department has achieved uncommon results through this effort.  Rates of prenatal weight gain, immunizations, breastfeeding, well child care and developmental screening have been steadily improving.  Crude rates of premature birth and infant mortality among Medicaid-eligible pregnant women who participate in these program are substantially better than those observed among similar women who did not participate in either program.

While we continue to make progress, there is a persistent racial disparity in infant mortality that must be eliminated.  An African American infant born in Illinois is still more than two and a half times as likely as a Caucasian infant to die before reaching one year of age.  Our current efforts are commendable, but they are not enough.

This tragic loss of life must not continue and its disparate impact on Illinois' minority communities must be addressed.  I look forward to working with each of you to improve the health of all Illinoisans.

Sincerely,

Michelle R.B. Saddler
Secretary

(Signed Copy of Letter on File)


Table of Contents

  1. EXECUTIVE SUMMARY
  2. INTRODUCTION
  3. PROGRAM DESCRIPTIONS
  4. FINANCING
  5. SERVICE DELIVERY SYSTEM
  6. CASELOAD
  7. PERFORMANCE
    1. 1. Enrollment in Both FCM and WIC
    2. 2. First Trimester Enrollment in FCM
    3. 3. Initiation and Duration of Breastfeeding in WIC
    4. 4. Three or more Well-Child Visits to FCM Infant before Age One
    5. 5. Fully Immunized Infants in FCM
    6. 6. Health Insurance Coverage of Infants and Children in FCM
    7. 7. Developmental Screening of Infants and Children in FCM
  8. OUTCOMES
    1. Very Low Birth Weight
  9. RACIAL AND ETHNIC DISPARITIES IN INFANT MORTALITY: THE PERSISTENT CHALLENGE
  10. CONCLUSION

EXECUTIVE SUMMARY

Illinois' infant mortality rate for 2009 (the latest year available) was 6.9 deaths for every 1,000 live births, the second lowest rate for the state. The absolute number of infant deaths -1,176- while the lowest recorded, is high in terms of personal loss and lives lost.

The Illinois Department of Human Services (IDHS) helps to reduce this loss through the integrated delivery of the Family Case Management (FCM) program and the Special Supplemental Nutrition Program for Women, Infants and Children (WIC). These programs, combined, serve 45 percent of all infants and 81 percent of the Medicaid-eligible infants born in Illinois. The Department supplements these statewide programs with targeted initiatives (Better Birth Outcomes and Chicago Healthy Start) for women whose chances of giving birth prematurely are greater than average and for infants who have a greater-than-average chance of dying before their first birthday.

Program Success - The Department monitors the performance of the FCM and WIC programs on several short-term health status indicators. At the end of fiscal year 2013, performance on each indicator was as follows:

  • The proportion of FCM-eligible children with health insurance was 91 percent;
  • The proportion of fully-immunized one-year-olds in FCM was 79 percent;
  • The proportion of WIC infants who are breastfed was 69 percent;
  • The proportion of infants in WIC who were breastfed through six months was 26 percent;
  • The proportion of infants in WIC who were breastfed exclusively at 3 months was 3 percent
  • The proportion of children in FCM who received at least three well-child health care visits during the first year of life was 88 percent; and
  • The proportion of women and infants active in either FCM or WIC that are also enrolled in the other program was over 90 percent.

Improved Health Status - For 14 consecutive years, infants born to Medicaid-eligible pregnant women who participated in both FCM and WIC have been found to be in better health than those born to Medicaid-eligible women who did not participate in either program. The rate of very low birth weight has been on average over 60 percent lower than that among non-participants, and the rate of infant mortality has averaged 70 percent lower.

Fiscal Savings - In addition to the significant health benefits afforded by the FCM and WIC programs, Illinois' investment in these programs saves the State approximately $200 million each year in Medicaid expenditures. Those expenses for health care in the first year of life were almost 30 percent lower among dual-program participants than among non-participants in 2009.

INTRODUCTION

The latest infant mortality statistics are for 2009. In that year, Illinois' infant mortality rate was 9 deaths for every 1,000 live births. The statistic represents improvement from the 2008 rate of 2 deaths per 1,000 live births. Yet, it remains higher than the lowest rate ever reported in Illinois, 6.6/1,000 live births in 2007.

Many factors contribute to the state's infant mortality rate. Medical and pharmacological treatments are available for the conditions that used to take the lives of infants who were born prematurely. Illinois maintains one of the best systems of hospital-based perinatal care services in the nation. Illinois' success in maternal and child health services is due in part to the Department of Human Services' ongoing collaborative efforts with both the Illinois Department of Public Health (IDPH) and the Illinois Department of Healthcare and Family Services (IDHFS).

