Title V Block Grant Application
Forms (1-21)
State: WI
Application Year: 2007

OMB Approval No. 0348-0043
APPLICATION FOR FEDERAL ASSISTANCE 2. DATE SUBMITTED
7/15/2006 		APPLICANT IDENTIFIER
1. TYPE OF SUBMISSION:

Application
Construction
Non-Construction		 Pre-application
Construction
Non-Construction 		3. DATE RECEIVED BY STATE
STATE APPLICATION IDENTIFIER
4. DATE RECEIVED BY FEDERAL AGENCY
FEDERAL IDENTIFIER
5. APPLICANT INFORMATION
Legal Name:
Wisconsin Department of Health and Family Services

Organizational DUNS:
036448835 		Organizational Unit:
Division of Public Health / BCHP
Address (give city, county, state and zip code)
One West Wilson Street
PO Box 7850
Madison, WI 53707
County: Dane 		Name and telephone number of the person to be contacted on matters involving this application (give area code)
Name: Susan Uttech
Email: uttecsm@dhfs.state.wi.us
Tel Number: 608-267-3561
Fax Number: 608-266-8925
6. EMPLOYER IDENTIFICATION NUMBER (EIN):
3 9
 
6 0 0 6 4 6 9
7. TYPE OF APPLICANT: (Enter appropriate letter in box) A
A. State
B. County
C. Municiple
D. Township
E. Interstate
F. Intermuniciple
G. Special District 		H. Independent School District
I. State Controlled Institution of Higher Learning
J. Private University
K. Indian Tribe
L. Individual
M. Profit Organization
N. Other (Specify)
8. TYPE OF APPLICATION:
New Continuation Revision
If Revision, enter appropriate letter(s) in box(es)
A. Increase Award   B. Decrease Award   C. Increase Duration
Decrease Duration Other (specify): 		9 NAME OF FEDERAL AGENCY:
Health Resources and Services Administration, Maternal and Child Health Bureau
10. CATALOG OF FEDERAL DOMESTIC ASSISTANCE NUMBER:
9 3
 
9 9 4
TITLE: Maternal and Child Health Services Block Grant 		11. DESCRIPTIVE TITLE OF APPLICANT'S PROJECT:
Title V MCH Block Grant
12. AREAS AFFECTED BY PROJECT (cities, communities, states, etc.):
State of Wisconsin
13. PROPOSED PROJECT: 14. CONGRESSIONAL DISTRICTS OF:
Start Date:
10/01/2006 		Ending Date:
09/30/2007 		a. Applicant
2nd Congressional Dist 		b. Project
Statewide
15. ESTIMATED FUNDING: 16. IS APPLICATION SUBJECT TO REVIEW BY STATE EXECUTIVE ORDER 12372 PROCESS?
a. YES, THIS PREAPPLICATION/APPLICATION WAS MADE AVAILABLE TO THE STATE EXECUTIVE ORDER 12372 PROCESS FOR REVIEW ON
DATE:
b. NOPROGRAM IS NOT COVERED BY E.O. 12372
OR PROGRAM HAS NOT BEEN SELECTED BY STATE FOR REVIEW
  a. Federal $
  b. Applicant $
  c. State $
  d. Local $
  e. Other $
  f. Program Income $
  g. TOTAL $ 17. IS THE APPLICANT DELINQUENT ON ANY FEDERAL DEBT
Yes. If "Yes", attach an explanation No
18. TO THE BEST OF MY KNOWLEDGE AND BELIEF, ALL DATA IN THIS APPLICATION/PREAPPLICATION ARE TRUE AND CORRECT. THE DOCUMENT HAS BEEN DULY AUTHORIZED BY THE GOVERNING BODY OF THE APPLICANT AND THE APPLICANT WILL COMPLY BY THE ATTACHED ASSURANCES IF THE ASSISTANCE IS AWARDED.
a. Typed Name of Authorized Representative
Fredi-Ellen Bove 		b. Title
Director, Office of Strategic Finance 		c. Telephone Number
608-266-2907
d. Signature of Authorized Representative
 		 e. Date Signed
 
Previous Editions Not Usable Standard Form 424 (REV. 4-88)
Prescribed by OMB A-102

 
Form 2
MCH Budget Details for FY 2007
[Secs. 504 (d) and 505(a)(3)(4)]
State: WI
1. Federal Allocation
   (Item 15a of the Application Face Sheet [SF 424])
   Of the Federal Allocation (1 above), the amount earmarked for: 		$
   A.Preventive and primary care for children:
   $ (%)
   B.Children with special health care needs:
   $ (%)
    (If either A or B is less than 30%, a waiver request must accompany the application)[Sec. 505(a)(3)]
   C.Title V admininstrative costs:
   $ (%)
(The above figure cannot be more than 10% )[Sec. 504(d)]
2. Unobligated Balance (Item 15b of SF 424) $
3. State MCH Funds (Item 15c of the SF 424) $
4. Local MCH Funds (Item 15d of SF 424) $
5. Other Funds (Item 15e of SF 424) $
6. Program Income (Item 15f of SF 424) $
7. Total State Match (Lines 3 through 6)
(Below is your State's FY 1989 Maintainence of Effort Amount)
$ 		$
8. FEDERAL-STATE TITLE V BLOCK GRANT PARTNERSHIP (SUBTOTAL)
(Total lines 1 through 6. Same as line 15g of SF 424) 		$
9. Other Federal Funds
(Funds under the control of the person responsible for the administration of the Title V program)
a. SPRANS: $
b. SSDI: $
c. CISS: $
d. Abstinence Education: $
e. Healthy Start: $
f. EMSC: $
g. WIC: $
h. AIDS: $
i. CDC: $
j. Education: $
k. Other:
    
$
$
$
$
$
$
10. Other Federal Funds (SUBTOTAL of all Funds under item 9)
 		$
11. STATE MCH BUDGET TOTAL
(Partnership subtotal + Other Federal MCH Funds subtotal)
 		$

Form Notes for Form 2
None
Field Level Notes
None


Form 3  
State MCH Funding Profile
[Secs. 505(a) and 506((a)(I-3)]
State: WI
 
FY 2005 FY 2006 FY 2007
Budgeted Expended Budgeted Expended Budgeted Expended
1. Federal Allocation
    (Line1, Form 2)		 $
 $
 $
 $
 $
 $
2. Unobligated Balance
    (Line2, Form 2)		 $
 $
 $
 $
 $
 $
3. State Funds
    (Line3, Form 2)		 $
 $
 $
 $
 $
 $
4. Local MCH Funds
    (Line4, Form 2)		 $
 $
 $
 $
 $
 $
5. Other Funds
    (Line5, Form 2)		 $
 $
 $
 $
 $
 $
6. Program Income
    (Line6, Form 2)		 $
 $
 $
 $
 $
 $
7. Subtotal
    (Line8, Form 2)		 $
 $
 $
 $
 $
 $
(THE FEDERAL-STATE TITLE BLOCK GRANT PARTNERSHIP)
8. Other Federal Funds
    (Line10, Form 2)		 $
 $
 $
 $
 $
 $
9. Total
    (Line11, Form 2)		 $
 $
 $
 $
 $
 $
(STATE MCH BUDGET TOTAL)
 
 


Form 3  
State MCH Funding Profile
[Secs. 505(a) and 506((a)(I-3)]
State: WI
 
FY 2002 FY 2003 FY 2004
Budgeted Expended Budgeted Expended Budgeted Expended
1. Federal Allocation
    (Line1, Form 2)		 $
 $
 $
 $
 $
 $
2. Unobligated Balance
    (Line2, Form 2)		 $
 $
 $
 $
 $
 $
3. State Funds
    (Line3, Form 2)		 $
 $
 $
 $
 $
 $
4. Local MCH Funds
    (Line4, Form 2)		 $
 $
 $
 $
 $
 $
5. Other Funds
    (Line5, Form 2)		 $
 $
 $
 $
 $
 $
6. Program Income
    (Line6, Form 2)		 $
 $
 $
 $
 $
 $
7. Subtotal
    (Line8, Form 2)		 $
 $
 $
 $
 $
 $
(THE FEDERAL-STATE TITLE BLOCK GRANT PARTNERSHIP)
8. Other Federal Funds
    (Line10, Form 2)		 $
 $
 $
 $
 $
 $
9. Total
    (Line11, Form 2)		 $
 $
 $
 $
 $
 $
(STATE MCH BUDGET TOTAL)
 
 

Form Notes for Form 3
None
Field Level Notes
1. Section Number: Main
Field Name: StateMCHFundsExpended
Row Name: State Funds
Column Name: Expended
Year: 2005
Field Note:
State Funds - This variance, an increase of $1,163,380 (12.6%), is due entirely to an increase in the amount of match provided by local agencies.

.
2. Section Number: Main
Field Name: StateMCHFundsExpended
Row Name: State Funds
Column Name: Expended
Year: 2004
Field Note:
This variance, an increase of $947,140 (10.38%), is due entirely to an increase in the amount of match provided by local agencies.
3. Section Number: Main
Field Name: ProgramIncomeExpended
Row Name: Program Income
Column Name: Expended
Year: 2005
Field Note:
Program Income - This variance, an increase of $750,095 (27.45%), is due entirely to an increase in the amount of program income generated by local agencies providing family planning reproductive health services
4. Section Number: Main
Field Name: ProgramIncomeExpended
Row Name: Program Income
Column Name: Expended
Year: 2004
Field Note:
This variance, an increase of $790,396 (27.56%), is due entirely to an increaese in the amount of program income generated by local agencies providing family planning/reproductive health services.


Form 4
Budget Details By Types of Individuals Served (I) and Sources of Other Federal Funds (II)  
  [Secs 506(2)(2)(iv)]  
  State: WI  
 
FY 2005 FY 2006 FY 2007
I. Federal-State MCH Block Grant Partnership Budgeted Expended Budgeted Expended Budgeted Expended
a. Pregnant Women $ $ $ $ $ $
b. Infants < 1 year old $ $ $ $ $ $
c. Children 1 to 22 years old $ $ $ $ $ $
d. Children with Special Healthcare Needs $ $ $ $ $ $
e. Others $ $ $ $ $ $
f. Administration $ $ $ $ $ $
g. SUBTOTAL $ $ $ $ $ $
 
II. Other Federal Funds (under the control of the person responsible for administration of the Title V program).
a. SPRANS $ $ $
b. SSDI $ $ $
c. CISS $ $ $
d. Abstinence Education $ $ $
e. Healthy Start $ $ $
f. EMSC $ $ $
g. WIC $ $ $
h. AIDS $ $ $
i. CDC $ $ $
j. Education $ $ $
k.Other
ECCS MCHB $ $ $
Intg Systems CSHCN $ $ $
Lead EPA $ $ $
Lead HRSA $ $ $
Newborn Hearing Scr $ $ $
Oral Healt HRSA $ $ $
HRSA $ $ $
Lead $ $ $
Lead Control $ $ $
Others $ $ $
III. SUBTOTAL $ $ $
 


Form 4
Budget Details By Types of Individuals Served (I) and Sources of Other Federal Funds (II)  
  [Secs 506(2)(2)(iv)]  
  State: WI  
 
FY 2002 FY 2003 FY 2004
I. Federal-State MCH Block Grant Partnership Budgeted Expended Budgeted Expended Budgeted Expended
a. Pregnant Women $ $ $ $ $ $
b. Infants < 1 year old $ $ $ $ $ $
c. Children 1 to 22 years old $ $ $ $ $ $
d. Children with Special Healthcare Needs $ $ $ $ $ $
e. Others $ $ $ $ $ $
f. Administration $ $ $ $ $ $
g. SUBTOTAL $ $ $ $ $ $
 
II. Other Federal Funds (under the control of the person responsible for administration of the Title V program).
a. SPRANS $ $ $
b. SSDI $ $ $
c. CISS $ $ $
d. Abstinence Education $ $ $
e. Healthy Start $ $ $
f. EMSC $ $ $
g. WIC $ $ $
h. AIDS $ $ $
i. CDC $ $ $
j. Education $ $ $
k.Other
ECCS & UNHS $ $ $
Lead $ $ $
Lead Control (HUD) $ $ $
Univ Newborn Hearing Screening $ $ $
Lead (EPA) $ $ $
Lead (HUD) $ $ $
III. SUBTOTAL $ $ $
 

Form Notes for Form 4
None
Field Level Notes
1. Section Number: I. Federal-State MCH Block Grant Partnership
Field Name: Children_0_1Expended
Row Name: Infants <1 year old
Column Name: Expended
Year: 2005
Field Note:
Infants Under One Year Old - This variance, an increase of $467,460 (22.3%), is due to an increase in expenditures in the Title V and Match components of the Federal/State Partnership - approximately $304,000 and $154,000 respectively. Title V expenditures increased for local aids by $162,000 and for state operations by $142,000.
2. Section Number: I. Federal-State MCH Block Grant Partnership
Field Name: Children_0_1Expended
Row Name: Infants <1 year old
Column Name: Expended
Year: 2004
Field Note:
This variance, an increase of $866,744 (60.47%), is due to an increase in expenditures in the Title V and Match components of the Federal/State Partnership - approximately $505,000 and $358,000 respectively. Title V expenditures increased for local aids by $350,000 and for state operations by $150,000. The increase in local aids generated the subsequent increase in match in a similar amount.
3. Section Number: I. Federal-State MCH Block Grant Partnership
Field Name: Children_1_22Expended
Row Name: Children 1 to 22 years old
Column Name: Expended
Year: 2005
Field Note:
Children One to 22 Years Old - This variance, an increase of $981,946 (13.2%), is due to an increase in expenditures in the Title V, Match and Program Income components of the Federal/State Partnership. While Title V State Operations expenditures decreased by approximately $100,000, Title V Local Aids expenditures increased by $200,000. Match increased by approximately $412,000 and Program Income by $477,000.
4. Section Number: I. Federal-State MCH Block Grant Partnership
Field Name: AllOthersExpended
Row Name: All Others
Column Name: Expended
Year: 2005
Field Note:
Others – This variance, an increase of $704,585 (16.3%), is due to primarily to increases in Program Income from family planning/reproductive health projects - $215,000 and Match provided by local agencies - $408,000. In addition, there was an increase the Title V component of approximately $82,000.


Form 5

State Title V Program Budget and Expenditures by Types of Services  
  [Secs. 505(a)(2)(A-B) and 506(a)(1)(A-D)]  
  State: WI  
 
Type of Service FY 2005 FY 2006 FY 2007
Budgeted Expended Budgeted Expended Budgeted Expended
I. Direct Health Care Services
(Basic Health Services and Health Services for CSHCN.)		 $ $ $ $ $ $
II. Enabling Services
(Transportation, Translation, Outreach, Respite Care, Health Education, Family Support Services, Purchase of Health Insurance, Case Management, and Coordination with Medicaid, WIC, and Education.) 		$ $ $ $ $ $
III. Population-Based Services
(Newborn Screening, Lead Screening, Immunization, Sudden Infant Death Syndrome Counseling, Oral Health, Injury Prevention, Nutrition, and Outreach/Public Education.) 		$ $ $ $ $ $
IV. Infrastructure Building Services
(Needs Assessment, Evaluation, Planning, Policy Development, Coordination, Quality Assurance, Standards Development, Monitoring, Training, Applied Research, Systems of Care, and Information Systems.) 		$ $ $ $ $ $
V. Federal-State Title V Block Grant Partnership Total
(Federal-State Partnership only. Item 15g of SF 42r. For the "Budget" columns this is the same figure that appears in Line 8, Form 2, and in the "Budgeted" columns of Line 7 Form 3. For the "Expended" columns this is the same figure that appears in the "Expended" columns of Line 7, Form 3.) 		$ $ $ $ $ $
 
 


Form 5

State Title V Program Budget and Expenditures by Types of Services  
  [Secs. 505(a)(2)(A-B) and 506(a)(1)(A-D)]  
  State: WI  
 
Type of Service FY 2002 FY 2003 FY 2004
Budgeted Expended Budgeted Expended Budgeted Expended
I. Direct Health Care Services
(Basic Health Services and Health Services for CSHCN.)		 $ $ $ $ $ $
II. Enabling Services
(Transportation, Translation, Outreach, Respite Care, Health Education, Family Support Services, Purchase of Health Insurance, Case Management, and Coordination with Medicaid, WIC, and Education.) 		$ $ $ $ $ $
III. Population-Based Services
(Newborn Screening, Lead Screening, Immunization, Sudden Infant Death Syndrome Counseling, Oral Health, Injury Prevention, Nutrition, and Outreach/Public Education.) 		$ $ $ $ $ $
IV. Infrastructure Building Services
(Needs Assessment, Evaluation, Planning, Policy Development, Coordination, Quality Assurance, Standards Development, Monitoring, Training, Applied Research, Systems of Care, and Information Systems.) 		$ $ $ $ $ $
V. Federal-State Title V Block Grant Partnership Total
(Federal-State Partnership only. Item 15g of SF 42r. For the "Budget" columns this is the same figure that appears in Line 8, Form 2, and in the "Budgeted" columns of Line 7 Form 3. For the "Expended" columns this is the same figure that appears in the "Expended" columns of Line 7, Form 3.) 		$ $ $ $ $ $
 
 

Form Notes for Form 5
None
Field Level Notes
1. Section Number: Main
Field Name: EnablingExpended
Row Name: Enabling Services
Column Name: Expended
Year: 2005
Field Note:
Enabling Services - This variance, an increase of $774,234 (20.9%), is due to an increase in the Title V and Match components of the Federal/State Partnership. Local agencies reported an increase in Title V funds of $164,000 and reported an increase of $610,000 in match.
2. Section Number: Main
Field Name: EnablingExpended
Row Name: Enabling Services
Column Name: Expended
Year: 2004
Field Note:
This variance, an increase of $511,038 (13.55%), is due to an increase in the Title V and Match components of the Federal/State Partnership. Local agencies received an increase in Title V funds of $102,000 and reported an increase of $408,000 in match.
3. Section Number: Main
Field Name: PopBasedExpended
Row Name: Population-Based Services
Column Name: Expended
Year: 2005
Field Note:
Population Based Services - This variance, an increase of 164,454 (15.8%), is due primarily to a $123,000 increase in the amount of match reported by local agencies, and to a lesser extent the increased amount of Title V expenditures reported by local agencies in the amount of $41,000.
4. Section Number: Main
Field Name: PopBasedExpended
Row Name: Population-Based Services
Column Name: Expended
Year: 2004
Field Note:
This variance, an increase of $106,675 (10.9%), is due almost entirely to an increase in the amount of match reported by local agencies.