  • - Illinois' infant mortality rate has declined by more than 40 percent since 1986, in part due to investments in the Family Case Management and WIC programs. -

Consecutive annual evaluations of infant mortality demonstrate that participation in both the Family Case Management (FCM) program and the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) during pregnancy substantially improves infant health.  This improvement contributes an estimated annual savings of approximately $200 million in Medicaid expenditures for care required during the first year of life. Additional savings from avoided special education, disability and rehabilitation costs potentially accrue over a lifetime.

PROGRAM DESCRIPTIONS

The IDHS administers a maternal and child health (MCH) strategy for the reduction of infant mortality. The strategy integrates two large-scale programs, the Family Case Management (FCM) program, and the Special Supplemental Nutrition Program for Women, Infants and Children, more commonly known as WIC. The Department supplements these basic services with programs targeted to women who have a greater chance of giving birth prematurely, i.e. the Chicago Healthy Start Initiative (CHSI) and Better Birth Outcomes.

The integration of these programs is supported and enhanced by the shared use of Cornerstone, the Department's maternal and child health management information system. This system collects and reports all of the information necessary for the operation of the FCM, WIC and Healthy Start programs. Cornerstone provides an integrated record of the services provided to each participant and a service plan that identifies the services that the family requires. Staff members within and among agencies have access to a comprehensive record of the services provided to participating families. This avoids the problem of duplicative data collection and recording.  Cornerstone promotes the integration and streamlines the delivery of MCH services.

  • - The FCM program links families to health and other services; WIC provides nutrition education and counseling, referrals and nutritious foods. -

Family Case Management is a statewide program that provides comprehensive service coordination to pregnant women, infants, and high-risk children. The Department funds 105 agencies, including local health departments, community-based organizations and Federally Qualified Health Centers, to conduct FCM activities. Assessments are conducted and care plans are developed to address a wide range of needs, including health care, mental health, educational, vocational, child care, transportation, psychosocial, nutritional, environmental, developmental, and other services. Contacts with clients include home and office visits at a frequency necessary to meet the client's needs. Most FCM providers are authorized to complete Medicaid Presumptive Eligibility applications for pregnant women and children and function as Application Agents for All Kids, Illinois' health insurance program for children.

A more intensive care coordination program directed exclusively to the needs of high-risk pregnant women was begun in 22 communities in January 2013. Known as Better Birth Outcomes, the program distinguishes high risk women from those of lower risk with the use of a standard assessment process. Prenatal education as developed by the March of Dimes is provided to each participant either by a registered nurse or a master's trained social worker.  Care coordination among medical and social service providers is the hallmark of the program.  Communication mechanisms between prenatal care providers and BBO care coordinators are in place. Interfaces between the state's large information systems (Medicaid Claims, Vital Statistics and Cornerstone) alert care coordinators of at risk women); inform the care providers and coordinators of the services being delivered; and report performance in terms of services delivered and pregnancy outcome.

The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) seeks to improve the health of women, infants, and children; to reduce the incidence of infant mortality, premature births and low birth weight; to promote breastfeeding; and to aid in the growth and development of children. The program serves income-eligible pregnant, breastfeeding and postpartum women, and infants and children up to five years of age who have a nutritional risk factor.

Participants receive food "prescriptions" based on their nutritional needs. WIC foods include milk, cheese, eggs, adult and infant cereal and juice, peanut butter, tuna, salmon, whole grains, carrots, beans, and infant formula. Food-specific vouchers are printed on site at WIC clinics statewide. Participants obtain their WIC foods by redeeming the vouchers at program-approved grocery stores throughout the state and at WIC Food Centers in certain areas of Chicago. The Department grants funds to 97 local agencies to provide WIC services, including local health departments, not-for-profit health care agencies and social service agencies.

  • - The Department supplements FCM and WIC with intensive services for high-risk women. -

The Chicago Healthy Start Initiative provides services through four Chicago Healthy Start Family Centers that serve as "one-stop shopping centers" for intensive case management and linkage to prenatal care, pediatric primary care, family support, early intervention, substance abuse prevention, domestic violence prevention, and mental health counseling. The centers also provide two essential enabling services -- episodic child care and transportation -- to remove common barriers to care. CHSI targets the Hermosa, Near West Side, Near South Side, Douglas, Grand Boulevard, Washington Park and Greater Grand Crossing Community Areas in the city of Chicago. This project is supported by a grant from the federal Maternal and Child Health Bureau.