Form 6

Number and Percentage of Newborns and Others Screened, Cases Confirmed, and Treated
Sect. 506(a)(2)(B)(iii)
State: WI
 
Total Births by Occurrence:   Reporting Year: 2005
 
Type of Screening Tests (A)
Receiving at least one Screen (1) 		(B)
No. of Presumptive Positive Screens 		(C)
No. Confirmed Cases (2) 		(D)
Needing Treatment that Received Treatment (3)
No. %
No.
%
Phenylketonuria
Congenital Hypothyroidism
Galactosemia
Sickle Cell Disease
Other Screening (Specify)
Biotinidase Deficiency
Cystic Fibrosis
Fatty Acid Oxidation
Organic Acidemia
Congenital Adrenal Hyperplasia (CAH)
Aminoacidopathies
Screening Programs for Older Children & Women (Specify Tests by name)
(1) Use occurrent births as denominator.
(2) Report only those from resident births.
(3) Use number of confirmed cases as denominator.
 
 

Form Notes for Form 6
Occurrent births: For CY 2005, according to the birth file closed 3/31/06, there were 69,770 occurrent births in Wisconsin; these data are provisional, Wisconsin Deparment of Health and Family Services, Division of Public Health, Bureau of Health Information and Policy. The count of occurrent births for 2005 is not available until the summer of 2007.
Data Issues: NBS data files and birth certificate records are not linked. Provisional occurrent birth data indicate a small discrepancy between the numbers of babies born in Wisconsin and the numbers screened; these data will not be final until summer 2006. These files are not linked.
NBS data includes resident and occurrent births. Resident birth data are not available.
Field Level Notes
1. Section Number: Main
Field Name: BirthOccurence
Row Name: Total Births By Occurence
Column Name: Total Births By Occurence
Year: 2007
Field Note:
For CY 2005, according to the birth file closed 3/31/06, there were 69,770 occurrent births in Wisconsin; these data are provisional, Wisconsin Deparment of Health and Family Services, Division of Public Health, Bureau of Health Information and Policy. The count of occurrent births for 2005 is not available until the summer of 2007.
2. Section Number: Main
Field Name: SickleCellDisease_Presumptive
Row Name: SickleCellDisease
Column Name: Presumptive positive screens
Year: 2007
Field Note:
The electrophoresis and HPLC technology used by the screening lab is essentially diagnostic for sickle cell disease. All screens positive for sickle cell disease are referred to a comprehensive sickle cell disease clinic for follow-up and treatment.
3. Section Number: Main
Field Name: SickleCellDisease_Confirmed
Row Name: SickleCellDisease
Column Name: Confirmed Cases
Year: 2007
Field Note:
The electrophoresis and HPLC technology used by the screening lab is essentially diagnostic for sickle cell disease. All screens positive for sickle cell disease are referred to a comprehensive sickle cell disease clinic for follow-up and treatment.
4. Section Number: Main
Field Name: SickleCellDisease_TreatmentNo
Row Name: SickleCellDisease
Column Name: Needing treatment that received treatment
Year: 2007
Field Note:
The electrophoresis and HPLC technology used by the screening lab is essentially diagnostic for sickle cell disease. All screens positive for sickle cell disease are referred to a comprehensive sickle cell disease clinic for follow-up and treatment.

FORM 7
Number of Individuals Served (Unduplicated) under Title V
(By Class of Individuals and Percent of Health Coverage)
[Sec. 506(a)(2)(A)(i-ii)]
State: WI
 
Reporting Year: 2005
 
TITLE V PRIMARY SOURCES OF COVERAGE
Types of Individuals Served (A)
Total Served		 (B)
Title XIX %		 (C)
Title XXI %		 (D)
Private/Other %		 (E)
None %		 (F)
Unknown %
Pregnant Women





Infants < 1 year old





Children 1 to 22 years old





Children with Special Healthcare Needs





Others





TOTAL
 
 

Form Notes for Form 7
Sources: 2005 Title V program data and Reproductive Health/Family Planning (RH/FP) data come from SPHERE (Secure Public Health Electronic Record Environment), the data collection system used by agencies receiving Title V funds, local agency reports, and 2005 NBS data from the Wisconsin State Laboratory of Hygiene. RH/FP data include persons receiving services supported with Title V (and matching) funds and do not include Title X. RH/FP data from previous years included individuals who received services in Title X family planning clinics whose care was partially supported with Title V matching funds. For 2005, women excluded from RH/FP services were: under age 22 and over age 22 (not pregnant) and received family planning services through agencies receiving federal Title X funds. For subsequent years, RH/FP data will exclude women age 22 and over age 22 (not pregnant) who receive family planning services through agencies receiving federal Title X funds. As a result, there were significant decreases reported for: 1 to 22 years old (34,506 fewer than 2004), Other [(>=22 and not pregnant) (13,608 fewer than 2004)], and Total (46,588 than 2004). Prior to 2005, agencies supported with TItle X family planning funds also received substantial Title V matching funds to support reproductive health care services. Following implementation of the Medicaid Family Planning Waiver, Title X agencies no longer received Title V matching funds. Therefore, individuals receiving services in these clinics did not have a portion of their care supported with Title V funds, and are not included in Form 7.
Health care coverage are required fields for local agencies that use SPHERE. Agencies not using SPHERE were required to report on health care coverage.
The data for primary sources of coverage for infants are: 1) estimates from the 2004 birth file; the 2005 birth file was not available for estimates of primary sources of coverage and NBS data do not have primary sources of coverage; 2) SPHERE data from 2005, and 3) local agency reports from 2005.
Field Level Notes
1. Section Number: Main
Field Name: Children_0_1_TS
Row Name: Infants <1 year of age
Column Name: Title V Total Served
Year: 2007
Field Note:
Data issues: Total infants <1 year of age includes: 1) 69,770 and 2) Title V = [ 5042 ( 769 CSHCN infants ) + (4,273 infants)]. The NBS file, SPHERE (data collection system used by agencies receiving Title V funds) and local agencies' data systems are not linked; therefore, the Title V infants are included in the NBS numbers because it's likely those infants were screened. The percentage of primary source of coverage for Title V infants are: Title XIX - 26.1%, Title XXI - 9.1%, Private/Other - 31.7%, None - 3.4%, Unknown - 29.6%.
2. Section Number: Main
Field Name: AllOthers_TS
Row Name: Others
Column Name: Title V Total Served
Year: 2007
Field Note:
Data issue: Others served include: 1) Title V = 6,853, 2) FP/RH = 28,269.

FORM 8
Deliveries and Infants Served By Title V and Entitled to Benefits Under Title XIX
(By Race and Ethnicity)
[Sec. 506(a)(2)(C-D)]
State: WI
 
Reporting Year: 2005
 
I. UNDUPLICATED COUNT BY RACE
  (A)
Total All Races		 (B)
White		 (C)
Black or African American		 (D)
American Indian or Native Alaskan		 (E)
Asian		 (F)
Native Hawaiian or Other Pacific Islander		 (G)
More than one race reported		 (H)
Other and Unknown
Deliveries
Total Deliveries in State
Title V Served
Eligible for Title XIX
Infants
Total Infants in State
Title V Served
Eligible for Title XIX
 
II. UNDUPLICATED COUNT BY ETHNICITY
HISPANIC OR LATINO (Sub-categories by country or area of origin)
  ( A )
Total NOT Hispanic or Latino		 ( B )
Total Hispanic or Latino		 ( C )
Ethnicity Not Reported		 ( B.1 )
Mexican		 ( B.2 )
Cuban		 ( B.3 )
Puerto Rican		 ( B.4 )
Central and South American		 ( B.5 )
Other and Unknown
Deliveries
Total Deliveries in State
Title V Served
Eligible for Title XIX
Infants
Total Infants in State
Title V Served
Eligible for Title XIX
 

Form Notes for Form 8
Sources: Total deliveries and infants in state: 2004 resident births, Wisconsin Department of Health and Family Services, Divsion of Public Health, Bureau of Health Information and Policy, 2005. Eligible for Title XIX: Medicaid status at birth depends on the mother being a Wisconsin resident, and to a lesser extent, on the birth occurring in Wisconsin, therefore, these data are restricted to infants born in Wisconsin whose mothers were Wisconsin residents. 2005 data are not available from the Bureau of Health Information and Policy until late summer 2006. Eligible for Title V: 2005 Title V program data SPHERE (Secure Public Health Electronic Record Environment) and local agency reports.
Field Level Notes
1. Section Number: I. Unduplicated Count By Race
Field Name: DeliveriesTotal_All
Row Name: Total Deliveries in State
Column Name: Total All Races
Year: 2007
Field Note:
2004 data; Wisconsin Department of Health and Family Services, Divsion of Public Health, Bureau of Health Information and Policy, 2006. 2005 data are not available until late summer 2006.
2. Section Number: I. Unduplicated Count By Race
Field Name: DeliveriesTotal_Asian
Row Name: Total Deliveries in State
Column Name: Asian
Year: 2007
Field Note:
Asian includes the Lao/Hmong (1,044 births in 2004) category whose race was indicated as "Laotian" or "Hmong" and mothers born in Laos. Asian includes Chinese, Japanese, Filipino, Vietnamese, Korean, Thai, and Cambodian.
3. Section Number: I. Unduplicated Count By Race
Field Name: DeliveriesTotal_Hawaiian
Row Name: Total Deliveries in State
Column Name: Native Hawaiian or Other Pacific Islander
Year: 2007
Field Note:
Native Hawaiian or Other Pacific Islander includes Hawaiian.
4. Section Number: I. Unduplicated Count By Race
Field Name: DeliveriesTitleV_All
Row Name: Title V Served
Column Name: Total All Races
Year: 2007
Field Note:
Data source: 2005 SPHERE data, 2006.
5. Section Number: I. Unduplicated Count By Race
Field Name: DeliveriesTitleXIX_All
Row Name: Eligible for Title XIX
Column Name: Total All Races
Year: 2007
Field Note:
2004 data; Wisconsin Department of Health and Family Services, Divsion of Public Health, Bureau of Health Information and Policy, 2006. 2005 data are not available until late summer 2006.
6. Section Number: I. Unduplicated Count By Race
Field Name: InfantsTotal_All
Row Name: Total Infants in State
Column Name: Total All Races
Year: 2007
Field Note:
2004 data; Wisconsin Department of Health and Family Services, Divsion of Public Health, Bureau of Health Information and Policy, 2006. 2005 data are not available until late summer 2006.
7. Section Number: I. Unduplicated Count By Race
Field Name: InfantsTitleV_All
Row Name: Title V Served
Column Name: Total All Races
Year: 2007
Field Note:
Data source: 2005 SPHERE data, 2006.
8. Section Number: I. Unduplicated Count By Race
Field Name: InfantsTitleXIX_All
Row Name: Eligible for Title XIX
Column Name: Total All Races
Year: 2007
Field Note:
2004 data; Wisconsin Department of Health and Family Services, Divsion of Public Health, Bureau of Health Information and Policy, 2006. 2005 data are not available until late summer 2006.
9. Section Number: II. Unduplicated Count by Ethnicity
Field Name: DeliveriesTotal_TotalNotHispanic
Row Name: Total Deliveries in State
Column Name: Total Not Hispanic or Latino
Year: 2007
Field Note:
2004 data; Wisconsin Department of Health and Family Services, Divsion of Public Health, Bureau of Health Information and Policy, 2006. 2005 data are not available until late summer 2006.
10. Section Number: II. Unduplicated Count by Ethnicity
Field Name: DeliveriesTotal_TotalHispanic
Row Name: Total Deliveries in State
Column Name: Total Hispanic or Latino
Year: 2007
Field Note:
Hispanics or Latinos may be any race.
11. Section Number: II. Unduplicated Count by Ethnicity
Field Name: DeliveriesTotal_Mexican
Row Name: Total Deliveries in State
Column Name: Mexican
Year: 2007
Field Note:
Not available.
12. Section Number: II. Unduplicated Count by Ethnicity
Field Name: DeliveriesTotal_Cuban
Row Name: Total Deliveries in State
Column Name: Cuban
Year: 2007
Field Note:
Not availalbe.
13. Section Number: II. Unduplicated Count by Ethnicity
Field Name: DeliveriesTotal_PuertoRican
Row Name: Total Deliveries in State
Column Name: Puerto Rican
Year: 2007
Field Note:
Not available.
14. Section Number: II. Unduplicated Count by Ethnicity
Field Name: DeliveriesTotal_CentralAmerican
Row Name: Total Deliveries in State
Column Name: Central and South American
Year: 2007
Field Note:
Not available.
15. Section Number: II. Unduplicated Count by Ethnicity
Field Name: DeliveriesTitleV_TotalNotHispanic
Row Name: Title V Served
Column Name: Total Not Hispanic or Latino
Year: 2007
Field Note:
Data source: 2005 SPHERE data, 2006.
16. Section Number: II. Unduplicated Count by Ethnicity
Field Name: DeliveriesTitleXIX_TotalNotHispanic
Row Name: Eligible for Title XIX
Column Name: Total Not Hispanic or Latino
Year: 2007
Field Note:
2004 data; Wisconsin Department of Health and Family Services, Divsion of Public Health, Bureau of Health Information and Policy, 2006. 2005 data are not available until late summer 2006.
17. Section Number: II. Unduplicated Count by Ethnicity
Field Name: DeliveriesTitleXIX_Mexican
Row Name: Eligible for Title XIX
Column Name: Mexican
Year: 2007
Field Note:
Not available.
18. Section Number: II. Unduplicated Count by Ethnicity
Field Name: DeliveriesTitleXIX_Cuban
Row Name: Eligible for Title XIX
Column Name: Cuban
Year: 2007
Field Note:
Not avaiable.
19. Section Number: II. Unduplicated Count by Ethnicity
Field Name: DeliveriesTitleXIX_PuertoRican
Row Name: Eligible for Title XIX
Column Name: Puerto Rican
Year: 2007
Field Note:
Not available.
20. Section Number: II. Unduplicated Count by Ethnicity
Field Name: DeliveriesTitleXIX_CentralAmerican
Row Name: Eligible for Title XIX
Column Name: Central and South American
Year: 2007
Field Note:
Not available.
21. Section Number: II. Unduplicated Count by Ethnicity
Field Name: InfantsTotal_TotalNotHispanic
Row Name: Total Infants in State
Column Name: Total Not Hispanic or Latino
Year: 2007
Field Note:
2004 data; Wisconsin Department of Health and Family Services, Divsion of Public Health, Bureau of Health Information and Policy, 2006. 2005 data are not available until late summer 2006.
22. Section Number: II. Unduplicated Count by Ethnicity
Field Name: InfantsTotal_TotalHispanic
Row Name: Total Infants in State
Column Name: Total Hispanic or Latino
Year: 2007
Field Note:
Hispanics or Latinos may be of any race.
23. Section Number: II. Unduplicated Count by Ethnicity
Field Name: InfantsTotal_Mexican
Row Name: Total Infants in State
Column Name: Mexican
Year: 2007
Field Note:
Not available.
24. Section Number: II. Unduplicated Count by Ethnicity
Field Name: InfantsTotal_Cuban
Row Name: Total Infants in State
Column Name: Cuban
Year: 2007
Field Note:
Not available.
25. Section Number: II. Unduplicated Count by Ethnicity
Field Name: InfantsTotal_PuertoRican
Row Name: Total Infants in State
Column Name: Puerto Rican
Year: 2007
Field Note:
Not available.
26. Section Number: II. Unduplicated Count by Ethnicity
Field Name: InfantsTotal_CentralAmerican
Row Name: Total Infants in State
Column Name: Central and South American
Year: 2007
Field Note:
Not available.
27. Section Number: II. Unduplicated Count by Ethnicity
Field Name: InfantsTitleV_TotalNotHispanic
Row Name: Title V Served
Column Name: Total Not Hispanic or Latino
Year: 2007
Field Note:
Data source: 2005 SPHERE data, 2006.
28. Section Number: II. Unduplicated Count by Ethnicity
Field Name: InfantsTitleXIX_TotalNotHispanic
Row Name: Eligible for Title XIX
Column Name: Total Not Hispanic or Latino
Year: 2007
Field Note:
2004 data; Wisconsin Department of Health and Family Services, Divsion of Public Health, Bureau of Health Information and Policy, 2006. 2005 data are not available until late summer 2006.
29. Section Number: II. Unduplicated Count by Ethnicity
Field Name: InfantsTitleXIX_Mexican
Row Name: Eligible for Title XIX
Column Name: Mexican
Year: 2007
Field Note:
Not available.
30. Section Number: II. Unduplicated Count by Ethnicity
Field Name: InfantsTitleXIX_Cuban
Row Name: Eligible for Title XIX
Column Name: Cuban
Year: 2007
Field Note:
Not available.
31. Section Number: II. Unduplicated Count by Ethnicity
Field Name: InfantsTitleXIX_PuertoRican
Row Name: Eligible for Title XIX
Column Name: Puerto Rican
Year: 2007
Field Note:
Not available.
32. Section Number: II. Unduplicated Count by Ethnicity
Field Name: InfantsTitleXIX_CentralAmerican
Row Name: Eligible for Title XIX
Column Name: Central and South American
Year: 2007
Field Note:
Not available.

Form 9
State MCH Toll-Free Telephone Line Data Form
[Secs. 505(a)(E) and 509(a)(8)]
State: WI
 
 
  FY 2007 FY 2006 FY 2005 FY 2004 FY 2003
1. State MCH Toll-Free "Hotline" Telephone Number
2. State MCH Toll-Free "Hotline" Name Wisconsin Maternal and Child Health Hotline  Wisconsin Maternal and Child Health Hotline  Wisconsin Maternal and Child Health Hotline  Wisconsin Maternal and Child Health Hotline  Wisconsin Maternal and Child Health Hotline 
3. Name of Contact Person for State MCH "Hotline"
4. Contact Person's Telephone Number
5. Number of calls received on the State MCH "Hotline" this reporting period
 
 

Form 9
State MCH Toll-Free Telephone Line Data Form (Optional)
[Secs. 505(a)(E) and 509(a)(8)]
State: WI
 
 
  FY 2007 FY 2006 FY 2005 FY 2004 FY 2003
1. State MCH Toll-Free "Hotline" Telephone Number
2. State MCH Toll-Free "Hotline" Name          
3. Name of Contact Person for State MCH "Hotline"
4. Contact Person's Telephone Number
5. Number of calls received on the State MCH "Hotline" this reporting period
 
 

Form Notes for Form 9
None
Field Level Notes
None

State MCH toll-free telephone line data form
 

Form 10
Title V Maternal & Child Health Services Block Grant
State Profile for FY 2007
[Sec. 506(a)(1)]
State: WI
 
 
 
1. State MCH Administration:
(max 2500 characters)
The Title V MCH/CSHCN Block Grant funds are administered by the Wisconsin Division of Public Health, Bureau of Community Health Promotion, Family Health Section. The FHS is clearly demarcated within the Division as the designee for administration of the Title V activities. This clear demarcation serves as a critical component to ensure comprehensive program activity and a single point of accountability for the state. The Family Health Section contains the MCH Unit which includes the MCH Program and the CSHCN Program.
 
Block Grant Funds  
2. Federal Allocation (Line 1, Form 2) $
3. Unobligated balance (Line 2, Form 2) $
4. State Funds (Line 3, Form 2) $
5. Local MCH Funds (Line 4, Form 2) $
6. Other Funds (Line 5, Form 2) $
7. Program Income (Line 6, Form 2) $
8. Total Federal-State Partnership (Line 8, Form 2) $
 
9. Most significant providers receiving MCH funds:
10. Individuals served by the Title V Program (Col. A, Form 7)
    a. Pregnant Women
    b. Infants < 1 year old
    c. Children 1 to 22 years old
    d. CSHCN
    e. Others
 
11. Statewide Initiatives and Partnerships:
 
a. Direct Medical Care and Enabling Services:
(max 2500 characters)
Wisconsin's Title V funds are distributed to local agencies and organizations (including tribes) on an annual basis through the Division of Public Health's performance-based contracting process. The purpose of performance-based contracting is to help agencies focus on improving health status and health outcomes for Wisconsin's citizens. Performance-based contracting is a non-competitive process and LHD's have the th first right of refusal to the allocated funds. Every fall, the Division of Public Health initiates a three-way negotiation process with representatives from the LHDs, the DPH regional office staff, and the DPH central office staff. To make the negotiation process easier, LHDs may (but are not required to) select from a list of template objectives developed specifically by the MCH/CSHCN Program that align with Wisconsin's priority needs for the maternal and child health population. (Template objectives are "pre-approved" activities and, as a result, streamline the negotiation process.) In 2006, the MCH/CSHCN Program developed 20 template objectives addressing the following topics: pregnancy and healthy outcomes; comprehensive physical exams for uninsured or underinsured children; child passenger safety; home safety assessments; prevention and intervention for early childhood dental caries; newborn home visitation; health education activities; nutrition coalition building; and breastfeeding promotion. If LHDs do not select a template objective(s), they created a separate, distinct objective(s) that met the needs of the maternal and child health population within their jurisdiction. In addition, the objective must be deemed as an acceptable activity by the MCH/CSHCN Program.
b. Population-Based Services:
(max 2500 characters)
Request for Proposals for statewide and regional MCH/CSHCN projects are released on a competitive basis approximately every 5 years. In the Spring 2005, we embarked on a new competitive process with statewide program activities scheduled beginning July 1, 2005 through December 31, 2010. The five statewide projects l address services to: improve infant health and reduce disparities in infant mortality; support a genetics system of care; improve child health and prevent childhood injury and death; improve maternal health and maternal care; and create a parent to parent matching program for families with CYSHCN. These projects perform under performance-based contracting, with some template objectives. The creation of the Regional CYSHCN Centers in January 2000 was in response to a series of assessments conducted throughout Wisconsin with families and providers along with technical assistance from national experts over the course of several years. The next funding cycle is this year, January 1, 2006 - December 31, 2010. The goal is to establish regional leadership, as an extension of the state CYSHCN Program and enhance the local capacity to serve children and youth with special health care needs and their families and to meet the six National Performance Measures, as part of the President's New Freedom Initiative. Additional key model elements include: consultation; referral and follow-up; health benefits counseling; medical and dental home; training and technical assistance; and adolescent transitioning to adult care.
c. Infrastructure Building Services:
(max 2500 characters)
Wisconsin's Title V dollars are at work to build systems to include: family planning and reproductive health; perinatal services; newborn blood and hearing screening; early childhood comprehensive services; child health services including oral health, asthma, and injury; children with special health care needs through the development of regional CSHCN centers; parent-to-parent support network; poison control services; integration of medical home; and the MCH Hotline (1-800-722-2295) including First Step for families who have children with special health care needs.
 
12. The primary Title V Program contact person: 13. The children with special health care needs (CSHCN) contact person:
Name
Title
Address
City
State
Zip
Phone
Fax
Email
Web
Name
Title
Address
City
State
Zip
Phone
Fax
Email
Web
 
 

Form Notes for Form 10
None
Field Level Notes
None

Form 11
Tracking Performance Measures
[Secs 485 (2)(2)(B)(iii) and 486 (a)(2)(A)(iii)]
State: WI
Form Level Notes for Form 11

Form 11 has columns for 2001 – 2005. After the data and accompanying note are entered into the performance measure's table, they are imported into the application's narrative (IV. C, IV. D). 2005 data were required; if 2005 data were not available, 2004 provisional data were entered with an accompanying note. For NPMs #1 - 6, 2001 data were not reported because they were new in 2004, and 2002 data were reported for the first time. NPMs # 11, 14 and 15, were new for the 2007 application and 2004 data were the first year reported. Data for these measures are from several sources, including national and state surveys, and data systems maintained by the state of Wisconsin. Data for measures #1 and 12 are CY 2005. Data for measures #8, 10, 13, 15, 16, 17, and 18 are for CY 2004 from the Wisconsin Department of Health and Family Services, Bureau of Health Information and Policy; these data are maintained in retrospective state databases and are not released or published until 18 months after the end of the data year; therefore, 2005 data will not be available until mid-2007. Data for measures #2, 3, 4, 5, and 6 are from the National Center for Health Statistics (NCHS) State and Local Area Integrated Telephone Survey (SLAITS) CSHCN module. Data for measures #7 and 14 are SFY 2004. Data for measure #9 are estimates for CY 2005. Data for measure #11 are for CY 2004. Negotiated State Performance Measures: For SPMs #1 - 5, 2001 - 2003 data were not reported because they were new for the 2007 application, and 2004 data were reported for the first time. Data for these measures are from several sources, including state surveys, national data systems, and data systems maintained by the state of Wisconsin. Data for measure #1 are from the Family Planning Program, data for #2 are from Medicaid data, data for #3 are from SPHERE, data for #4, 6, 7, 9, and 10 are maintained in retrospective state databases and are not released or published until 18 months after the end of the data year; therefore, 2005 data will not be available until mid-2007. Data for #5 is from the NCHS National Survey of Children's Health. Data for #8 is from the CDC's Pediatric Nutrition Surveillance System; 2005 data are not available until 2007, 2004 data were use for the required 2005 indicator and are marked "provisional."
Performance Measure # 01
The percent of screen positive newborns who received timely follow up to definitive diagnosis and clinical management for condition(s) mandated by their State-sponsored newborn screening programs.
Annual Objective and Performance Data
2001 2002 2003 2004 2005
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final? Final Final
 
Annual Objective and Performance Data
2006 2007 2008 2009 2010
Annual Performance Objective
Annual Indicator Please fill in only the Objectives for the above years. Numerator, Denominator and Annual Indicators are not required for future year data.
Numerator
Denominator

Field Level Notes

1. Section Number: Performance Measure #1
Field Name: PM01
Row Name:
Column Name:
Year: 2005
Field Note:
Source: Numerator: NBS program, State Lab of Hygiene, Wisconsin, 2005. The number of infants that were confirmed with a condition through newborn screening and who receive appropriate follow-up care.
Denominator: NBS program, State Lab of Hygiene, Wisconsin, 2005. The number of screened through NBS and confirmed with a condition.
Wisconsin screens for 47 congenital disorders. Every newborn with an abnormal NBS result is tracked by the NBS Program to a normal result or appropriate clinical care.
2. Section Number: Performance Measure #1
Field Name: PM01
Row Name:
Column Name:
Year: 2004
Field Note:
Source: Numerator: NBS program, State Lab of Hygiene, Wisconsin, 2004. The number of infants that were confirmed with a condition through newborn screening and who receive appropriate follow-up care.
Denominator: NBS program, State Lab of Hygiene, Wisconsin, 2004. The number of screened through NBS and confirmed with a condition.
Wisconsin screens for 26 congenital disorders. Every newborn with an abnormal NBS result is tracked by the NBS Program to a normal result or appropriate clinical care.
3. Section Number: Performance Measure #1
Field Name: PM01
Row Name:
Column Name:
Year: 2003
Field Note:
Source: Numerator: NBS program, State Lab of Hygiene, Wisconsin, 2003. The number of infants that were confirmed with a condition through newborn screening and who receive appropriate follow-up care.
Denominator: NBS program, State Lab of Hygiene, Wisconsin, 2003. The number of screened through NBS and confirmed with a condition.
Wisconsin screens for 26 congenital disorders. Every newborn with an abnormal NBS result is tracked by the NBS Program to a normal result or appropriate clinical care.

Performance Measure # 02
The percent of children with special health care needs age 0 to 18 years whose families partner in decision making at all levels and are satisfied with the services they receive. (CSHCN survey)
Annual Objective and Performance Data
2001 2002 2003 2004 2005
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final? Final Final
 
Annual Objective and Performance Data
2006 2007 2008 2009 2010
Annual Performance Objective
Annual Indicator Please fill in only the Objectives for the above years. Numerator, Denominator and Annual Indicators are not required for future year data.
Numerator
Denominator

Field Level Notes

1. Section Number: Performance Measure #2
Field Name: PM02
Row Name:
Column Name:
Year: 2005
Field Note:
The data reported in 2005 are pre-populated with the data from 2004 for this performance measure.
2. Section Number: Performance Measure #2
Field Name: PM02
Row Name:
Column Name:
Year: 2004
Field Note:
The data reported in 2004 are pre-populated with the data from 2003 for this performance measure.
3. Section Number: Performance Measure #2
Field Name: PM02
Row Name:
Column Name:
Year: 2003
Field Note:
Source: NCHS SLAITS CSHCN module; the data reported in 2002 pre-populated the data for 2003 for this performance measure.

Performance Measure # 03
The percent of children with special health care needs age 0 to 18 who receive coordinated, ongoing, comprehensive care within a medical home. (CSHCN Survey)
Annual Objective and Performance Data
2001 2002 2003 2004 2005
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final? Final Final
 
Annual Objective and Performance Data
2006 2007 2008 2009 2010
Annual Performance Objective
Annual Indicator Please fill in only the Objectives for the above years. Numerator, Denominator and Annual Indicators are not required for future year data.
Numerator
Denominator

Field Level Notes

1. Section Number: Performance Measure #3
Field Name: PM03
Row Name:
Column Name:
Year: 2005
Field Note:
The data reported in 2005 are pre-populated with the data from 2004 for this performance measure.
2. Section Number: Performance Measure #3
Field Name: PM03
Row Name:
Column Name:
Year: 2004
Field Note:
The data reported in 2004 are pre-populated with the data from 2003 for this performance measure.
3. Section Number: Performance Measure #3
Field Name: PM03
Row Name:
Column Name:
Year: 2003
Field Note:
Source: NCHS SLAITS CSHCN module; the data reported in 2002 pre-populated the data for 2003 for this performance measure.

Performance Measure # 04
The percent of children with special health care needs age 0 to 18 whose families have adequate private and/or public insurance to pay for the services they need. (CSHCN Survey)
Annual Objective and Performance Data
2001 2002 2003 2004 2005
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final? Final Final
 
Annual Objective and Performance Data
2006 2007 2008 2009 2010
Annual Performance Objective
Annual Indicator Please fill in only the Objectives for the above years. Numerator, Denominator and Annual Indicators are not required for future year data.
Numerator
Denominator

Field Level Notes

1. Section Number: Performance Measure #4
Field Name: PM04
Row Name:
Column Name:
Year: 2005
Field Note:
The data reported in 2005 are pre-populated with the data from 2004 for this performance measure.
2. Section Number: Performance Measure #4
Field Name: PM04
Row Name:
Column Name:
Year: 2004
Field Note:
The data reported in 2004 are pre-populated with the data from 2003 for this performance measure.
3. Section Number: Performance Measure #4
Field Name: PM04
Row Name:
Column Name:
Year: 2003
Field Note:
Source: NCHS SLAITS CSHCN module; the data reported in 2002 pre-populated the data for 2003 for this performance measure.

Performance Measure # 05
Percent of children with special health care needs age 0 to 18 whose families report the community-based service systems are organized so they can use them easily. (CSHCN Survey)
Annual Objective and Performance Data
2001 2002 2003 2004 2005
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final? Final Final
 
Annual Objective and Performance Data
2006 2007 2008 2009 2010
Annual Performance Objective
Annual Indicator Please fill in only the Objectives for the above years. Numerator, Denominator and Annual Indicators are not required for future year data.
Numerator
Denominator

Field Level Notes

1. Section Number: Performance Measure #5
Field Name: PM05
Row Name:
Column Name:
Year: 2005
Field Note:
The data reported in 2005 are pre-populated with the data from 2004 for this performance measure.
2. Section Number: Performance Measure #5
Field Name: PM05
Row Name:
Column Name:
Year: 2004
Field Note:
The data reported in 2004 are pre-populated with the data from 2003 for this performance measure.
3. Section Number: Performance Measure #5
Field Name: PM05
Row Name:
Column Name:
Year: 2003
Field Note:
Source: NCHS SLAITS CSHCN module; the data reported in 2002 pre-populated the data for 2003 for this performance measure.

Performance Measure # 06
The percentage of youth with special health care needs who received the services necessary to make transitions to all aspects of adult life, including adult health care, work, and independence.
Annual Objective and Performance Data
2001 2002 2003 2004 2005
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final? Final Final
 
Annual Objective and Performance Data
2006 2007 2008 2009 2010
Annual Performance Objective
Annual Indicator Please fill in only the Objectives for the above years. Numerator, Denominator and Annual Indicators are not required for future year data.
Numerator
Denominator

Field Level Notes

1. Section Number: Performance Measure #6
Field Name: PM06
Row Name:
Column Name:
Year: 2005
Field Note:
The data reported in 2005 are pre-populated with the data from 2004 for this performance measure.
2. Section Number: Performance Measure #6
Field Name: PM06
Row Name:
Column Name:
Year: 2004
Field Note:
The data reported in 2004 are pre-populated with the data from 2003 for this performance measure. State data was not robust enough to use; therefore national data is shown. Projections for 2005-2009 are very rough estimates. We expect to have state-level data from the Wisconsin Family Health Survey in time for next year to supplement and adjust projections (if necessary).
3. Section Number: Performance Measure #6
Field Name: PM06
Row Name:
Column Name:
Year: 2003
Field Note:
Source: NCHS SLAITS CSHCN module; the data reported in 2002 pre-populated the data for 2003 for this performance measure.

Performance Measure # 07
Percent of 19 to 35 month olds who have received full schedule of age appropriate immunizations against Measles, Mumps, Rubella, Polio, Diphtheria, Tetanus, Pertussis, Haemophilus Influenza, and Hepatitis B.
Annual Objective and Performance Data
2001 2002 2003 2004 2005
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final? Final Provisional
 
Annual Objective and Performance Data
2006 2007 2008 2009 2010
Annual Performance Objective
Annual Indicator Please fill in only the Objectives for the above years. Numerator, Denominator and Annual Indicators are not required for future year data.
Numerator
Denominator

Field Level Notes

1. Section Number: Performance Measure #7
Field Name: PM07
Row Name:
Column Name:
Year: 2005
Field Note:
Data issues: Due to fiscal constraints, CDC's National Immunization Survey was not completed for SFY 2005 (7/1/04-6/30/05), therefore, we used 2004 data for 2005.
Although the national goal for 2010 is 90%, we have slightly revised our objectives to reflect 2004's data and program expertise.
2. Section Number: Performance Measure #7
Field Name: PM07
Row Name:
Column Name:
Year: 2004
Field Note:
Source: National immunization survey for Wisconsin for SFY 2004 (July 1, 2003--June 30, 2004) with 4 DTaP:3 polio:1 MMR:3 hep B :3 Hib among children 19-35 months of age for Wisconsin is 80.6% (709/880, a slight drop from last year's indicator of 82.6%. We speculate the drop may be due to the on and off again DTaP vaccine shortage or vaccine safety issues. For series complete, including varciella, Wisconsin's level for 4:3:1:3:3:1 for cy 2004 is 78%
Although the national goal for 2010 is 90%, we have slightly revised our objectives to reflect this year's data and program expertise.
3. Section Number: Performance Measure #7
Field Name: PM07
Row Name:
Column Name:
Year: 2003
Field Note:
Source: National immunization survey for Wisconsin for SFY 2003 (July 1, 2002--June 30, 2003) with 4 DTaP:3 polio:1 MMR:3 hep B:3 Hib among children 19-35 months of age for Wisconsin is 82.6% (727/880). The national goal for 2010 is 90%, we revised our objectives accordingly.

Performance Measure # 08
The rate of birth (per 1,000) for teenagers aged 15 through 17 years.
Annual Objective and Performance Data
2001 2002 2003 2004 2005
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final? Final Provisional
 
Annual Objective and Performance Data
2006 2007 2008 2009 2010
Annual Performance Objective
Annual Indicator Please fill in only the Objectives for the above years. Numerator, Denominator and Annual Indicators are not required for future year data.
Numerator
Denominator

Field Level Notes

1. Section Number: Performance Measure #8
Field Name: PM08
Row Name:
Column Name:
Year: 2005
Field Note:
Data issue: Data for 2005 are not available from the Bureau of Health Information and Policy until 2007.
2. Section Number: Performance Measure #8
Field Name: PM08
Row Name:
Column Name:
Year: 2004
Field Note:
Source: Wisconsin Department of Health and Family Services, Division of Public Health, Bureau of Health Information and Policy, Bureau of Health Information. Wisconsin Interactive Statistics on Health (WISH), http://dhfs.wisconsin.gov/wish/, Birth Counts Module, accessed 04/03/2006.
3. Section Number: Performance Measure #8
Field Name: PM08
Row Name:
Column Name:
Year: 2003
Field Note:
Sources: Numerator: Wisconsin Department of Health and Family Services, Wisconsin Division of Public Health, Bureau of Health Information and Policy, Wisconsin Births and Infants Deaths, 2003, Madison, Wisconsin, 2005. Denominator: Wisconsin Department of Health and Family Services, Division of Public Health, Bureau of Health Information and Policy, Bureau of Health Information. Wisconsin Interactive Statistics on Health (WISH), http://dhfs.wisconsin.gov/wish/, Population Module, accessed 03/01/2005.

Performance Measure # 09
Percent of third grade children who have received protective sealants on at least one permanent molar tooth.
Annual Objective and Performance Data
2001 2002 2003 2004 2005
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final? Final Final
 
Annual Objective and Performance Data
2006 2007 2008 2009 2010
Annual Performance Objective
Annual Indicator Please fill in only the Objectives for the above years. Numerator, Denominator and Annual Indicators are not required for future year data.
Numerator
Denominator

Field Level Notes

1. Section Number: Performance Measure #9
Field Name: PM09
Row Name:
Column Name:
Year: 2005
Field Note:
Source: Numerator: calculated by taking 2001's indicator, the most recent Wisconsin Division of Public Health "Make Your Smile Count" suvey of third grade children, 2001-02. Denominator: the number of third grade children enrolled in public and private schools. Future data are dependent on funding for another survey.
2. Section Number: Performance Measure #9
Field Name: PM09
Row Name:
Column Name:
Year: 2004
Field Note:
Source: Numerator: calculated by taking 2001's indicator, the most recent Wisconsin Division of Public Health "Make Your Smile Count" suvey of third grade children, 2001-02. Denominator: the number of third grade children enrolled in public and private schools. Future data are dependent on funding for another survey.
3. Section Number: Performance Measure #9
Field Name: PM09
Row Name:
Column Name:
Year: 2003
Field Note:
Source: Numerator: calculated by taking 2001's indicator, the most recent Wisconsin Division of Public Health "Make Your Smile Count" suvey of third grade children, 2001-02. Denominator: the number of third grade children enrolled in public and private schools
SY 2002-2003. A follow up survey is planned for 2005-06.