FINANCING

Illinois' integrated maternal and child health program for the reduction of infant mortality is supported by a combination of state and federal resources. The SFY'10 through SFY'14 budgets by program component are presented in Table 1.

Table 1 Budget for Integrated Infant Mortality Reduction Strategy by Program Component and Fiscal Year ($000s)

PROGRAM SFY'10 SFY'11 SFY'12 SFY'13 SFY'14
WIC (all sources) $304,500.00 $318,091.69 $310,500.00 $310000.00 $310,000.00
FCM $42,742.17 $39,572.30 $36,776.69 $38470.68 $34,929.71
TIPCM $4,284.75 $3,761.77 $3,407.13 n/a $n/a
CHSI $1,775.00 $1,443.98 $1,443.98 $1438.86 $1,438.86
TOTAL $353,301.92 $362,869.74 $352,127.80 $349909.54 $346,368.57

The FCM program is supported by several funding sources: General Revenue Fund, Title V - Maternal and Child Health Services Block Grant, and Title XX - Social Services Block Grant.  Local health departments also add their own funds for the operation of the program. Federal matching funds supplement the state and federal appropriations. The Department has worked closely with the IDHFS since 1990 to obtain federal matching funds through the Medicaid program for FCM expenditures. Further, as units of local government, local health departments may receive federal match for the local funds they expend in support of the FCM program. This has increased the total amount of funds available for the FCM program by about $14 million per year without an increase in the Department's appropriation for the FCM program. However, as presented in Table 1, state support for Case Management has eroded from FY2010 to FY2014; approximately 19 percent less funding was directed to this service.

The WIC budget includes funds for program operations at the state and local levels (referred to as Nutrition Services and Administration, or NSA) and for the purchase of food. The food funds include an award from the USDA and rebates on the purchase of infant formula from Mead-Johnson. Rebates add an average of $80 million to the program's food budget each year. Grant awards to local agencies are based on estimated caseload.

SERVICE DELIVERY SYSTEM

These services are delivered at the community level by grantees of the IDHS. Most often, these are local health departments. Community health centers and social service agencies also play an integral role in the delivery of primary and preventive care to pregnant women, mothers, infants, children and adolescents.

Local health departments. Local health departments have a unique responsibility to assess needs, develop policy to address community problems and assure that services are delivered to address those problems. Local health departments also are accountable to the public for the health of the entire community. Local health departments are well positioned to provide maternal and child health services in their jurisdictions.

Community Health Centers. There are over 450 community health center and federally qualified health center sites in Illinois. Community health centers provide a complete array of primary health care services in medically under-served communities. Several are IDHS grantees for these and other programs. Erie Family Health Center, Near North Health Services Corporation and Mile Square Health Center have been partners in the CHSI for many years.

Community-Based Organizations. Several prominent community-based organizations in Chicago and suburban Cook County have participated in the FCM program and its predecessors, as well as the WIC program, since the mid-1980s. These organizations bring an extensive knowledge of the communities they serve, are familiar with the cultural diversity of their communities and employ staff who remain sensitive to community needs, beliefs and cultures.

CASELOAD

The number of persons served by the FCM and WIC programs during SFY 13 is presented in Table 2. FCM does not keep a separate count of the number of participating postpartum or breastfeeding women. However, under USDA guidelines, these women comprise a separate category of eligibility for the WIC program.

Table 2 Number of Persons Served in FCM and WIC Programs by Type of Client and Program - SFY 2013

Program
Type of Client FCM* WIC
Pregnant Women 89,472 100,765
Post Partum Breastfeeding Women NA 48,928
Infants 130,673 162,731
Children 32,089 190,813
Total 252,234 503,237

Source: Cornerstone
*FCM does not have a category of post-partum breastfeeding women.

The caseload of FCM dropped for FY2013. This is in part due to the continuing decrease in state funding. Furthermore, several community based organizations and downstate health departments declined to be providers of FCM in recent years. The primary reason for their withdrawal from the program being finances; the late and slow payment of General Revenue funding hinders agency's abilities to remain viable. Although caseloads were reassigned, the disruption of service delivery is evident in the caseload figures presented in Table 3.