Performance Measure # 10
The rate of deaths to children aged 14 years and younger caused by motor vehicle crashes per 100,000 children.
Annual Objective and Performance Data
2001 2002 2003 2004 2005
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final? Final Provisional
 
Annual Objective and Performance Data
2006 2007 2008 2009 2010
Annual Performance Objective
Annual Indicator Please fill in only the Objectives for the above years. Numerator, Denominator and Annual Indicators are not required for future year data.
Numerator
Denominator

Field Level Notes

1. Section Number: Performance Measure #10
Field Name: PM10
Row Name:
Column Name:
Year: 2005
Field Note:
Data issue: Data for 2005 are not available from the Bureau of Health Information and Policy until 2007.
2. Section Number: Performance Measure #10
Field Name: PM10
Row Name:
Column Name:
Year: 2004
Field Note:
Data issues: Source: Wisconsin Department of Health and Family Services, Division of Public Health, Bureau of Health Information and Policy, Bureau of Health Information. Wisconsin Interactive Statistics on Health (WISH), http://dhfs.wisconsin.gov/wish/, Injury Mortality Module, accessed 04/05/2006.
3. Section Number: Performance Measure #10
Field Name: PM10
Row Name:
Column Name:
Year: 2003
Field Note:
Sources: Numerator: Wisconsin Department of Health and Family Services, Wisconsin Division of Public Health, Bureau of Health Information and Policy, Wisconsin Deaths, 2003, Madison, Wisconsin, 2005. Denominator: Wisconsin Department of Health and Family Services, Division of Health Care Financing, Bureau of Health Information. Wisconsin Interactive Statistics on Health (WISH), http://dhfs.wisconsin.gov/wish/, Population Module, accessed 03/01/2005.

Performance Measure # 11
The percent of mothers who breastfeed their infants at 6 months of age.
Annual Objective and Performance Data
2001 2002 2003 2004 2005
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final? Provisional
 
Annual Objective and Performance Data
2006 2007 2008 2009 2010
Annual Performance Objective
Annual Indicator Please fill in only the Objectives for the above years. Numerator, Denominator and Annual Indicators are not required for future year data.
Numerator
Denominator

Field Level Notes

1. Section Number: Performance Measure #11
Field Name: PM11
Row Name:
Column Name:
Year: 2005
Field Note:
Source: 2004 Pregnancy Nutrition Surveillance System report.
Data issue: Data for 2005 are not available from the Pediatric Nutrition Surveillance System until 2007. Our objectives reflect the Wisconsin Nutrition and Physical Acticity State Plan's 2007 objective that 50% of mothers will breastfeed their infants at 6 months of age; Healthiest Wisconsin 2010's Adequate and Appropriate Nutrition priority also has this same objective.

Performance Measure Retired 11
Percentage of mothers who breastfeed their infants at hospital discharge.
Annual Objective and Performance Data
2001 2002 2003 2004 2005
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final? Final Final
 
Annual Objective and Performance Data
2006 2007 2008 2009 2010
Annual Performance Objective
Annual Indicator Please fill in only the Objectives for the above years. Numerator, Denominator and Annual Indicators are not required for future year data.
Numerator
Denominator

Field Level Notes

1. Section Number: Old Performance Measure #11
Field Name: PM11R07
Row Name:
Column Name:
Year: 2005
Field Note:
Since this National Performance Measure is "retired" we are using 2003 data.
2. Section Number: Old Performance Measure #11
Field Name: PM11R07
Row Name:
Column Name:
Year: 2004
Field Note:
Since this National Performance Measure is "retired" we are using 2003 data.
3. Section Number: Old Performance Measure #11
Field Name: PM11R07
Row Name:
Column Name:
Year: 2003
Field Note:
Source: 2003 Mothers Survey, Ross Products Division.
Numerator: Unweighted data.
Denominator: Unweighted data.
Data issues: Breastfeeding data are not recorded on the Wisconsin birth certificate or hospital discharge data; therefore, the data we report comes from the Ross Mothers Survey; an on-going survey mailed to a representative sample of new mothers with infants 1 month, 2 months, etc. until 1 year old. The mother self-reports the type of milk her baby was fed in the hospital, at 1 week, in the last 30 days, and most often in the last week. The survey does not distinguish between exclusive and partial breastfeeding.

Performance Measure # 12
Percentage of newborns who have been screened for hearing before hospital discharge.
Annual Objective and Performance Data
2001 2002 2003 2004 2005
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final? Final Final
 
Annual Objective and Performance Data
2006 2007 2008 2009 2010
Annual Performance Objective
Annual Indicator Please fill in only the Objectives for the above years. Numerator, Denominator and Annual Indicators are not required for future year data.
Numerator
Denominator

Field Level Notes

1. Section Number: Performance Measure #12
Field Name: PM12
Row Name:
Column Name:
Year: 2005
Field Note:
Data on hearing screening are reported on one page of the newborn blood-spot card that goes to the Wisconsin State Lab of Hygiene. The data are delivered as a space-delimited file at least once a month, converted to a SAS dataset, and used to compile monthly reports on hearing screening in Wisconsin. The hearing screening records are also sent directly to the Wisconsin Early Hearing Detection and Intervention Tracking Referral and Coordination (WE-TRAC) System.
Data issues: Hearing screening results are occasionally separated from the blood card, delaying accurate reporting. Alternatively, sometimes the blood screening is repeated, but not the hearing screening, therefore, there may be duplicate (inaccurate) reporting. In 2005, the processing logic used to handle SLH records was changed to greatly reduce the occurance of duplicate cases. In 2006 functionality will be added to WE-TRAC to handle any remaining duplicate records. The WE-TRAC system began a phased release that will continue through 2006. Data will be collected directly from facilities using WE-TRAC, which will place accurate testing and follow-up responsibility on the birth hospitals, lessening the possibility that hearing screening results (and follow-up services) will be lost or delayed.
2. Section Number: Performance Measure #12
Field Name: PM12
Row Name:
Column Name:
Year: 2004
Field Note:
Data on hearing screening are reported on one page of the newborn blood-spot card that goes to the Wisconsin State Lab of Hygiene. The data are delivered as a space-delimited file at least once a month, converted to a SAS dataset, and used to compile monthly reports on hearing screening in Wisconsin. The hearing screening records are also sent directly to the Wisconsin Early Hearing Detection and Intervention Tracking Referral and Coordination (WE-TRAC) System.
Data issues: Hearing screening results are occasionally separated from the blood card, delaying accurate reporting. Alternatively, sometimes the blood screening is repeated, but not the hearing screening, therefore, there may be duplicate (inaccurate) reporting. Beginning in 2005, data will be collected directly from WE-TRAC which will place accurate testing and follow-up responsibility on the birth hospitals, lessening the possibility that hearing screening results (and follow-up services) will be lost or delayed.
3. Section Number: Performance Measure #12
Field Name: PM12
Row Name:
Column Name:
Year: 2003
Field Note:
Comment: Data on hearing screening are reported on one page of the newborn blood-spot card that goes to the Wisconsin State Lab of Hygiene. The data are delivered to us as a tab-delimited file at least once a month, converted to a SAS dataset, and used to compile monthly reports on hearing screening in Wisconsin. The hearing screening records are also sent directly to the Wisconsin Early Hearing Detection and Intervention Tracking Referral and Coordination (WE-TRAC) System.
Data issues: Hearing screening results are occasionally separated from the blood card, delaying accurate reporting. Alternatively, sometimes the blood screening is repeated, but not the hearing screening, therefore, there may be duplicate (inaccurate) reporting. Beginning in 2005, data will be collected directly from WE-TRAC which will place accurate testing and follow-up responsibility on the birth hospitals, lessening the possibility that hearing screening results (and follow-up services) will be lost or delayed.

Performance Measure # 13
Percent of children without health insurance.
Annual Objective and Performance Data
2001 2002 2003 2004 2005
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final? Final Provisional
 
Annual Objective and Performance Data
2006 2007 2008 2009 2010
Annual Performance Objective
Annual Indicator Please fill in only the Objectives for the above years. Numerator, Denominator and Annual Indicators are not required for future year data.
Numerator
Denominator

Field Level Notes

1. Section Number: Performance Measure #13
Field Name: PM13
Row Name:
Column Name:
Year: 2005
Field Note:
Data issue: Data for 2005 are not available from the Bureau of Health Information and Policy until 2007.
2. Section Number: Performance Measure #13
Field Name: PM13
Row Name:
Column Name:
Year: 2004
Field Note:
Source: Wisconsin Department of Health and Family Services, Division of Public Health, Bureau of Health Information and Policy, Family Health Survey, 2004. Madison, Wisconsin: 2006. Numerator: Weighted data. Denominator: Weighted data.
Data issues: Estimated numbers have been rounded to the nearest 1,000. The annual Wisconsin Family Health Survey is a random digit dial telephone survey that collects and reports information about health status, problems, insurance coverage, and use of health care services among Wisconsin residents. The survey has questions about health-related limitations and chronic conditions for persons greater than age seventeen.
Indicator: 2004 data indicate a slight increase in the percentage of children without health insurance in Wisconsin.
3. Section Number: Performance Measure #13
Field Name: PM13
Row Name:
Column Name:
Year: 2003
Field Note:
Source: Wisconsin Department of Health and Family Services, Division of Public Health, Bureau of Health Information and Policy, Family Health Survey, 2003. Madison, Wisconsin: 2005. Numerator: Weighted data. Denominator: Weighted data.
Data issues: Estimated numbers have been rounded to the nearest 1,000.The annual Wisconsin Family Health Survey is a random digit dial telephone survey that collects and reports information about health status, problems, insurance coverage, and use of health care services among Wisconsin residents. The survey has questions about health-related limitations and chronic conditions for persons greater than age seventeen.
Indicator: 2003 data indicate a decrease in the percentage of children without health insurance in Wisconsin. The state's continued progress in reducing the percentage of children without health insurance can be associated with Wisconsin's maintenance of its "open enrollment policy" for BadgerCare and Medicaid. Despite a major deficit in the 2003-2005 biennial budget, only minor changes were made to Medicaid/BadgerCare's scope of services and its enrollment policies. Therefore, while other states opted to cap enrollment or to implement enrollment cuts, Wisconsin's "family Medicaid enrollment" has continued to increase. Because Wisconsin's "Children's Health Insurance Program" enrolls whole families, parents have an economic incentive to continue to enroll children. We have flat-lined out objectives to 2009 because we think it is unreasonable to go below 2% for this indicator.

Performance Measure # 14
Percentage of children, ages 2 to 5 years, receiving WIC services with a Body Mass Index (BMI) at or above the 85th percentile.
Annual Objective and Performance Data
2001 2002 2003 2004 2005
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final? Final Provisional
 
Annual Objective and Performance Data
2006 2007 2008 2009 2010
Annual Performance Objective
Annual Indicator Please fill in only the Objectives for the above years. Numerator, Denominator and Annual Indicators are not required for future year data.
Numerator
Denominator

Field Level Notes

1. Section Number: Performance Measure #14
Field Name: PM14
Row Name:
Column Name:
Year: 2005
Field Note:
Data issues: Data for 2005 are not available from the Pediatric Nutrition Surveillance System until 2007.

Performance Measure # 15
Percentage of women who smoke in the last three months of pregnancy.
Annual Objective and Performance Data
2001 2002 2003 2004 2005
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final? Provisional
 
Annual Objective and Performance Data
2006 2007 2008 2009 2010
Annual Performance Objective
Annual Indicator Please fill in only the Objectives for the above years. Numerator, Denominator and Annual Indicators are not required for future year data.
Numerator
Denominator

Field Level Notes

1. Section Number: Performance Measure #15
Field Name: PM15
Row Name:
Column Name:
Year: 2005
Field Note:
Source: There were 70,131 births in Wisconsin in 2004. Birth certificate data indicate that 60,200 reported they did not smoke during pregnancy; 9,812 reported smoking, and there were 119 missing. Wisconsin Department of Health and Family Services, Division of Public Health, Bureau of Health Information and Policy. Wisconsin Interactive Statistics on Health (WISH), http://dhfs.wisconsin.gov/wish, Birth Counts Module, accessed 04/05/2006.
Data issues: These data are from 2004 and for SPM #7, the percent of women who use tobacco during pregnancy. 2005 data will not be available from the Bureau of Health Information and Policy until 2007. Furthermore, the Bureau of Health Information and Policy most likely will not have data for this indicator until 2010 after the revised birth certificate is implemented with a new on-line system projected to be in place by 2009. Wisconsin was awarded the Pregnancy Risk Assessment Monitoring System (PRAMS) in April, 2006. We do not expect to have data from PRAMS until 2010.

Performance Measure # 16
The rate (per 100,000) of suicide deaths among youths aged 15 through 19.
Annual Objective and Performance Data
2001 2002 2003 2004 2005
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final? Final Provisional
 
Annual Objective and Performance Data
2006 2007 2008 2009 2010
Annual Performance Objective
Annual Indicator Please fill in only the Objectives for the above years. Numerator, Denominator and Annual Indicators are not required for future year data.
Numerator
Denominator

Field Level Notes

1. Section Number: Performance Measure #16
Field Name: PM16
Row Name:
Column Name:
Year: 2005
Field Note:
Data for 2005 are not available until from the Bureau of Health Information and Policy until 2007.
2. Section Number: Performance Measure #16
Field Name: PM16
Row Name:
Column Name:
Year: 2004
Field Note:
Source: Wisconsin Department of Health and Family Services, Division of Public Health, Bureau of Health Information and Policy, Bureau of Health Information. Wisconsin Interactive Statistics on Health (WISH), http://dhfs.wisconsin.gov/wish/, Mortality Module, accessed 03/08/2006.
We revised our objectives to reflect the number of suicide deaths in WIsconsin and the federal HP 2010 obj 18-1 (8.9 deaths per 100,000.) Our 2010 objective of 8.5 is slightly lower than the federal objective. Wisconsin was recently awarded a DHSS $1.1 million dollar grant for 3 years to prevent youth suicide.
3. Section Number: Performance Measure #16
Field Name: PM16
Row Name:
Column Name:
Year: 2003
Field Note:
Sources: Numerator: Wisconsin Department of Health and Family Services, Division of Public Health, Bureau of Health Information and Policy, Wisconsin Deaths, 2003, Madison, Wisconsin, 2005. Denominator: Wisconsin Department of Health and Family Services, Division of Public Health, Bureau of Health Information and Policy, Wisconsin Interactive Statistics on Health (WISH), http://dhfs.wisconsin.gov/wish/, Population Module, accessed 05/11/05.

Performance Measure # 17
Percent of very low birth weight infants delivered at facilities for high-risk deliveries and neonates.
Annual Objective and Performance Data
2001 2002 2003 2004 2005
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final? Final Provisional
 
Annual Objective and Performance Data
2006 2007 2008 2009 2010
Annual Performance Objective
Annual Indicator Please fill in only the Objectives for the above years. Numerator, Denominator and Annual Indicators are not required for future year data.
Numerator
Denominator

Field Level Notes

1. Section Number: Performance Measure #17
Field Name: PM17
Row Name:
Column Name:
Year: 2005
Field Note:
Data issue: Data for 2005 are not available from the Bureau of Health Information and Policy until 2007.
2. Section Number: Performance Measure #17
Field Name: PM17
Row Name:
Column Name:
Year: 2004
Field Note:
Source: Wisconsin Department of Health and Family Service, Wisconsin Division of Public Health, Bureau of Health Information and Policy. 95% confidence intervals are: 80..2%, 74.6%.
3. Section Number: Performance Measure #17
Field Name: PM17
Row Name:
Column Name:
Year: 2003
Field Note:
Source: Wisconsin Department of Health and Family Services, Wisconsin Division of Public Health, Bureau of Health Information and Policy.
Data issues: In Wisconsin, hospitals self-designate level of care. Wisconsin does not have a regulatory function to standardize these self-designations. We are now using a consistent definition for facilities for high-risk deliveries and neonates; defined as "birth record indicates transfer "to NICU or another hospital" and the transfer hospital is the same as the birth hospital." Corrected data since 2000 are:
2000: 676/814 = 83.0% (95% CI - 81.9%, 84.2%)
2001: 692/857 = 80.8% (95% CI - 79.5%, 82.0%)
2002: 646/831 = 77.7% (95% CI - 76.2%, 79.3%)
2003: 698/870 = 80.2% (95% CI - 77.6%, 82.8%)
These data indicate a slight decrease in the percentage of very low birth infants born at high risk facilities for deliveries and neonates from 2000 to 2002, and the 2003 rate about the same as 2002. The four year average (2000-2003) is 80.4% (95% CI - 79.8%, 81.%).
In addition, a Minnesota facility serves as the Level III perinatal center for high-risk deliveries in northwestern Wisconsin and does not provide birth data to our vital records.

Performance Measure # 18
Percent of infants born to pregnant women receiving prenatal care beginning in the first trimester.
Annual Objective and Performance Data
2001 2002 2003 2004 2005
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final? Final Provisional
 
Annual Objective and Performance Data
2006 2007 2008 2009 2010
Annual Performance Objective
Annual Indicator Please fill in only the Objectives for the above years. Numerator, Denominator and Annual Indicators are not required for future year data.
Numerator
Denominator

Field Level Notes

1. Section Number: Performance Measure #18
Field Name: PM18
Row Name:
Column Name:
Year: 2005
Field Note:
Data issue: Data for 2005 are not available from the Bureau of Health Information and Policy until 2007.
2. Section Number: Performance Measure #18
Field Name: PM18
Row Name:
Column Name:
Year: 2004
Field Note:
Source: Wisconsin Department of Health and Family Services, Division of Public Health, Bureau of Health Information and Policy, Bureau of Health Information. Wisconsin Interactive Statistics on Health (WISH), http://dhfs.wisconsin.gov/wish/, Birth Counts Module, accessed 04/05/2006.
3. Section Number: Performance Measure #18
Field Name: PM18
Row Name:
Column Name:
Year: 2003
Field Note:
Source: Numerator and Denominator: Wisconsin Department of Health and Family Services, Division of Public Health, Bureau of Health Information and Policy, Wisconsin Births and Infant Deaths, 2003, October 2004.