Table 3 Total Number of Persons Served in FCM and WIC Programs by Program and State Fiscal Year

Fiscal Year
Program 2006 2007 2008 2009 2010 2011 2012 2013
FCM 371,676 345,769 342,428 329,658 312,389 288,159 266,635 252,234
WIC 514,350 519,250 532,753 549,086 553,342 538,782 520,557 503,237

Source:  Cornerstone

The FCM and WIC programs together reach over 45 percent of all infants and over 81 percent of Medicaid-eligible infants born in Illinois each year. Women who are at greatest risk for giving birth prematurely or having a baby with other health problems are overrepresented in the caseload of the FCM and WIC programs. Approximately, three-fourths of African American, Hispanic, single and teen-aged women who give birth in Illinois each year participate in the FCM or WIC programs; the programs are reaching their intended target population. Refer to Table 4.

  • - FCM and WIC serve more than 45 percent of all infants born in Illinois and over 81 percent of all Medicaid eligible infants. -

Table 4 Number and Percent of All Live Births and Live Births to FCM or WIC Participants, by Demographic Group; Illinois, 2009

Live Births
ALL FCM or WIC Participants
GROUP Number Percent Number Percent Percent of Group
White 125,618 75.9% 51,547 68.5% 41.0%
Black 29,280 17.7% 21,006 27.9% 71.7%
Asian and Native American* 10,709 6.5% 2,686 3.6% 25.1%
All 165,607 100.0% 75,236 100.0% 45.4%
Hispanic 40,019 24.2% 25,841 34.3% 64.6%
Single 67,017 41.0% 51,524 68.5% 75.9%
Teen 15,953 9.6% 13,450 17.9% 84.3%

Source: Vital Records, Cornerstone
*Includes all other races.

PERFORMANCE

Program performance is measured against several short-term health status indicators among the women, infants and children enrolled in FCM, WIC or both programs. Measures include:

  1. Enrollment in both FCM and WIC
  2. First trimester enrollment in FCM
  3. Initiation of breastfeeding in WIC
  4. Three or more well-child visits to FCM infants before age one
  5. Fully immunized infants in FCM
  6. Health insurance coverage of infants and children in FCM
  7. Developmental screening of infants and children in FCM

The Department uses its maternal and child health management information system, Cornerstone, to generate quarterly reports on these performance measures. Agency performance provides the basis for ongoing technical assistance. These reports can be found at http://www.dhs.state.il.us/page.aspx?item=31152 for provider and public access.

1. Enrollment in Both FCM and WIC

Since 1998, DHS has pushed for the integration of FCM and WIC services. An evaluation of Medicaid-eligible women found that those who participated in FCM and WIC during pregnancy in 1996 had substantially lower rates of premature birth and infant mortality.  The graph below displays the proportion of clients in one program that are also enrolled in the other program. For example, the line labeled 'WIC' shows the proportion of WIC clients that were also enrolled in FCM. At the end of Fiscal Year 2013, 93.2 percent of WIC participants were participating in FCM and 95.7 percent of FCM participants were receiving WIC services.

Program Integration of WIC & FCM FY08-FY13

Prgram Integration of WIC & FCM - FY08-FY13

FISCAL YEAR MONTH WIC PERCENT FCM PERCENT
FY08 Sept-07 91.58% 94.59%
Dec-07 90.56% 94.68%
Mar-08 91.44% 94.99%
Jun-08 92.80% 95.60%
FY09 Sep-08 93.17% 95.81%
Dec-08 92.89% 95.90%
Mar-09 92.49% 96.25%
Jun-09 92.44% 95.65%
FY10 Sep-09 92.19% 95.67%
Dec-09 92.63% 95.82%
Mar-10 92.94% 95.90%
Jun-10 92.63% 95.94%
FY11 Sep-10 92.57% 95.96%
Dec-10 92.08% 95.73%
Mar-11 92.11% 95.74%
Jun-11 93.45% 95.54%
FY12 Sep-11 88.67% 95.74%
Dec-11 92.71% 95.60%
Mar-12 92.89% 95.48%
Jun-12 92.85% 95.38%
FY13 Sep-12 92.92% 95.46%
Dec-12 92.79% 95.40%
Mar-13 93.25% 95.58%
Jun-13 93.21% 95.71%

Source: Cornerstone

2. First Trimester Enrollment in FCM

Enrollment in FCM services during the first trimester of pregnancy is essential to ensure maximum impact on the health of the mother and the newborn infant. The graph below shows that there has been a gradual upward trend over several years in the proportion of program participants who enrolled in the programs during the first trimester of pregnancy.

Prenatal Participants' First Trimester Enrollment in FCM FY08-FY13

Prenatal Participants' First Trimester Enrollment in FCM - FY08-FY13

FISCAL YEAR MONTH FCM PERCENT
FY08 Sept-07 49.45%
Dec-07 51.55%
Mar-08 51.97%
Jun-08 52.27%
FY09 Sep-08 49.72%
Dec-08 52.98%
Mar-09 54.23%
Jun-09 52.46%
FY10 Sep-09 47.84%
Dec-09 51.83%
Mar-10 52.89%
Jun-10 51.37%
FY11 Sep-10 49.51%
Dec-10 53.63%
Mar-11 53.23%
Jun-11 52.12%
FY12 Sep-11 44.63%
Dec-11 48.18%
Mar-12 47.50%
Jun-12 47.54%
FY13 Sep-12 49.80%
Dec-12 51.80%
Mar-13 51.10%
Jun-13 49.90%

Source: Cornerstone

Local FCM agencies use a variety of strategies to reach low-income families in the communities they serve. These may include door-to-door canvassing, distribution of printed materials and use of mass media, as well as nontraditional methods that may be necessary to identify potential participants in hard-to-reach populations, such as persons who abuse drugs or engage in prostitution.

The Department also takes advantage of its computer technology to increase the proportion of Medicaid-eligible pregnant women who enroll in FCM and to improve the proportion of women who enroll in the first trimester of pregnancy. Local FCM service providers are indirectly linked to the Department's Family Community Resource Centers through an electronic data exchange. Each month, information about pregnant women who have enrolled in the Medicaid program is transferred from the Client Information System used by the Family Community Resource Centers to the Cornerstone system. The information is then distributed to local service providers and is ultimately used to conduct targeted outreach efforts.

3. Initiation and Duration of Breastfeeding in WIC

The American Academy of Pediatrics (AAP) recommends exclusive breastfeeding for about 6 months, with continuation of breastfeeding for 1 year or longer as mutually desired by mother and infant, a recommendation concurred to by the WHO and the Institute of Medicine. In 70 local agencies, breastfeeding peer counselors are part of the WIC team, promoting breastfeeding, educating women on the "how-to's" of breastfeeding and supporting breastfeeding mothers when they deliver and begin breastfeeding. WIC participants' peer counselors are women from the community who have successfully breastfed their own infants.  They receive specialized training to serve as peer counselors. Representing diverse cultural backgrounds, they offer encouragement, information, and support to other WIC mothers.

The graph displays the proportion of women who participated in the WIC program during pregnancy and began to breastfeed their infants right after giving birth.

The rate of breastfeeding at hospital discharge has increased among WIC participants from 66 percent in 2008 to 69 percent for SFY 2013.

WIC Participants' Initiation of Breastfeeding FY08-FY13

WIC Participants' Initiation of Breastfeeding - FY08-FY13

FISCAL YEAR MONTH WIC PERCENT
FY08 Sep-07 65.28%
Dec-07 63.69%
Mar-08 65.27%
Jun-08 66.15%
FY09 Sep-08 64.76%
Dec-08 65.22%
Mar-09 65.64%
Jun-09 67.00%
FY10 Sep-09 65.87%
Dec-09 64.52%
Mar-10 66.25%
Jun-10 67.55%
FY11 Sep-10 68.71%
Dec-10 67.68%
Mar-11 68.62%
Jun-11 69.33%
FY12 Sep-11 69.05%
Dec-11 69.52%
Mar-12 70.00%
Jun-12 70.26%
FY13 Sep-12 68.49%
Dec-12 68.31%
Mar-13 68.77%
Jun-13 69.88%

Source:  Cornerstone

4. Three or more Well-Child Visits to FCM Infant before Age One

The American Academy of Pediatrics recommends routine well child visits. Providers monitor a child's growth and development, provide preventive health care services (i.e., immunizations), screen for potentially serious health problems (i.e., lead poisoning or problems with vision or hearing) and inform parents through anticipatory guidance. The Academy recommends six such visits during the first year of life, to occur at one month, two months, four months, six months, nine months and twelve months of age.

The Department monitors FCM agencies to ensure that participating infants receive at least three well child visits during the first year of life. The graph displays the proportion of infants who met this standard.