State Performance Measure # 1
Percent of eligible women enrolled in the Wisconsin Medicaid Family Planning Waiver during the year.
Annual Objective and Performance Data
2001 2002 2003 2004 2005
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final? Final Provisional
 
Annual Objective and Performance Data
2006 2007 2008 2009 2010
Annual Performance Objective
Annual Indicator Please fill in only the Objectives for the above years. Numerator, Denominator and Annual Indicators are not required for future year data.
Numerator
Denominator

Field Level Notes

1. Section Number: State Performance Measure #1
Field Name: SM1
Row Name:
Column Name:
Year: 2005
Field Note:
Data source: 2005 enrollment data from Wisconsin Department of Health and Family Services, Division of Health Care Financing, Medicaid program data.

State Performance Measure # 2
Percent of Medicaid and BadgerCare recipients, ages 3-20, who received any dental service during the reporting year.
Annual Objective and Performance Data
2001 2002 2003 2004 2005
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final? Final Final
 
Annual Objective and Performance Data
2006 2007 2008 2009 2010
Annual Performance Objective
Annual Indicator Please fill in only the Objectives for the above years. Numerator, Denominator and Annual Indicators are not required for future year data.
Numerator
Denominator

Field Level Notes

1. Section Number: State Performance Measure #2
Field Name: SM2
Row Name:
Column Name:
Year: 2005
Field Note:
Data issue: Data for 2005 are not available from the Division of Health Care Financing until 2007.

State Performance Measure # 3
Percent of children, ages 6 months-5 years, who have age-appropriate social and emotional developmental levels.
Annual Objective and Performance Data
2001 2002 2003 2004 2005
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final? Provisional Final
 
Annual Objective and Performance Data
2006 2007 2008 2009 2010
Annual Performance Objective
Annual Indicator Please fill in only the Objectives for the above years. Numerator, Denominator and Annual Indicators are not required for future year data.
Numerator
Denominator

Field Level Notes

1. Section Number: State Performance Measure #3
Field Name: SM3
Row Name:
Column Name:
Year: 2005
Field Note:
Data Source: 2005 data from the Secure Public Health Electronic Reporting Environment (SPHERE).

State Performance Measure # 4
Rate per 1,000 of substantiated reports of child maltreatment to Wisconsin children, ages 0 - 17, during the year.
Annual Objective and Performance Data
2001 2002 2003 2004 2005
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final? Final Provisional
 
Annual Objective and Performance Data
2006 2007 2008 2009 2010
Annual Performance Objective
Annual Indicator Please fill in only the Objectives for the above years. Numerator, Denominator and Annual Indicators are not required for future year data.
Numerator
Denominator

Field Level Notes

1. Section Number: State Performance Measure #4
Field Name: SM4
Row Name:
Column Name:
Year: 2005
Field Note:
Data issue: Data for 2005 are not available from the Division of Children and Family Services until 2007.

State Performance Measure # 5
Percent of children who receive coordinated, ongoing comprehensive care within a medical home.
Annual Objective and Performance Data
2001 2002 2003 2004 2005
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final? Final Final
 
Annual Objective and Performance Data
2006 2007 2008 2009 2010
Annual Performance Objective
Annual Indicator Please fill in only the Objectives for the above years. Numerator, Denominator and Annual Indicators are not required for future year data.
Numerator
Denominator

Field Level Notes

1. Section Number: State Performance Measure #5
Field Name: SM5
Row Name:
Column Name:
Year: 2005
Field Note:
Data issue: These are Wisconsin-specific weighted data from the National Survey of Children's Health, National Center for Health Statisitics, Centers for Disease Control and Prevention.
2. Section Number: State Performance Measure #5
Field Name: SM5
Row Name:
Column Name:
Year: 2004
Field Note:
Data issue: These are Wisconsin-specific weighted data from the National Survey of Children's Health, National Center for Health Statisitics, Centers for Disease Control and Prevention.
3. Section Number: State Performance Measure #5
Field Name: SM5
Row Name:
Column Name:
Year: 2003
Field Note:
Data issue: These are Wisconsin-specific weighted data from the National Survey of Children's Health, National Center for Health Statisitics, Centers for Disease Control and Prevention.

State Performance Measure # 6
Percent of children less than 12 years of age who receive one physical exam a year.
Annual Objective and Performance Data
2001 2002 2003 2004 2005
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final? Final Provisional
 
Annual Objective and Performance Data
2006 2007 2008 2009 2010
Annual Performance Objective
Annual Indicator Please fill in only the Objectives for the above years. Numerator, Denominator and Annual Indicators are not required for future year data.
Numerator
Denominator

Field Level Notes

1. Section Number: State Performance Measure #6
Field Name: SM6
Row Name:
Column Name:
Year: 2005
Field Note:
Data issue: Data for 2005 are not available from the Bureau of Health Information and Policy until 2007.
2. Section Number: State Performance Measure #6
Field Name: SM6
Row Name:
Column Name:
Year: 2004
Field Note:
Source: Wisconsin Department of Health and Family Services, Division of Public Health, Bureau of Health Information and Policy, Family Health Survey, 2005. Madison, Wisconsin, 2006. The annual Wisconsin Family Health Survey is a random digit dial telephone survey that collects and reports information about health status, problems, insurance status, and use of health services among Wisconsin residents.
Numerator: Weighted data. Denominator: Weighted data.
Data issues: We did not revise subsequent year's objectives; the data reflect random fluctuations.
3. Section Number: State Performance Measure #6
Field Name: SM6
Row Name:
Column Name:
Year: 2003
Field Note:
Source: Wisconsin Department of Health and Family Services, Division of Public Health, Bureau of Health Information and Policy, Family Health Survey, 2003. Madison, Wisconsin, 2005. The annual Wisconsin Family Health Survey is a random digit dial telephone survey that collects and reports information about health status, problems, insurance status, and use of health services among Wisconsin residents.
Numerator: Weighted data. Denominator: Weighted data.
Data issues: We did not revise subsequent year's objectives; the data reflect random fluctuations.

State Performance Measure # 7
Percent of women who use tobacco during pregnancy.
Annual Objective and Performance Data
2001 2002 2003 2004 2005
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final? Final Provisional
 
Annual Objective and Performance Data
2006 2007 2008 2009 2010
Annual Performance Objective
Annual Indicator Please fill in only the Objectives for the above years. Numerator, Denominator and Annual Indicators are not required for future year data.
Numerator
Denominator

Field Level Notes

1. Section Number: State Performance Measure #7
Field Name: SM7
Row Name:
Column Name:
Year: 2005
Field Note:
Data issue: Data for 2005 are not available from the Bureau of Health Information and Policy until 2007.
2. Section Number: State Performance Measure #7
Field Name: SM7
Row Name:
Column Name:
Year: 2004
Field Note:
Data issues: This is a new SPM measure for the 2007 Title V Block Grant Application and data were not reported for 2004.
3. Section Number: State Performance Measure #7
Field Name: SM7
Row Name:
Column Name:
Year: 2003
Field Note:
Data issues: This is a new SPM measure for the 2007 Title V Block Grant Application and data were not reported for 2003.

State Performance Measure # 8
Percent of children, ages 2-4, who are obese or overweight.
Annual Objective and Performance Data
2001 2002 2003 2004 2005
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final? Final Provisional
 
Annual Objective and Performance Data
2006 2007 2008 2009 2010
Annual Performance Objective
Annual Indicator Please fill in only the Objectives for the above years. Numerator, Denominator and Annual Indicators are not required for future year data.
Numerator
Denominator

Field Level Notes

1. Section Number: State Performance Measure #8
Field Name: SM8
Row Name:
Column Name:
Year: 2005
Field Note:
Data issue: Data for 2005 are not available from the Pediatric Nutrition Surveillance System (PedNSS) until 2007.
2. Section Number: State Performance Measure #8
Field Name: SM8
Row Name:
Column Name:
Year: 2004
Field Note:
Source: 2004 Pediatric Nutrition Surveillance System (PedNSS), Centers for Disease Control and Prevention.
3. Section Number: State Performance Measure #8
Field Name: SM8
Row Name:
Column Name:
Year: 2003
Field Note:
Source: 2003 Pediatric Nutrition Surveillance System (PedNSS), Centers for Disease Control and Prevention.

State Performance Measure # 9
Ratio of the black infant mortality rate to the white infant mortality rate.
Annual Objective and Performance Data
2001 2002 2003 2004 2005
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final? Final Provisional
 
Annual Objective and Performance Data
2006 2007 2008 2009 2010
Annual Performance Objective
Annual Indicator Please fill in only the Objectives for the above years. Numerator, Denominator and Annual Indicators are not required for future year data.
Numerator
Denominator

Field Level Notes

1. Section Number: State Performance Measure #9
Field Name: SM9
Row Name:
Column Name:
Year: 2005
Field Note:
Data issue: Data for 2005 are not available from the Bureau of Health Information and Policy until 2007.
2. Section Number: State Performance Measure #9
Field Name: SM9
Row Name:
Column Name:
Year: 2004
Field Note:
Source: Wisconsin Department of Health and Family Services, Division of Public Health, Bureau of Health Information and Policy, Wisconsin Interactive Statistics on Health (WISH), http://dhfs.wisconsin.gov/wish/Infant Mortality Module, accessed 04/05/06.
3. Section Number: State Performance Measure #9
Field Name: SM9
Row Name:
Column Name:
Year: 2003
Field Note:
Source: Numerator and Denominator: Wisconsin Department of Health and Family Services, Wisconsin Division of Health Care Financing, Bureau of Health Information and Policy, Wisconsin Births and Infant Deaths, 2003. Madison, Wisconsin, 2005.

State Performance Measure # 10
Death rate per 100,000 among youth, ages 15-19, due to motor vehicle crashes.
Annual Objective and Performance Data
2001 2002 2003 2004 2005
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final? Final Provisional
 
Annual Objective and Performance Data
2006 2007 2008 2009 2010
Annual Performance Objective
Annual Indicator Please fill in only the Objectives for the above years. Numerator, Denominator and Annual Indicators are not required for future year data.
Numerator
Denominator

Field Level Notes

1. Section Number: State Performance Measure #10
Field Name: SM10
Row Name:
Column Name:
Year: 2005
Field Note:
Data issue: Data for 2005 are not available from the Bureau of Health Information and Policy until 2007.
2. Section Number: State Performance Measure #10
Field Name: SM10
Row Name:
Column Name:
Year: 2004
Field Note:
Source: Wisconsin Department of Health and Family Services, Divsion of Public Health, Bureau of Health Information and Policy, Wisconsin Interactive Statistics on Health (WISH), http:// dhfs.wisconsin.gov/wish/Mortality Module, accessed 04/05/06.
3. Section Number: State Performance Measure #10
Field Name: SM10
Row Name:
Column Name:
Year: 2003
Field Note:
Sources: Numerator: Wisconsin Department of Health and Family Services, Wisconsin Division of Health Care Financing, Bureau of Health Information, Wisconsin Deaths, 2003, Madison, Wisconsin, 2004. Denominator: Wisconsin Department of Health and Family Services, Division of Health Care Financing, Bureau of Heatlh Information. Wisconsin Interactive Statistics on Health (WISH), http://dhfs.wisconsin.gov/wish/Population Module, accessed 03/10/05.

Form 12
Tracking Health Outcome Measures
[Secs 505 (a)(2)(B)(iii) and 506 (a)(2)(A)(iii)]
State: WI
Form Level Notes for Form 12

None
Outcome Measure # 01
The infant mortality rate per 1,000 live births.
Annual Objective and Performance Data
2001 2002 2003 2004 2005
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final? Final Provisional
 
Annual Objective and Performance Data
2006 2007 2008 2009 2010
Annual Performance Objective
Annual Indicator Please fill in only the Objectives for the above years. Numerator, Denominator and Annual Indicators are not required for future year data.
Numerator
Denominator

Field Level Notes

1. Section Number: Outcome Measure 1
Field Name: OM01
Row Name:
Column Name:
Year: 2005
Field Note:
Since 2005 data required by the TVIS, 2004 data were used as estimates for 2005. These data are maintained in retrospective state databases and are not released or published until 12-18 months after the end of the data year; therefore, 2005 data will not be available until mid-2007.
2. Section Number: Outcome Measure 1
Field Name: OM01
Row Name:
Column Name:
Year: 2004
Field Note:
Source: Wisconsin Department of Health and Family Services, Division of Public Health, Bureau of Health Information and Policy, Wisconsin Interactive Statistics on Health (WISH), http://dhfs.wisconsin.gov/wish/Infant Mortality Module, accessed 04/05/06.
3. Section Number: Outcome Measure 1
Field Name: OM01
Row Name:
Column Name:
Year: 2003
Field Note:
Source: Numerator and Denominator: Wisconsin Department of Health and Family Services, Division of Public Health, Bureau of Health Information and Policy, Wisconsin Births and Infant Deaths, 2003. Madison, Wisconsin, 2005.

Outcome Measure # 02
The ratio of the black infant mortality rate to the white infant mortality rate.
Annual Objective and Performance Data
2001 2002 2003 2004 2005
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final? Final Provisional
 
Annual Objective and Performance Data
2006 2007 2008 2009 2010
Annual Performance Objective
Annual Indicator Please fill in only the Objectives for the above years. Numerator, Denominator and Annual Indicators are not required for future year data.
Numerator
Denominator

Field Level Notes

1. Section Number: Outcome Measure 2
Field Name: OM02
Row Name:
Column Name:
Year: 2005
Field Note:
Data issue: Since 2005 data required by the TVIS, 2004 data were used as estimates for 2005. These data are maintained in retrospective state databases and are not released or published until 12-18 months after the end of the data year; therefore, 2005 data will not be available until mid-2007.
2. Section Number: Outcome Measure 2
Field Name: OM02
Row Name:
Column Name:
Year: 2004
Field Note:
Source: Wisconsin Department of Health and Family Services, Division of Public Health, Bureau of Health Information and Policy, Wisconsin Interactive Statistics on Health (WISH), http://dhfs.wisconsin.gov/wish/Infant Mortality Module, accessed 04/05/06.
3. Section Number: Outcome Measure 2
Field Name: OM02
Row Name:
Column Name:
Year: 2003
Field Note:
Source: Numerator and Denominator: Wisconsin Department of Health and Family Services, Division of Public Health, Bureau of Health Information and Policy, Wisconsin Births and Infant Deaths, 2003. Madison, Wisconsin, 2005.

Outcome Measure # 03
The neonatal mortality rate per 1,000 live births.
Annual Objective and Performance Data
2001 2002 2003 2004 2005
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final? Final Provisional
 
Annual Objective and Performance Data
2006 2007 2008 2009 2010
Annual Performance Objective
Annual Indicator Please fill in only the Objectives for the above years. Numerator, Denominator and Annual Indicators are not required for future year data.
Numerator
Denominator

Field Level Notes

1. Section Number: Outcome Measure 3
Field Name: OM03
Row Name:
Column Name:
Year: 2005
Field Note:
Data issue: Since 2005 data required by the TVIS, 2004 data were used as estimates for 2005. These data are maintained in retrospective state databases and are not released or published until 12-18 months after the end of the data year; therefore, 2005 data will not be available until mid-2007.
2. Section Number: Outcome Measure 3
Field Name: OM03
Row Name:
Column Name:
Year: 2004
Field Note:
Source: Wisconsin Department of Health and Family Services, DIvision of Public Health, Bureau of Health Information and Policy, Wisconsin Interactive Statistics on Health (WISH), http://dhfs.wisconsin.gov/wish/Infant Mortality Module, accessed 04/05/06.
3. Section Number: Outcome Measure 3
Field Name: OM03
Row Name:
Column Name:
Year: 2003
Field Note:
Source: Numerator and Denominator: Wisconsin Department of Health and Family Services, Division of Public Health, Bureau of Health Information and Policy, Wisconsin Births and Infant Deaths, 2003. Madison, Wisconsin, 2005.

Outcome Measure # 04
The postneonatal mortality rate per 1,000 live births.
Annual Objective and Performance Data
2001 2002 2003 2004 2005
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final? Final Provisional
 
Annual Objective and Performance Data
2006 2007 2008 2009 2010
Annual Performance Objective
Annual Indicator Please fill in only the Objectives for the above years. Numerator, Denominator and Annual Indicators are not required for future year data.
Numerator
Denominator

Field Level Notes

1. Section Number: Outcome Measure 4
Field Name: OM04
Row Name:
Column Name:
Year: 2005
Field Note:
Data issue: Since 2005 data required by the TVIS, 2004 data were used as estimates for 2005. These data are maintained in retrospective state databases and are not released or published until 12-18 months after the end of the data year; therefore, 2005 data will not be available until mid-2007.
2. Section Number: Outcome Measure 4
Field Name: OM04
Row Name:
Column Name:
Year: 2004
Field Note:
Source: Wisconsin Department of Health and Family Services, Division of Public Health, Bureau of Health Information and Policy, Wisconsin Interactive Statistics on Health (WISH), http://dhfs.wisconsin.gov/wish/, Infant Mortality Module, accessed 04/05/06.
3. Section Number: Outcome Measure 4
Field Name: OM04
Row Name:
Column Name:
Year: 2003
Field Note:
Source: Numerator and Denominator: Wisconsin Department of Health and Family Services, Division of Public Health, Bureau of Health Information and Policy, Wisconsin Births and Infant Deaths, 2003. Madison, Wisconsin, 2005.

Outcome Measure # 05
The perinatal mortality rate per 1,000 live births plus fetal deaths.
Annual Objective and Performance Data
2001 2002 2003 2004 2005
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final? Final Provisional
 
Annual Objective and Performance Data
2006 2007 2008 2009 2010
Annual Performance Objective
Annual Indicator Please fill in only the Objectives for the above years. Numerator, Denominator and Annual Indicators are not required for future year data.
Numerator
Denominator

Field Level Notes

1. Section Number: Outcome Measure 5
Field Name: OM05
Row Name:
Column Name:
Year: 2005
Field Note:
Since 2005 data required by the TVIS, 2004 data were used as estimates for 2005. These data are maintained in retrospective state databases and are not released or published until 12-18 months after the end of the data year; therefore, 2005 data will not be available until mid-2007.
2. Section Number: Outcome Measure 5
Field Name: OM05
Row Name:
Column Name:
Year: 2004
Field Note:
Numerator: Sum of fetal deaths >_ 28 week and infant deaths < 7 days (181+221=402 ) from the Wisconsin Department of Health and Family Services, Division of Public Health, Bureau of Health Information and Policy, 2006. Denominator: Sum of number of live births + number of fetal deaths, Wisconsin Department of Health and Family Services, Division of Public Health, Bureau of Health Information and Policy, 2006.
Source: Wisconsin Department of Health and Family Services, Division of Public Health, Bureau of Health Information and Policy, 2006.
Data issues: For years 1998-2001, the perinatal mortality rate was calculated using fetal deaths 20 or more weeks in gestation, not 28 or more weeks in gestation. Therefore, previous years' indicators were higher than for 2001; we revised our objectives accordingly.
3. Section Number: Outcome Measure 5
Field Name: OM05
Row Name:
Column Name:
Year: 2003
Field Note:
Numerator: Sum of fetal deaths >_ 28 week and infant deaths < 7 days (214 + ) from the fetal death report, Wisconsin Department of Health and Family Services, Division of Public Health, Bureau of Health Information and Policy, 2005. Denominator: Sum of number of live births + number of fetal deaths, Wisconsin Department of Health and Family Services, Division of Public Health, Bureau of Health Information and Policy, 2005.
Source: Wisconsin Department of Health and Family Services, Division of Public Health, Bureau of Health Information and Policy, 2005.
Data issues: For years 1998-2001, the perinatal mortality rate was calculated using fetal deaths 20 or more weeks in gestation, not 28 or more weeks in gestation. Therefore, previous years' indicators were higher than for 2001; we revised our objectives accordingly.