FCM Eligible Infants with Three or More Well-Child Visits FY08-FY13

FCM Eligible Infants with Three or More Well-Child Visits - FY08-FY13


FISCAL YEAR

MONTH
PERCENT of FCM Eligible Infants
with Three or More Well-Child Visits
FY08 Sep-07 82.91%
Dec-07 84.00%
Mar-08 82.72%
Jun-08 85.15%
FY09 Sep-08 86.23%
Dec-08 85.09%
Mar-09 84.03%
Jun-09 84.78%
FY10 Sep-09 84.78%
Dec-09 85.11%
Mar-10 84.10%
Jun-10 84.67%
FY11 Sep-10 85.55%
Dec-10 85.49%
Mar-11 86.56%
Jun-11 87.68%
FY12 Sep-11 86.36%
Dec-11 88.31%
Mar-12 89.20%
Jun-12 88.15%
FY13 Sep-12 89.20%
Dec-12 88.70%
Mar-13 86.50%
Jun-13 86.90%

Source:  Cornerstone

5. Fully Immunized Infants in FCM

The graph below displays two performance measures and groups of children in the FCM program:

Statewide Immunication Campaign FY08-FY13

Statewide Immunization Campaign FY2008-FY2013

FISCAL YEAR MONTH PERCENTAGE
FY08 Sep-07 75%
Dec-07 77%
Mar-08 78%
Jun-08 76%
FY09 Sep-08 77%
Dec-08 79%
Mar-09 80%
Jun-09 80%
FY10 Sep-09 80%
Dec-09 80%
Mar-10 80%
Jun-10 80%
FY11 Sep-10 81%
Dec-10 80%
Mar-11 81%
Jun-11 81%
FY12 Sep-11 78%
Dec-11 84%
Mar-12 84%
Jun-12 82%
FY13 Sep-12 84%
Dec-12 83%
Mar-13 80%
Jun-13 79%

 Source: Cornerstone

The graph shows the proportion of children between 12 and 18 months of age that were active in the FCM program and had received:

  • 3 doses of diphtheria, pertussis and tetanus vaccine;
  • 2 doses of oral polio vaccine; and
  • 2 doses of Haemophilus influenzae type B vaccine.

6. Health Insurance Coverage of Infants and Children in FCM

Health insurance is essential for access to health care services. Virtually every child on FCM is, by definition, eligible for the State of Illinois' All Kids program. The Department has been working with the IDHFS to increase the proportion of FCM-eligible children who also are enrolled in All Kids if they are not covered by their parents' health insurance. Local FCM agencies have been trained and certified by the IDHFS as "All Kids Application Agents."

Local FCM program staff persons assist eligible families in applying for coverage through All Kids.

FCM Children with Insurance FY08-FY13

FCM Children with Insurance - FY08-FY13

FISCAL YEAR MONTH PERCENTAGE
FY08 Sep-07 95.40%
Dec-07 95.76%
Mar-08 94.89%
Jun-08 95.73%
FY09 Sep-08 95.63%
Dec-08 95.51%
Mar-09 95.44%
Jun-09 95.55%
FY10 Sep-09 95.72%
Dec-09 95.86%
Mar-10 95.82%
Jun-10 95.74%
FY11 Sep-10 96.08%
Dec-10 96.12%
Mar-11 96.29%
Jun-11 96.45%
FY12 Sep-11 92.69%
Dec-11 93.12%
Mar-12 90.55%
Jun-12 90.00%
FY13 Sep-12 90.06%
Dec-12 89.85%
Mar-13 90.64%
Jun-13 90.75%

Source: Cornerstone

The graph displays the proportion of children in the FCM program who were covered by public or private health insurance.

7. Developmental Screening of Infants and Children in FCM

Infants and young children should be screened routinely for evidence of delays in cognitive, linguistic, motor, social and emotional development. Through routine screening, developmental delays can be promptly identified and therapy initiated.

The Department monitors the proportion of infants in the FCM program who have been screened for problems with physical or cognitive development at least once a year.

The graph displays the proportion of 12-month-old children in FCM or WIC that had been screened for developmental delay at least once in the prior 12 months. Beginning in FY10, the data for 12-month-old children in WIC was eliminated and only the data for 12-month-old children in FCM was used to measure this particular performance indicator.

FCM & WIC Developmental Assessment at 12 Months of Age * (*FCM Only starting in FY10) FY08-FY13

FCM & WIC Developmental Assessment at 12 Months of Age* - FY08-FY13

FISCAL YEAR MONTH PERCENTAGE
FY08 Sept 2007 80.2%
Dec 2007 81.7%
Mar 2008 82.1%
Jun 2008 80.8%
FY09 Sept 2008 80.7%
Dec 2008 82.2%
Mar 2009 81.4%
Jun 2009 82.4%
FY10 Sept 2009 89.7%
Dec 2009 88.4%
Mar 2010 87.1%
Jun 2010 88.3%
FY11 Sept 2010 90.5%
Dec 2010 90.8%
Mar 2011 90.9%
Jun 2011 90.9%
FY12 Sept 2011 91.44%
Dec 2011 92.03%
Mar 2012 93.55%
Jun 2012 93.64%
FY13 Sept 2012 88.8%
Dec 2012 88.3%
Mar 2013 89.3%
Jun 2013 89.6%