Outcome Measure # 06
The child death rate per 100,000 children aged 1 through 14.
Annual Objective and Performance Data
2001 2002 2003 2004 2005
Annual Performance Objective
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final? Final Provisional
 
Annual Objective and Performance Data
2006 2007 2008 2009 2010
Annual Performance Objective
Annual Indicator Please fill in only the Objectives for the above years. Numerator, Denominator and Annual Indicators are not required for future year data.
Numerator
Denominator

Field Level Notes

1. Section Number: Outcome Measure 6
Field Name: OM06
Row Name:
Column Name:
Year: 2005
Field Note:
Data issue: Since 2005 data required by the TVIS, 2004 data were used as estimates for 2005. These data are maintained in retrospective state databases and are not released or published until 12-18 months after the end of the data year; therefore, 2005 data will not be available until mid-2007.
2. Section Number: Outcome Measure 6
Field Name: OM06
Row Name:
Column Name:
Year: 2004
Field Note:
Source: Wisconsin Department of Health and Family Services, Division of Public Health, Bureau of Health Information and Policy, Wisconsin Interactive Statistics on Health (WISH), http://dhfs.wisconsin.gov/wish/, Mortality Module, accessed 04/05/06.
3. Section Number: Outcome Measure 6
Field Name: OM06
Row Name:
Column Name:
Year: 2003
Field Note:
Source: Numerator: Wisconsin Department of Health and Family Services, Division of Public Health, Bureau of Health Information and Policy, Wisconsin Deaths, 2003, Madison, Wisconsin, 2005. Denominator: Wisconsin Department of Health and Family Services, Division of Public Health, Bureau of Health Information and Policy, Wisconsin Interactive Statistics on Health (WISH), http://dhfs.wisconsin.gov/wish/, Population Module, accessed 03/01/05.

Form 13
Characteristics Documenting Family Participation in CSHCN Programs
State: WI
 
1. Family members participate on advisory committee or task forces and are offering training, mentoring, and reimbursement, when appropriate.
  
 
2. Financial support (financial grants, technical assistance, travel, and child care) is offered for parent activities or parent groups.
  
 
3. Family members are involved in the Children with Special Health Care Needs elements of the MCH Block Grant Application process.
  
 
4. Family members are involved in service training of CSHCN staff and providers.
  
 
5. Family members hired as paid staff or consultants to the State CSHCN program (a family member is hired for his or her expertise as a family member).
  
 
6. Family members of diverse cultures are involved in all of the above activities.
  
 

Total Score:   

Rating Key
0 = Not Met
1 = Partially Met
2 = Mostly Met
3 = Completely Met
 
 

Form Notes for Form 13
None
Field Level Notes
None

Form 14
List of MCH Priority Needs
[Sec. 505(a)(5)]
State: WI   FY: 2007
Your State's 5-year Needs Assessment should identify the need for preventive and primary care services for pregnant women, mothers, and infants; preventive and primary care services for children and services for Children with Special Health Care Needs. With each year's Block Grant application, provide a list (whether or not the priority needs change) of the top maternal and child health needs in your state. Using simple sentence or phrase ,list below your State's needs. Examples of such statements are: "To reduce the barriers to the delivery of care for pregnant women, " and "The infant mortality rate for minorities should be reduced."

MCHB will capture annually every State's top 7 to 10 priority needs in an information system for comparison, tracking, and reporting purposes; you must list at least 7 and no more than 10. Note that the numbers listed below are for computer tracking only and are not meant to indicate priority order. If your State wishes to report more than 10 priority needs, list additional priority needs in a note at the form level.
1. Disparities in Birth Outcomes: To improve birth outcomes among minority populations
2. Contraceptive Services (access to): To improve access and utilization to contraceptive services
3. Mental Health: To assure mental health services for all MCH populations
4. Medical Home: To assure a medical home for all children
5. Dental Health: To assure dental health for all children
6. Health Insurance and Access to Health Care: To assure health insurance and access to health care for all
7. Smoking and Tobacco Use: To decrease tobacco use among women and children
8. Intentional Childhood Injuries: To decrease intentional childhood injuries
9. Unintentional Childhood Injuries: To decrease unintentional childhood injuries
10. Overweight and At Risk for Overweight: To promote healthy lifestyles including promoting physical activity to achieve healthy weight

Form Notes for Form 14
None
Field Level Notes
None

 

Form 15
Technical Assistance(TA) Request

 
 
STATE: WI   APPLICATION YEAR: 2007
 
No. Category of Technical Assistance Requested Description of Technical Assistance Requested
(max 250 characters) 		Reason(s) Why Assistance
Is Needed
(max 250 characters) 		What State, Organization or
Individual Would You suggest
Provide the TA (if known)
(max 250 characters)
1. General Systems Capacity Issues
If you selected State or National Performance Measure Issue categories above, identify the performance measure to which this issue pertains by entering the measure number here: 		TA to facilitate collaboration with other state and territorial adolescent health coordinators.  To improve access to national resources and experts on adolescent health.  AMCHP 
2. General Systems Capacity Issues
If you selected State or National Performance Measure Issue categories above, identify the performance measure to which this issue pertains by entering the measure number here: 		TA on MCHB's expectation of how the work and activities of the ECCS Program needs to be integrated into the ongoing MCH/CYSCHN Programs.  Need assistance integrating new programs and services in the area of Mental Health and Social-Emotional Development, Parenting Education, and Family Support.  To be determined in consultation with MCHB staff. 
3. Data-related Issues - Data Systems Development
If you selected State or National Performance Measure Issue categories above, identify the performance measure to which this issue pertains by entering the measure number here: 		TA to assist with designing and writing specifications for a Web-based child health profile to be used by providers and the public health community.  Wisconsin intends to add a child health profile to the WI PHIN/SPHERE. Need TA from MCHB and/or other states that have developed an on-line child health profile.  To be determined in consultation with MCHB staff. 
4.
If you selected State or National Performance Measure Issue categories above, identify the performance measure to which this issue pertains by entering the measure number here: 		     
5.
If you selected State or National Performance Measure Issue categories above, identify the performance measure to which this issue pertains by entering the measure number here: 		     
6.
If you selected State or National Performance Measure Issue categories above, identify the performance measure to which this issue pertains by entering the measure number here: 		     
7.
If you selected State or National Performance Measure Issue categories above, identify the performance measure to which this issue pertains by entering the measure number here: 		     
8.
If you selected State or National Performance Measure Issue categories above, identify the performance measure to which this issue pertains by entering the measure number here: 		     
9.
If you selected State or National Performance Measure Issue categories above, identify the performance measure to which this issue pertains by entering the measure number here: 		     
10.
If you selected State or National Performance Measure Issue categories above, identify the performance measure to which this issue pertains by entering the measure number here: 		     
11.
If you selected State or National Performance Measure Issue categories above, identify the performance measure to which this issue pertains by entering the measure number here: 		     
12.
If you selected State or National Performance Measure Issue categories above, identify the performance measure to which this issue pertains by entering the measure number here: 		     
 
 

Form Notes for Form 15
None
Field Level Notes
None

Form 16
State Performance and Outcome Measure Detail Sheet
State: WI
 
SP # 
Performance Measure: Percent of eligible women enrolled in the Wisconsin Medicaid Family Planning Waiver during the year.
Status: Active
Goal Increase the percent of income eligible reproductive-age women in Wisconsin who are enrolled in the Wisconsin Medicaid Family Planning Waiver.
Definition
Numerator:
Number of women enrolled in the Family Planning Waiver
Denominator:
Number of women, ages 15-44, estimated to be Medicaid income eligible minus those who have existing Medicaid/BadgerCare coverage.
Units: 100   Text: Percent
   
Healthy People 2010 Objective 9.3
Increase the proportion of females at risk of unintended pregnancy (and their partners) who use contraception.
Data Sources and Data Issues Enrollment data from Wisconsin Department of Health and Family Services, Division of Health Care Financing, Medicaid program data.
Significance Access to affordable and quality contraceptive and related reproductive health services is necessary for increased use of contraception among sexually active women and couples at risk of unintended pregnancy.

SP # 
Performance Measure: Percent of Medicaid and BadgerCare recipients, ages 3-20, who received any dental service during the reporting year.
Status: Active
Goal To increase the percentage of Medicaid and BadgerCare recipients, aged 3-20, who received any dental service during the state fiscal year.
Definition
Numerator:
Numerator: Number of Wisconsin Medicaid and BadgerCare recipients, aged 3-20, who received any dental service during the state fiscal year.
Denominator:
Denominator: Total number of Wisconsin Medicaid and BadgerCare, aged 3-20, recipients during the state fiscal year.
Units: 100   Text: Percent
   
Healthy People 2010 Objective 21-12
Increase the proportion of children and adolescents under age 19 years of age at or below 200 percent of the Federal poverty level who received any preventive dental service during the past year.
21-10
Increase the proportion of children and adults who use the oral health care system each year.
Data Sources and Data Issues Wisconsin Department of Health and Family Services, Division of Health Care Financing, Medicaid Program, claims and eligibility data for services provided.
Significance Oral diseases and conditions can be consequential to growth, function, ability to attend to learning, self-image and employability. The most frequent symptom of dental pathology is pain which can distract children from learning and playing, and limit their ability to eat and speak. Extensive early childhood caries has been shown to inhibit attainment of normal weight and height in toddlers. Dental and oral diseases are increasingly understood to compromise general health and function. Dental visits increase with increasing income and parental education. Low-income children who suffer from the most dental disease have the least access to care, despite publicly financed dental coverage.

SP # 
Performance Measure: Percent of children, ages 6 months-5 years, who have age-appropriate social and emotional developmental levels.
Status: Active
Goal To increase the percentage of children with age-appropriate social and emotional developmental levels.
Definition The number of children, ages 6 months through 5 years, who have age-appropriate social and emotional developmental levels.
Numerator:
The number of children, ages 6 months through 5 years, who have age-appropriate social and emotional developmental levels.
Denominator:
The number of children, ages 6 months through 5 years, who receive mental health screening using the "Ages and Stages Questionnaire: Social and Emotional Domain during the reporting period (ASQ:SE)."
Units: 100   Text: Percent
   
Healthy People 2010 Objective 18-7
Increase the proportion of children with mental health problems who receive treatment.

Data Sources and Data Issues Secure Public Health Electronic Record Environment (SPHERE) data reported by agencies who perform mental health screening for young children using the "Ages and Stages Questionnaire®: Social-Emotional (ASQ:SE)". This questionnaire/screening tool assesses children’s social-emotional development at 6, 12, 18, 24, 30, 36, 48, and 60 months.
Significance Infant and early childhood mental health is of growing interest in public health. Wisconsin Governor Jim Doyle’s KidsFirst Initiative recommends implementation of the Wisconsin Infant and Early Childhood Mental Health Plan developed by the Wisconsin Initiative for Infant Mental Health. One of the key recommendations is mental health screening and referral for children birth to age five. SPHERE collects information on developmental screening provided by POCAN , Home Visitation Outcomes Projects, and Title V-funded projects (local health departments and private non-profits including CSHCN Regional Centers and Regional Center contractees), and Tribal Agencies (Honoring our Children). POCAN is the acronym for the comprehensive targeted home visiting program authorized under 46.515 Wisconsin statutes and stands for Prevention of Child Abuse and Neglect. In 2004, 2,662 Wisconsin children under six years of age received a developmental assessment.

SP # 
Performance Measure: Rate per 1,000 of substantiated reports of child maltreatment to Wisconsin children, ages 0 - 17, during the year.
Status: Active
Goal To decrease the number of children, ages 0-17, being maltreated in Wisconsin during the reporting year.
Definition The number of substantiated reports of child maltreatment to Wisconsin children, ages 0-17, during the calendar year.
Numerator:
The number of child abuse and neglect reports and substantiations in a given calendar year.
Denominator:
The number of children under age 18.
Units: 1000   Text: Rate
   
Healthy People 2010 Objective 15-33
Reduce maltreatment and maltreatment fatalities of children.
15-34
Reduce the rate of physical assault by current or former intimate partners (for persons 12 and older).
Data Sources and Data Issues Annual Report to the Govenor and Legislature on Wisconsin Child Abuse and Neglect, Office of Policy, Evalution and Planning, Divison of Children and Family Services, Wisconsin Department of Health and Family Services.
Significance Child maltreatment has physical, psychological, behavioral and societal consequences that can lead into long-term physical and mental health problems and economic consequences.

SP # 
Performance Measure: Percent of children who receive coordinated, ongoing comprehensive care within a medical home.
Status: Active
Goal To increase the percentage of Wisconsin children who have a medical home.
Definition The American Academy of Pediatrics describes care from a medical home as accessible, continuous, coordinated, family-centered, comprehensive, compassionate and culturally-competent.
Numerator:
Weighted number of children from the National Survey of Children's Health, National Center for Health Statistics, Centers for Disease Control and Prevention.
Denominator:
Weighted number of children from the National Survey of Children's Health, National Center for Health Statistics, Centers for Disease Control and Prevention.
Units: 100   Text: Percent
   
Healthy People 2010 Objective 1-4. Access to quality health services.
Increase the proportion of persons who have a specific source of ongoing care.
Data Sources and Data Issues National Survey of Children's Health, National Center for Health Statistics, Centers for Disease Control and Prevention.
Significance A medical home is an approach to providing continuous and comprehensive primary care in a high-quality and cost-effective manner.

SP # 
Performance Measure: Percent of children less than 12 years of age who receive one physical exam a year.
Status: Active
Goal Increase the percent of children less than 12 years of age who receive one physical exam per year.
Definition
Numerator:
Weighted number of children who received at least one physical exam within the past year.
Denominator:
Census estimate of children during calendar year.
Units: 100   Text: Percent
   
Healthy People 2010 Objective


Data Sources and Data Issues Wisconsin Family Health Survey, Bureau of Health Care Financing Annual EPSDT Participation Report
Significance Health maintenance through primary care services, including well child check-ups results in early detection and treatment of health problems and improves the chances of leading a healthy life. The implementation of Wisconsin's Children's Health Insurance Program (BadgerCare) will increase health care utilization by children birth to 12 years of age.

SP # 
Performance Measure: Percent of women who use tobacco during pregnancy.
Status: Active
Goal Decrease the percent of women who use tobacco during pregnancy.
Definition
Numerator:
Number of women who self-report the use of tobacco during pregnancy during the calendar year.
Denominator:
Total number of live births toWisconsin women per calendar year.
Units: 100   Text: Percent
   
Healthy People 2010 Objective


Data Sources and Data Issues Wisconsin birth certificate data file.
Significance Wisconsin's maternal smoking rate (16.5% in 2000) is above the national average (12.2% in 2000). Poor pregnancy outcomes due to maternal smoking are well documented. These substances can endanger the pregnancy and the newborn's health (low birth weight, higher risk of unsuccessful pregnancy and premature birth, and other health problems).

SP # 
Performance Measure: Percent of children, ages 2-4, who are obese or overweight.
Status: Active
Goal To reduce the percent of children, ages 2-4, who are obese or overweight
Definition
Numerator:
Unduplicated number of enrolled WIC participants who are children, ages 2-4, in Wisconsin at => 95 percentile during the reporting period.
Denominator:
Unduplicated number of enrolled WIC participants who are children, ages 2-4, in Wisconsin during the reporting period.
Units: 100   Text: Percent
   
Healthy People 2010 Objective


Data Sources and Data Issues CDC, Pediatric Nutrition Surveillance System (PedNSS)/WIC data.
Significance Childhood and adolescent obesity can lead to negative psychosocial and medical conditions. Medical conditions related to child and adolescent obesity can be both short and long-term. Overweight and obese children are at risk for sleep apnea, orthopedic complications, Type 2 diabetes, and elevated levels of cholesterol, blood pressure, triglycerides, and fasting insulin. Overweight adolescents have a 1.5 to 2-fold increased risk for being overweight as adults. As a result, they are also at increased risk for long-term medical conditions such as coronary heart disease, colon cancer, diabetes, asthma, and arthritis.

SP # 
Performance Measure: Ratio of the black infant mortality rate to the white infant mortality rate.
Status: Active
Goal To reduce the disparity (ratio) between the black and white infant mortality rates.
Definition Ratio of the black infant mortality rate to the white infant mortality rate.
Numerator:
The black infant mortatlity rate per 1,000 live births during the reporting period (most recent data for calendar year).
Denominator:
The white infant mortality rate per 1,000 live births during the reporting period (most recent data for calendar year).
Units: 1   Text: Ratio
   
Healthy People 2010 Objective


Data Sources and Data Issues State vital records.
Significance A significant gap exists in Wisconsin between the infant mortality rates (IMR) of African American and white infants. Infants born to African American women in Wisconsin are almost three times as likely to die in the first year of life than infants born to white mothers. This disparity of 3 to 1 exceeds the disparity of 2.4 to 1 for the nation as a whole. Although the overall IMR for Wisconsin declined from 17 infant deaths per 1,000 live births in 1970 to 7.2 per 1,000 in 1998, the IMR for African American babies hovered near 18 per 1,000 live births for the last decade. The IMR for whites was 5.6 infant deaths per 1,000 live births in 1998 compared to the block rate of 17.9 per 1,000 live births. This trend continued in 1999 and 2000.

SP # 
Performance Measure: Death rate per 100,000 among youth, ages 15-19, due to motor vehicle crashes.
Status: Active
Goal To decrease the number of deaths to youths, ages 15-19, due to motor vehicle crashes.
Definition
Numerator:
The number of deaths from motor vehicle crashes in Wisconsin to youths, ages 15-19, during the reporting period.
Denominator:
The number of youths in Wisconsin, ages 15-19, during the reporting period.
Units: 100000   Text: Rate
   
Healthy People 2010 Objective


Data Sources and Data Issues Wisconsin death certificate data file.
Significance Motor vehicle crashes are the leading cause of death for youth. Wisconsin's young drivers are more likely to be in a motor vehicle crash than any other age group.

Form Notes for Form 16
None
Field Level Notes
None

Form 17
Health Systems Capacity Indicators
Forms for HSCI 01 through 04, 07 & 08 - Multi-Year Data
State: WI
Form Level Notes for Form 17

None
Health Systems Capacity Measure # 01
The rate of children hospitalized for asthma (ICD-9 Codes: 493.0 -493.9) per 10,000 children less than five years of age.
Annual Indicator Data
2001 2002 2003 2004 2005
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final? Final Provisional

Field Level Notes

1. Section Number: Health Systems Capacity Indicator #01
Field Name: HSC01
Row Name:
Column Name:
Year: 2005
Field Note:
Data issue: 2006 data are not available until 2007.
2. Section Number: Health Systems Capacity Indicator #01
Field Name: HSC01
Row Name:
Column Name:
Year: 2004
Field Note:
Source: These data are from 2002 and the most recent available. The Wisconsin Department of Health and Family Services has hospital discharge data only through September 30, 2003 discharges. The responsibility for collection of hospital inpatient discharge records from Wisconsin hospitals was transferred to the Wisconsin Hospital Association at that time. Access by DHFS to more recent discharge records is pending completion of negotiations on a data use agreement.
2004 data were updated in 5/06. Source: Numerator: Wisconsin Department of Health and Family Services, Wisconsin Hospital Discharge Data, Bureau of Health Information and Policy, 2006.
Denominator: Wisconsin Dept. of Health and Family Services, Divsion of Public Health, Bureau of Health Information and Policy. Wisconsin Interactive Statistics on Health (WISH) data query system, http:// dhfs.wisconsin.gov/wish/,Population Module, accessed 5/22/06.
3. Section Number: Health Systems Capacity Indicator #01
Field Name: HSC01
Row Name:
Column Name:
Year: 2003
Field Note:
Source: Numerator: Wisconsin Department of Health and Family Services, Wisconsin Hospital Discharge Data, Bureau of Health Information and Policy, 2006.
Denominator: Wisconsin Dept. of Health and Family Services, Divsion of Public Health, Bureau of Health Information and Policy. Wisconsin Interactive Statistics on Health (WISH) data query system, http:// dhfs.wisconsin.gov/wish/,Population Module, accessed 5/22/06.

Health Systems Capacity Measure # 02
The percent Medicaid enrollees whose age is less than one year during the reporting year who received at least one initial periodic screen.
Annual Indicator Data
2001 2002 2003 2004 2005
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final? Final Final

Field Level Notes

1. Section Number: Health Systems Capacity Indicator #02
Field Name: HSC02
Row Name:
Column Name:
Year: 2005
Field Note:
Source: Numerator and denominator from the Medicaid Evaluation and Decision Support Data Warehouse for SFY2005.
2. Section Number: Health Systems Capacity Indicator #02
Field Name: HSC02
Row Name:
Column Name:
Year: 2004
Field Note:
Source: Numerator and denominator from the Medicaid Evaluation and Decision Support Data Warehouse for SFY2004.
3. Section Number: Health Systems Capacity Indicator #02
Field Name: HSC02
Row Name:
Column Name:
Year: 2003
Field Note:
Source: Numerator and denominator from the Medicaid Evaluation and Decision Support Data Warehouse for SFY2003.

Health Systems Capacity Measure # 03
The percent State Childrens Health Insurance Program (SCHIP) enrollees whose age is less than one year during the reporting year who received at least one periodic screen.
Annual Indicator Data
2001 2002 2003 2004 2005
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final? Final Final

Field Level Notes

1. Section Number: Health Systems Capacity Indicator #03
Field Name: HSC03
Row Name:
Column Name:
Year: 2005
Field Note:
Source: Numerator and denominator from the Medicaid Evaluation and Decision Support Data Warehouse for SFY2005.
2. Section Number: Health Systems Capacity Indicator #03
Field Name: HSC03
Row Name:
Column Name:
Year: 2004
Field Note:
Source: Numerator and denominator from the Medicaid Evaluation and Decision Support Data Warehouse for SFY2004.
3. Section Number: Health Systems Capacity Indicator #03
Field Name: HSC03
Row Name:
Column Name:
Year: 2003
Field Note:
Source: Numerator and denominator from the Medicaid Evaluation and Decision Support Data Warehouse for SFY2003.
Data issues: BadgerCare began in July 1999 as a Medicaid program to implement SCHIP. Low-income uninsured families who are not eligible for Medicaid qualify for BadgerCare if family income is at or below 185% of the federal poverty level (FPL). Families remain eligible for BadgerCare until their income exceeds 200% FPL. BadgerCare has increased enrollment of children in Medicaid. Since the implementation of BadgerCare, an additional 74,900 children have enrolled in Medicaid. Many BadgerCare families are mixed _ younger children are in Medicaid, who are eligible for Healthy Start with incomes up to 185% of the FPL, and older siblings and parents in BadgerCare. An increase in the numbers of infants to age one receiving at least one EPSDT service from BadgerCare has increased due to continued growth of the program. Families enrolled with incomes below 185% and remain with income ranges between 185% to 200 FPL. Families with an income at or above 150% of the federal poverty level pay a premium equal to 3% of their income.

Health Systems Capacity Measure # 04
The percent of women (15 through 44) with a live birth during the reporting year whose observed to expected prenatal visits are greater than or equal to 80 percent on the Kotelchuck Index.
Annual Indicator Data
2001 2002 2003 2004 2005
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final? Final Provisional

Field Level Notes

1. Section Number: Health Systems Capacity Indicator #04
Field Name: HSC04
Row Name:
Column Name:
Year: 2005
Field Note:
Data issue: Data for 2005 are not available from the Bureau of Health Information and Policy until 2007.
2. Section Number: Health Systems Capacity Indicator #04
Field Name: HSC04
Row Name:
Column Name:
Year: 2004
Field Note:
Source: Wisconsin Department of Health and Family Services, Division of Public Health, Bureau of Health Information and Policy, 2006.
3. Section Number: Health Systems Capacity Indicator #04
Field Name: HSC04
Row Name:
Column Name:
Year: 2003
Field Note:
Source: Numerator and denominator: Wisconsin Department of Health and Family Services, Wisconsin Division of Health Care Financing, Bureau of Health Information, Wisconsin Births and Infant Deaths, 2003. Madison, Wisconsin, 2005.

Health Systems Capacity Measure # 07A
Percent of potentially Medicaid-eligible children who have received a service paid by the Medicaid Program.
Annual Indicator Data
2001 2002 2003 2004 2005
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final? Final Final

Field Level Notes

1. Section Number: Health Systems Capacity Indicator #07A
Field Name: HSC07A
Row Name:
Column Name:
Year: 2005
Field Note:
Source: Numerator and denominator from the Medicaid Evaluation and Decision Support Data Warehouse for SFY2005.
2. Section Number: Health Systems Capacity Indicator #07A
Field Name: HSC07A
Row Name:
Column Name:
Year: 2004
Field Note:
Source: Numerator and denominator from the Medicaid Evaluation and Decision Support Data Warehouse for SFY2004.
Indicator: In our managed care-oriented "family Medicaid system," the percentage of child Medicaid/BadgerCare recipients actually receiving Medicaid through an HMO has been steadily dropping. As of April, 2005, the total number of recipients receiving MA through an HMO was about 353,000, according to the Wisconsin Assn of Health Plans. However, the total family Medicaid population has grown to 535,000. Therefore, only 65.9% family Medicaid recipients received services. Also, Medicaid HMOs have steadily withdrawn geographically from the rural areas. We have not revised our objectives because we believe that the 2003 indicator reflects the population entering the Medicaid program and does not accurately reflect trends.
3. Section Number: Health Systems Capacity Indicator #07A
Field Name: HSC07A
Row Name:
Column Name:
Year: 2003
Field Note:
Source: Numerator and denominator from the Medicaid Evaluation and Decision Support Data Warehouse for SFY2003.

Health Systems Capacity Measure # 07B
The percent of EPSDT eligible children aged 6 through 9 years who have received any dental services during the year.
Annual Indicator Data
2001 2002 2003 2004 2005
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final? Final Final

Field Level Notes

1. Section Number: Health Systems Capacity Indicator #07B
Field Name: HSC07B
Row Name:
Column Name:
Year: 2005
Field Note:
Source: Numerator and denominator from the Medicaid Evaluation and Decision Support Data Warehouse for SFY2005.
2. Section Number: Health Systems Capacity Indicator #07B
Field Name: HSC07B
Row Name:
Column Name:
Year: 2004
Field Note:
Source: Numerator and denominator from the Medicaid Evaluation and Decision Support Data Warehouse for SFY2004. The difference in the percentage of EPSDT eligible children receiving services from SFY2003 to SFY 2004 is statistically significant (53.1% to 34%). In Wisconsin's
managed care-oriented "family Medicaid system," the percentage of child Medicaid or BadgerCare recipients actually receiving Medicaid through an HMO has been steadily dropping. As of April, 2005, the total number of recipients receiving MA through an HMO is about 353,000, according to the Wisconsin Assn of Health Plans. However, the total family Medicaid population has grown to 535,000. This means that only 65.9 percent of all family Medicaid recipients receive HealthCheck through a system with financial incentives to render HealthCheck in WI.
A "Medicaid managed care map" of Wisconsin shows that MA HMOs have steadily withdrawn from rural areas, especially. Therefore, although the number of Medicaid/BadgerCare children has steadily grown, the number of children who receive Medicaid through a system that provides financial incentives to perform HealthCheck has not.
3. Section Number: Health Systems Capacity Indicator #07B
Field Name: HSC07B
Row Name:
Column Name:
Year: 2003
Field Note:
Source: Numerator and denominator from the Medicaid Evaluation and Decision Support Data Warehouse for SFY2003.

Health Systems Capacity Measure # 08
The percent of State SSI beneficiaries less than 16 years old receiving rehabilitative services from the State Children with Special Health Care Needs (CSHCN) Program.
Annual Indicator Data
2001 2002 2003 2004 2005
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final? Final Final

Field Level Notes

1. Section Number: Health Systems Capacity Indicator #08
Field Name: HSC08
Row Name:
Column Name:
Year: 2005
Field Note:
The denominator, 14,201 is in a report from the Social Security Administration and the numerator is the same. Data Issue: All SSI beneficiaries less than 16 years old are automatically eligible for Wisconsin's Medicaid Program which provides comprehensive rehabilitative services. This indicator is consistent with other states with universal Medicaid coverage for these services. Each month, SSA sends the Wisconsin CYSCHN Program the names and addresses of all children under 16 years with filed applications for SSI benefits. Families are then sent information about the regional CYSHCN Centers and other resrouces.
2. Section Number: Health Systems Capacity Indicator #08
Field Name: HSC08
Row Name:
Column Name:
Year: 2004
Field Note:
The denominator of 13,727 is provided within a report from the Social Security Administration and the numerator is the same. Data Issue: All SSI beneficiaries less than 16 years old are automatically eligible for Wisconsin's Medicaid Program which provides comprehensive rehabilitative services. As such, Title V's role is focused on assuring families are aware of and enrolled in SSI. This indicator is consistent with other States with universal Medicaid coverage for these services.
3. Section Number: Health Systems Capacity Indicator #08
Field Name: HSC08
Row Name:
Column Name:
Year: 2003
Field Note:
The denominator of 13,446 is provided within a report from the Social Security Administration and the numerator is the same. Data Issue: All SSI beneficiaries less than 16 years old are automatically eligible for Wisconsin's Medicaid Program which provides comprehensive rehabilitative services. As such, Title V's role is focused on assuring families are aware of and enrolled in SSI. This indicator is consistent with other States with universal Medicaid coverage for these services.

Form 18
Health Systems Capacity Indicator #05
(Medicaid and Non-Medicaid Comparison)
State: WI
 
 
INDICATOR #05
Comparison of health system capacity indicators for Medicaid, non-Medicaid, and all MCH populations in the State		 YEAR DATA SOURCE POPULATION
MEDICAID NON-MEDICAID ALL
a) Percent of low birth weight (< 2,500 grams) 2004 Payment source from birth certificate 
b) Infant deaths per 1,000 live births 2002 Matching data files 
c) Percent of infants born to pregnant women receiving prenatal care beginning in the first trimester 2004 Payment source from birth certificate 
d) Percent of pregnant women with adequate prenatal care(observed to expected prenatal visits is greater than or equal to 80% [Kotelchuck Index]) 2002 Payment source from birth certificate 
 
 

 

Form 18
Health Systems Capacity Indicator #06(Medicaid eligibility level)
State: WI
 
 
INDICATOR #06
The percent of poverty level for eligibility in the State's Medicaid programs for infants (0 to 1), children, Medicaid and pregnant women.		 YEAR PERCENT OF POVERTY LEVEL
MEDICAID
(Valid range: 100-300 percent)
a) Infants (0 to 1)
 2005 
b) Medicaid Children
(Age range to )
(Age range to )
(Age range to )
2005 


c) Pregnant Women
 2005 
 
 
 

Form 18
Health Systems Capacity Indicator #06(SCHIP eligibility level)
State: WI
 
 
INDICATOR #06
The percent of poverty level for eligibility in the State's SCHIP programs for infants (0 to 1), children, SCHIP and pregnant women.		 YEAR PERCENT OF POVERTY LEVEL
SCHIP
a) Infants (0 to 1)
 2005 
b) Medicaid Children
(Age range to )
(Age range to )
(Age range to )
2005 


c) Pregnant Women
 2005 
 
 

Form Notes for Form 18
HSI #05A-D. Wisconsin infant birth and death data are maintained by DHFS, DPH, BHIP, Vital Statistics unit and 2003 and 2004 data for infant deaths (matching data files) and the Kotelchuk Index) were not linked as of 7/05/06 by the Bureau of Health Information and Policy.

HSI #06 (Medicaid and SCHIP Eligibility Level) are SFY data.
Field Level Notes
1. Section Number: Indicator 05
Field Name: LowBirthWeight
Row Name: Percent of ow birth weight (<2,500 grams)
Column Name:
Year: 2007
Field Note:
Data for 2005 are not available from the Bureau of Health Information and Policy until 2007.
2. Section Number: Indicator 05
Field Name: InfantDeath
Row Name: Infant deaths per 1,000 live births
Column Name:
Year: 2007
Field Note:
Data for 2003, 2004, and 2005 are not available from the linked birth/death infant files. These are 2002 data from the linked birth/death infant files.
3. Section Number: Indicator 05
Field Name: CareFirstTrimester
Row Name: Percent of infants born to pregnant women receiving prenatal care beginning in the first trimester
Column Name:
Year: 2007
Field Note:
Data for 2005 are not available from the Bureau of Health Information and Policy until 2007.
4. Section Number: Indicator 05
Field Name: AdequateCare
Row Name: Percent of pregnant women with adequate prenatal care
Column Name:
Year: 2007
Field Note:
Data for 2003, 2004, and 2005 are not available from the linked birth/death infant files. These are 2002 data from the linked birth/death infant files.

 

Form 19
Health Systems Capacity Indicator - Reporting and Tracking Form
State: WI
 
 

HEALTH SYSTEMS CAPACITY INDICATOR #09A (General MCH Data Capacity)
(The Ability of the State to Assure MCH Program Access to Policy and Program Relevant Informatioin)

 
DATABASES OR SURVEYS Does your MCH program have the ability to obtain data for program planning or policy purposes in a timely manner?
(Select 1 - 3) *		 Does your MCH program have Direct access to the electronic database for analysis?
(Select Y/N)
ANNUAL DATA LINKAGES
Annual linkage of infant birth and infant death certificates 		3  No 
Annual linkage of birth certificates and Medicaid Eligibility or Paid Claims Files 3  No 
Annual linkage of birth certificates and WIC eligibility files 2  No 
Annual linkage of birth certificates and newborn screening files 1  No 
REGISTRIES AND SURVEYS
Hospital discharge survey for at least 90% of in-State discharges 		2  Yes 
Annual birth defects surveillance system 3  Yes 
Survey of recent mothers at least every two years (like PRAMS) 3  No 
*Where:
1 = No, the MCH agency does not have this ability.
2 = Yes, the MCH agency sometimes has this ability, but not on a consistent basis.
3 = Yes, the MCH agency always has this ability.
 
 

 

Form 19
Health Systems Capacity Indicator - Reporting And Tracking Form
State: WI
 
 
DATA SOURCES Does your state participate in the YRBS survey?
(Select 1 - 3)*		 Does your MCH program have direct access to the state YRBS database for analysis?
(Select Y/N)
Youth Risk Behavior Survey (YRBS) 3  No 
Other: 3  Yes 
   
   
*Where:
1 = No
2 = Yes, the State participates but the sample size is not large enough for valid statewide estimates for this age group.
3 = Yes, the State participates and the sample size is large enough for valid statewide estimates for this age group.
Notes:
1. HEALTH SYSTEMS CAPACITY INDICATOR #09B was formerly reported as Developmental Health Status Indicator #05.
 
   
 
 
 

Form Notes for Form 19
None
Field Level Notes
1. Section Number: Indicator 09A
Field Name: RecentMother
Row Name: Survey of recent mothers at least every two years (like PRAMS)
Column Name:
Year: 2007
Field Note:
Wisconsin was awarded PRAMS in April 2006; however, we do not expect to have data for analysis until 2008-2009; the data analysis will be housed in the Bureau of Health Information and Policy, Division of Public Health. Title V is administered by the Bureau of Community Health Promotion, Division of Public Health.
2. Section Number: Indicator 09B
Field Name: Other1_09B
Row Name: Other
Column Name:
Year: 2007
Field Note:
The Wisconsin Youth Tobacco Survey is a comprehensive measure of youth awareness, attitudes, and related behaviors about tobacco use in Wisconsin. The survey is conducted in both public middle and high schools during the spring semester of even years (2004, 2006, 2008, etc.).

Form 20
Health Status Indicators #01-#05
Multi-Year Data
State: WI
Form Level Notes for Form 11

None
Health Status Indicator Measure # 01A
The percent of live births weighing less than 2,500 grams.
Annual Indicator Data
2001 2002 2003 2004 2005
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final? Final Provisional

Field Level Notes

1. Section Number: Health Status Indicator #01A
Field Name: HSI01A
Row Name:
Column Name:
Year: 2005
Field Note:
Data issue: 2005 data are not available from the Bureau of Health Information and Policy until 2007.
2. Section Number: Health Status Indicator #01A
Field Name: HSI01A
Row Name:
Column Name:
Year: 2004
Field Note:
Source: Wisconsin Department of Health and Family Services, Division of Public Health, Bureau of Health Information and Policy, Wisconsin Interactive Statistics on Health (WISH) data query sytem, http://dhfs.wisconsin.gov/wish/,Low Birthweight Module, accessed 3/13/2006.
3. Section Number: Health Status Indicator #01A
Field Name: HSI01A
Row Name:
Column Name:
Year: 2003
Field Note:
Source: Wisconsin Department of Health and Family Services, Division of Public Health, Bureau of Health Information and Policy, Wisconsin Births and Infant Deaths, 2003, Madison, Wisconsin, 2005.