Source:  Cornerstone

OUTCOMES

Illinois' integrated strategy for improving maternal and child health focuses on four outcomes:

  • Reducing the very low birth weight rate
  • Reducing the low birth weight rate
  • Reducing Medicaid expenditures during the first year of life
  • Reducing the infant mortality rate

Very low birth weight infants (newborns who weigh less than 3 pounds 2 ounces) require intensive medical care. While these infants represent less than two percent of all live births, they also account for two-thirds of the infants who die in the first year of life. Interventions that reduce the very low birth weight rate will also reduce Medicaid expenditures during the first year of life and reduce the infant mortality rate.

The integrated delivery of the FCM and WIC programs affects the state's infant mortality rate and health care expenditures. The health status of infants born to Medicaid-eligible women who participated in both FCM and WIC has been substantially better than that of infants born to Medicaid eligible women who did not participate in either program. In particular, the rate of premature birth is more than 30 percent lower among participants in both programs. The rate of low birth weight is 30 percent lower; the rate of infant mortality is more than 55 percent lower; and on average health care expenditures during the first year of life are almost 30 percent lower.

Very Low Birth Weight

The very low birth weight rate among women who participated in both FCM and WIC was 1.1 percent in 2009, almost a third lower than the rate observed among Medicaid-eligible women who did not participate in either program during pregnancy (2.9%).

Very Low Birth Rate:  Medicaid Eligible Infants 1997-2009

Very Low Birth Rate: Medicaid Eligible Infants 1997-2009

YEAR WIC & FCM MEDICAID ONLY
1997 1.3 3.9
1998 1.4 3.7
1999 1.3 4.3
2000 1.3 3.4
2001 1.2 3.7
2002 1.3 4.2
2003 1.4 3.9
2004 1.4 3.8
2005 1.4 4.1
2006 1.3 3.3
2007 1.2 3.5
2008 1.4 2.9
2009 1.1 2.9

Source: Cornerstone, Vital Records

Infant Mortality Rate 1990-2009

Infant Mortality Rate 1990-2009

YEAR RATE PER 1,000 LIVE BIRTHS INFANT MORTALITY RATE (IMR)
1990 2,090 10.7
1991 2,068 10.7
1992 1,911 10.0
1993 1,838 9.6
1994 1,711 9.0
1995 1,724 9.3
1996 1,536 8.4
1997 1,476 8.2
1998 1,505 8.2
1999 1,504 8.3
2000 1,528 8.3
2001 1,379 7.5
2002 1,304 7.2
2003 1,380 7.6
2004 1,317 7.3
2005 1,294 7.2
2006 1,343 7.4
2007 1,196 6.6
2008 1,263 7.2
2009 1,176 6.9

Source: http://www.idph.state.il.us/health/infant/cumrate.html

Illinois has made steady progress in reducing its infant mortality rate, in part, due to the improvement of birth outcomes as a result of at-risk women participating in the FCM and WIC programs.

RACIAL AND ETHNIC DISPARITIES IN INFANT MORTALITY:  THE PERSISTENT CHALLENGE

Infant Mortality by Race - Illinois, 1980-2009

Infant Mortality by Race in Illinois - 1980-2009

YEAR ILLINOIS WHITE BLACK
80 14.7 12.1 26.3
81 13.9 11.6 24.5
82 13.6 11.4 24.6
83 12.3 10.0 23.2
84 12.0 9.7 22.1
85 11.6 9.4 21.4
86 12.0 9.6 22.3
87 11.6 9.6 20.7
88 11.2 9.1 20.9
89 11.7 8.7 22.0
90 10.7 7.4 22.1
91 10.7 7.7 21.1
92 10.0 7.4 19.5
93 9.6 7.2 18.8
94 9.0 6.7 17.9
95 9.3 7.4 18.2
96 8.4 6.3 17.5
97 8.2 6.1 16.5
98 8.2 6.3 16.8
99 8.3 6.0 17.3
00 8.3 6.2 16.3
01 7.5 6.1 14.7
02 7.2 5.4 15.6
03 7.6 6.1 15.6
04 7.3 5.8 15.1
05 7.2 5.8 15.1
06 7.4 5.9 14.3
07 6.6 5.2 13.4
08 7.2 5.8 13.9
09 6.9 5.4 14

Source: Vital Records

The graph presents the 2009 infant mortality rates of African American, Caucasian and Illinois' entire population. The rate among African Americans, while the third lowest on record, is at an unacceptably high level of 14 per 1,000 live births.

Illinois infant mortality rate has declined by more than 40 percent since 1986. Despite the steady progress, a significant disparity in infant mortality rates persists between African American and Caucasian infants (See Table 5). An African American infant born in Illinois during 2009 was 2.6 times more likely than a Caucasian infant to die before reaching its first birthday. This disparity has persisted for many years and must no longer be accepted. To that end, IDHS in partnership with other organizations committed to improving maternal and child health among all Illinoisans are creating interventions designed specifically to reduce racial disparities in health care and health outcome. These strategies include participating in a statewide Prematurity Prevention Task Force which was tasked with development of a set of recommendations that were presented to the Illinois legislative body in October 2012, increasing focus on care of high-risk pregnant women through Better Birth Outcomes, partnering with March of Dimes on a campaign to reduce elective late preterm deliveries, developing an Illinois Blueprint on Breastfeeding, partnering with Illinois Department of Healthcare and Family Services on a number of CHIPRA workgroups aimed at improving perinatal health, joining the national COIN initiative to improve perinatal outcomes, and most recently, participating in the formation of a statewide Perinatal Collaborative.

Table 5 Ratio of African American and Caucasian Infant Mortality; Illinois  1982-2009

Year Ratio
1982 2.2 : 1
1983 2.3 : 1
1984 2.3: 1
1985 2.3: 1
1986 2.3: 1
1987 2.2: 1
1988 2.3: 1
1989 2.5: 1
1990 2.9: 1
1991 2.7: 1
1992 2.6: 1
1993 2.7: 1
1994 2.7: 1
1995 2.5: 1
1996 2.8: 1
1997 2.7: 1
1998 2.7: 1
1999 2.8: 1
2000 2.5: 1
2001 2.5: 1
2002 2.8: 1
2003 2.6: 1
2004 2.5: 1
2005 2.7: 1
2006 2.4: 1
2007 2.6: 1
2008 2.4: 1
2009 2.6: 1

Breastfeeding is a significant determinant of infant health. Illinois is in the forefront of promoting breastfeeding initiation and exclusivity. Effective January 2013, the Hospital Infant Feeding Act makes Illinois the first state in the nation to require that all birthing hospitals adopt a policy promoting breastfeeding. In the WIC program, Peer Counselors are used to help women initiate and continue breastfeeding. The Peer Counselors are mothers who have personal experience with breastfeeding and are trained to provide basic breastfeeding information and encouragement to new mothers. Peer Counselors are familiar with the resources available to WIC clients, have familiarity with the questions a new breastfeeding mother may ask, and recognize when to refer mothers to other resources during critical periods when mothers may experience difficulty. Peer Counselors are recruited and hired from WIC's target population of low-income women and undergo training to provide mother-to-mother support in group settings and one-to-one counseling through telephone calls or visits in the home, clinic, or hospital.

CONCLUSION

As reflected in this report, there is a wealth of data to indicate that Illinois' infant mortality reduction programming is working to improve outcomes. Mothers, infants and children on Medicaid who participate in Family Case Management and WIC present better birth outcomes than those receiving Medicaid only. Prevention programming aimed at both individuals and communities is not only saving lives but also conserving limited resources. Health service indicators such as immunization rates, well child visits and insurance coverage are much higher now than in the recent past, due to the concerted efforts of FCM and WIC service participants, providers and administrators. Despite these improvements, Illinois will realize minimal gains in its infant mortality ranking until the ratio of black to white infant deaths is improved.  Enhancement of services directed to preventing very low birth-weight such as Intensive Prenatal Case Management, and Chicago Healthy Start hold significant potential for lowering the disparity between black and white infant mortality rates and Illinois' overall infant mortality rate.


Illinois Department of Human Services
401 South Clinton Street, CHicago, Illinois  60607
100 South Grand Avenue, East, Springfield, Illinois  62762
www.dhs.state.il.us

Programs, activities and employment opportunities in the Illinois Department of Human Services are open and accessible to any individual or group without regard to age, sex, race, sexual orientation, disability, ethnic origin or religion. The department is an equal opportunity employer and practices affirmative action and reasonable accommodation programs.
DHS 4185 (R-04-14) The Reduction of Infant Mortality In Illinois - Annual Report for Fiscal Year 2013
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