Health Status Indicator Measure # 01B
The percent of live singleton births weighing less than 2,500 grams.
Annual Indicator Data
2001 2002 2003 2004 2005
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final? Final Provisional

Field Level Notes

1. Section Number: Health Status Indicator #01B
Field Name: HSI01B
Row Name:
Column Name:
Year: 2005
Field Note:
Data issue: 2005 data are not available from the Bureau of Health Information and Policy until 2007.
2. Section Number: Health Status Indicator #01B
Field Name: HSI01B
Row Name:
Column Name:
Year: 2004
Field Note:
Source: Wisconsin Department of Health and Family Services, Division of Public Health, Bureau of Health Information and Policy, Wisconsin Interactive Statistics on Health (WISH) data query sytem, http://dhfs.wisconsin.gov/wish/,Low Birthweight Module, accessed 3/13/2006.
3. Section Number: Health Status Indicator #01B
Field Name: HSI01B
Row Name:
Column Name:
Year: 2003
Field Note:
Source: Wisconsin Department of Health and Family Services, Division of Public Health, Bureau of Health Information and Policy, Wisconsin Births and Infant Deaths, 2003, Madison, Wisconsin, 2005.

Health Status Indicator Measure # 02A
The percent of live births weighing less than 1,500 grams.
Annual Indicator Data
2001 2002 2003 2004 2005
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final? Final Provisional

Field Level Notes

1. Section Number: Health Status Indicator #02A
Field Name: HSI02A
Row Name:
Column Name:
Year: 2005
Field Note:
Data issue: 2005 data are not available from the Bureau of Health Information and Policy until 2007.
2. Section Number: Health Status Indicator #02A
Field Name: HSI02A
Row Name:
Column Name:
Year: 2004
Field Note:
Source: Wisconsin Department of Health and Family Services, Division of Public Health, Bureau of Health Information and Policy, Wisconsin Interactive Statistics on Health (WISH) data query sytem, http://dhfs.wisconsin.gov/wish/,Low Birthweight Module, accessed 3/13/2006.
3. Section Number: Health Status Indicator #02A
Field Name: HSI02A
Row Name:
Column Name:
Year: 2003
Field Note:
Source: Wisconsin Department of Health and Family Services, Division of Public Health, Bureau of Health Information and Policy, Wisconsin Births and Infant Deaths, 2003, Madison, Wisconsin, 2005.

Health Status Indicator Measure # 02B
The percent of live singleton births weighing less than 1,500 grams.
Annual Indicator Data
2001 2002 2003 2004 2005
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final? Final Provisional

Field Level Notes

1. Section Number: Health Status Indicator #02B
Field Name: HSI02B
Row Name:
Column Name:
Year: 2005
Field Note:
Data issue: 2005 data are not available from the Bureau of Health Information and Policy until 2007.
2. Section Number: Health Status Indicator #02B
Field Name: HSI02B
Row Name:
Column Name:
Year: 2004
Field Note:
Source: Wisconsin Department of Health and Family Services, Division of Public Health, Bureau of Health Information and Policy, Wisconsin Interactive Statistics on Health (WISH) data query sytem, http://dhfs.wisconsin.gov/wish/,Low Birthweight Module, accessed 3/13/2006.
3. Section Number: Health Status Indicator #02B
Field Name: HSI02B
Row Name:
Column Name:
Year: 2003
Field Note:
Source: Wisconsin Department of Health and Family Services, Division of Public Health Care, Bureau of Health Information and Policy, Wisconsin Births and Infant Deaths, 2003, Madison, Wisconsin, 2005.

Health Status Indicator Measure # 03A
The death rate per 100,000 due to unintentional injuries among children aged 14 years and younger.
Annual Indicator Data
2001 2002 2003 2004 2005
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final? Final Provisional

Field Level Notes

1. Section Number: Health Status Indicator #03A
Field Name: HSI03A
Row Name:
Column Name:
Year: 2005
Field Note:
Data issue: 2005 data are not available from the Bureau of Health Information and Policy until 2007.
2. Section Number: Health Status Indicator #03A
Field Name: HSI03A
Row Name:
Column Name:
Year: 2004
Field Note:
Source: Wisconsin Department of Health and Family Services, Division of Public Health, Bureau of Health Information and Policy, Wisconsin Interactive Statistics on Health (WISH) data query sytem, http://dhfs.wisconsin.gov/wish/,Mortality Module, accessed 3/13/2006.
3. Section Number: Health Status Indicator #03A
Field Name: HSI03A
Row Name:
Column Name:
Year: 2003
Field Note:
Numerator: Wisconsin Department of Health and Family Services, Division of Public Health, Bureau of Health Information and Policy. Wisconsin Deaths, 2003, Madison, Wisconsin, 2004. Denominator: Wisconsin Interactive Statistics on Health (WISH), http://dhfs.wisconsin.gov/wish/, Population Module, accessed 05/07/05.
http://dhfs.wisconsin.gov/wish/,Population Module, accessed 03/01/04.

Health Status Indicator Measure # 03B
The death rate per 100,000 for unintentional injuries among children aged 14 years and younger due to motor vehicle crashes.
Annual Indicator Data
2001 2002 2003 2004 2005
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final? Final Provisional

Field Level Notes

1. Section Number: Health Status Indicator #03B
Field Name: HSI03B
Row Name:
Column Name:
Year: 2005
Field Note:
Data issue: 2005 data are not available from the Bureau of Health Information and Policy until 2007.
2. Section Number: Health Status Indicator #03B
Field Name: HSI03B
Row Name:
Column Name:
Year: 2004
Field Note:
Source: Wisconsin Department of Health and Family Services, Division of Public Health, Bureau of Health Information and Policy, Wisconsin Interactive Statistics on Health (WISH) data query sytem, http://dhfs.wisconsin.gov/wish/,Mortality Module, accessed 3/13/2006.
3. Section Number: Health Status Indicator #03B
Field Name: HSI03B
Row Name:
Column Name:
Year: 2003
Field Note:
Source: Numerator Wisconsin Department of Health and Family Services, Division of Public Health, Bureau of Health Information and Policy, Wisconsin Deaths, 2003. Madison, Wisconsin, 2004.
Denominator: Wisconsin Department of Health and Family Services, Division of Health Care Financing, Bureau of Health Information. Wisconsin Interactive Statistics on Health (WISH), http://dhfs.wisconsin.gov/wish/,Population Module, accessed 05/01/05.

Health Status Indicator Measure # 03C
The death rate per 100,000 from unintentional injuries due to motor vehicle crashes among youth aged 15 through 24 years.
Annual Indicator Data
2001 2002 2003 2004 2005
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final? Final Provisional

Field Level Notes

1. Section Number: Health Status Indicator #03C
Field Name: HSI03C
Row Name:
Column Name:
Year: 2005
Field Note:
Data issue: 2005 data are not available from the Bureau of Health Information and Policy until 2007.
2. Section Number: Health Status Indicator #03C
Field Name: HSI03C
Row Name:
Column Name:
Year: 2004
Field Note:
Source: Wisconsin Department of Health and Family Services, Division of Public Health, Bureau of Health Information and Policy, Wisconsin Interactive Statistics on Health (WISH) data query sytem, http://dhfs.wisconsin.gov/wish/,Mortality Module, accessed 3/13/2006.
3. Section Number: Health Status Indicator #03C
Field Name: HSI03C
Row Name:
Column Name:
Year: 2003
Field Note:
Source: Numerator: Wisconsin Department of Health and Family Services, Division of Public Healht, Bureau of Health Information and Policy, Wisconsin Deaths 2003, Madison, Wisconsin, 2004.
Denominator: Wisconsin Department of Health and Family Services, Division of Public Health, Bureau of Health Information and Policy, Wisconsin Interactive Statistics on Health (WISH), http://dhfs.wisconsin.gov/wish/, Population Module, accessed 03/01/05.

Health Status Indicator Measure # 04A
The rate per 100,000 of all nonfatal injuries among children aged 14 years and younger.
Annual Indicator Data
2001 2002 2003 2004 2005
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final? Final Provisional

Field Level Notes

1. Section Number: Health Status Indicator #04A
Field Name: HSI04A
Row Name:
Column Name:
Year: 2005
Field Note:
Data issue: 2005 data are not available from the Bureau of Health Information and Policy until 2007.
2. Section Number: Health Status Indicator #04A
Field Name: HSI04A
Row Name:
Column Name:
Year: 2004
Field Note:
Source: Wisconsin Department of Health and Family Services, Division of Public Health, Bureau of Health Information and Policy, Wisconsin Interactive Statistics on Health (WISH) data query sytem, tp://dhfs.wisconsin.gov/wish/, Injury Hospitlization Module, accessed 3/13/2006.
3. Section Number: Health Status Indicator #04A
Field Name: HSI04A
Row Name:
Column Name:
Year: 2003
Field Note:
Data issues: Collection of hospitalization data for is the responsibility of the Wisconsin Hospital Association as of September 2003 and access by DHFS to more recent discharge data is pending completion of negotiations on a data use agreement; therefore, we have the four most recent quarters of data available from October 2002-September 2003.Source: Numerator Wisconsin Department of Health and Family Services, Wisconsin Division of Health Care Financing, Bureau of Health Information, 2004.
Denominator: Wisconsin Department of Health and Family Services, Division of Health Care Financing, Bureau of Health Information. Wisconsin Interactive Statistics on Health (WISH), http://dhfs.wisconsin.gov/wish/,Population Module, accessed 03/01/05.

Health Status Indicator Measure # 04B
The rate per 100,000 of nonfatal injuries due to motor vehicle crashes among children aged 14 years and younger.
Annual Indicator Data
2001 2002 2003 2004 2005
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final? Final Provisional

Field Level Notes

1. Section Number: Health Status Indicator #04B
Field Name: HSI04B
Row Name:
Column Name:
Year: 2005
Field Note:
Data issue: 2005 data are not available from the Bureau of Health Information and Policy until 2007.
2. Section Number: Health Status Indicator #04B
Field Name: HSI04B
Row Name:
Column Name:
Year: 2004
Field Note:
Source: Wisconsin Department of Health and Family Services, Division of Public Health, Bureau of Health Information and Policy, Wisconsin Interactive Statistics on Health (WISH) data query sytem, tp://dhfs.wisconsin.gov/wish/, Injury Hospitlization Module, accessed 3/13/2006.
3. Section Number: Health Status Indicator #04B
Field Name: HSI04B
Row Name:
Column Name:
Year: 2003
Field Note:
Data issues: Collection of hospitalization data for is the responsibility of the Wisconsin Hospital Association as of September 2003 and access by DHFS to more recent discharge data is pending completion of negotiations on a data use agreement; therefore, we have the four most recent quarters of data available from October 2002-September 2003.Source: Numerator Wisconsin Department of Health and Family Services, Wisconsin Division of Health Care Financing, Bureau of Health Information, 2004.
Denominator: Wisconsin Department of Health and Family Services, Division of Health Care Financing, Bureau of Health Information. Wisconsin Interactive Statistics on Health (WISH), http://dhfs.wisconsin.gov/wish/,Population Module, accessed 03/01/05.

Health Status Indicator Measure # 04C
The rate per 100,000 of nonfatal injuries due to motor vehicle crashes among youth aged 15 through 24 years.
Annual Indicator Data
2001 2002 2003 2004 2005
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final? Final Provisional

Field Level Notes

1. Section Number: Health Status Indicator #04C
Field Name: HSI04C
Row Name:
Column Name:
Year: 2005
Field Note:
Data issue: 2005 data are not available from the Bureau of Health Information and Policy until 2007.
2. Section Number: Health Status Indicator #04C
Field Name: HSI04C
Row Name:
Column Name:
Year: 2004
Field Note:
Source: Wisconsin Department of Health and Family Services, Division of Public Health, Bureau of Health Information and Policy, Wisconsin Interactive Statistics on Health (WISH) data query sytem, tp://dhfs.wisconsin.gov/wish/, Injury Hospitlization Module, accessed 3/13/2006.
3. Section Number: Health Status Indicator #04C
Field Name: HSI04C
Row Name:
Column Name:
Year: 2003
Field Note:
Data issues: Collection of hospitalization data for is the responsibility of the Wisconsin Hospital Association as of September 2003 and access by DHFS to more recent discharge data is pending completion of negotiations on a data use agreement; therefore, we have the four most recent quarters of data available from October 2002-September 2003.Source: Numerator Wisconsin Department of Health and Family Services, Wisconsin Division of Health Care Financing, Bureau of Health Information, 2004.
Denominator: Wisconsin Department of Health and Family Services, Division of Health Care Financing, Bureau of Health Information. Wisconsin Interactive Statistics on Health (WISH), http://dhfs.wisconsin.gov/wish/,Population Module, accessed 03/01/05.

Health Status Indicator Measure # 05A
The rate per 1,000 women aged 15 through 19 years with a reported case of chlamydia.
Annual Indicator Data
2001 2002 2003 2004 2005
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final? Final Provisional

Field Level Notes

1. Section Number: Health Status Indicator #05A
Field Name: HSI05A
Row Name:
Column Name:
Year: 2005
Field Note:
Data issue: Data for 2005 are not available from the Wisconsin STD Program until 2007.
2. Section Number: Health Status Indicator #05A
Field Name: HSI05A
Row Name:
Column Name:
Year: 2004
Field Note:
Source: Numerator: Wisconsin Department of Health and Famly Services, Division of Public Health, Wisconsin STD Program, 2006.
Denominator: Source: Wisconsin Department of Health and Family Services, Division of Public Health, Bureau of Health Information and Policy, Wisconsin Interactive Statistics on Health (WISH) data query sytem, tp://dhfs.wisconsin.gov/wish/, Population Module, accessed 3/13/2006.
3. Section Number: Health Status Indicator #05A
Field Name: HSI05A
Row Name:
Column Name:
Year: 2003
Field Note:
Source: Wisconsin Department of Health and Family Services, Division of Public Health, Bureau of Communicable Diseases, 2004.

Health Status Indicator Measure # 05B
The rate per 1,000 women aged 20 through 44 years with a reported case of chlamydia.
Annual Indicator Data
2001 2002 2003 2004 2005
Annual Indicator
Numerator
Denominator
Is the Data Provisional or Final? Final Provisional

Field Level Notes

1. Section Number: Health Status Indicator #05B
Field Name: HSI05B
Row Name:
Column Name:
Year: 2005
Field Note:
Data issue: Data for 2005 not available from the Wisconsin STD Program until 2007.
2. Section Number: Health Status Indicator #05B
Field Name: HSI05B
Row Name:
Column Name:
Year: 2004
Field Note:
Source: Numerator: Wisconsin Department of Health and Famly Services, Division of Public Health, Wisconsin STD Program, 2006.
Denominator: Source: Wisconsin Department of Health and Family Services, Division of Public Health, Bureau of Health Information and Policy, Wisconsin Interactive Statistics on Health (WISH) data query sytem, tp://dhfs.wisconsin.gov/wish/, Population Module, accessed 3/13/2006.
3. Section Number: Health Status Indicator #05B
Field Name: HSI05B
Row Name:
Column Name:
Year: 2003
Field Note:
Source: Wisconsin Department of Health and Family Services, Division of Public Health, Bureau of Communicable Diseases, 2004.

 

Form 21
Health Status Indicators
Demographic Data
State: WI

   
 
 

HSI #06A - Demographics (Total Population) Infants and children aged 0 through 24 years enumerated by sub-populations of age group and race. (Demographics)

  For both parts A and B: Reporting Year: 2005     Is this data from a State Projection? No     Is this data final or provisional? Final
 
CATEGORY
TOTAL POPULATION BY RACE		 Total All Races White Black or African American American Indian or Native Alaskan Asian Native Hawaiian or Other Pacific Islander More than one race reported Other and Unknown
Infants 0 to 1
Children 1 through 4
Children 5 through 9
Children 10 through 14
Children 15 through 19
Children 20 through 24
Children 0 through 24
 
 

HSI #06B - Demographics (Total Population) Infants and children aged 0 through 24 years enumerated by sub-populations of age group and ethnicity. (Demographics)

 
CATEGORY
TOTAL POPULATION BY HISPANIC ETHNICITY		 Total NOT Hispanic or Latino Total Hispanic or Latino Ethnicity Not Reported
Infants 0 to 1
Children 1 through 4
Children 5 through 9
Children 10 through 14
Children 15 through 19
Children 20 through 24
Children 0 through 24
 

 

Form 21
Health Status Indicators
Demographic Data
State: WI

   
 
 

HSI #07A - Demographics (Total live births) Live births to women (of all ages) enumerated by maternal age and race. (Demographics)

  For both parts A and B: Reporting Year: 2004     Is this data from a State Projection? No     Is this data final or provisional? Final
 
CATEGORY
TOTAL LIVE BIRTHS BY RACE		 Total All Races White Black or African American American Indian or Native Alaskan Asian Native Hawaiian or Other Pacific Islander More than one race reported Other and Unknown
Women < 15
Women 15 through 17
Women 18 through 19
Women 20 through 34
Women 35 or older
Women of all ages
 
 

HSI #07B - Demographics (Total live births) Live births to women (of all ages) enumerated by maternal age and ethnicity. (Demographics)

 
CATEGORY
TOTAL LIVE BIRTHS BY HISPANIC ETHNICITY		 Total NOT Hispanic or Latino Total Hispanic or Latino Ethnicity Not Reported
Women < 15
Women 15 through 17
Women 18 through 19
Women 20 through 34
Women 35 or older
Women of all ages
 

 

Form 21
Health Status Indicators
Demographic Data
State: WI
 
 

HSI #08A - Demographics (Total deaths) Deaths of Infants and children aged 0 through 24 years enumerated by age subgroup and race. (Demographics)

  For both parts A and B: Reporting Year: 2004     Is this data from a State Projection? No     Is this data final or provisional? Final
 
CATEGORY
TOTAL DEATHS BY RACE		 Total All Races White Black or African American American Indian or Native Alaskan Asian Native Hawaiian or Other Pacific Islander More than one race reported Other and Unknown
Infants 0 to 1
Children 1 through 4
Children 5 through 9
Children 10 through 14
Children 15 through 19
Children 20 through 24
Children 0 through 24
 
 

HSI #08B - Demographics (Total deaths) Deaths of Infants and children aged 0 through 24 years enumerated by age subgroup and ethnicity. (Demographics)

 
CATEGORY
TOTAL DEATHS BY HISPANIC ETHNICITY		 Total NOT Hispanic or Latino Total Hispanic or Latino Ethnicity Not Reported
Infants 0 to 1
Children 1 through 4
Children 5 through 9
Children 10 through 14
Children 15 through 19
Children 20 through 24
Children 0 through 24
 

 

Form 21
Health Status Indicators
Demographic Data
State: WI
 
 

HSI #09A - Demographics (Miscellaneous Data) Infants and children aged 0 through 19 years in miscellaneous situations or enrolled in various State programs enumerated by race. (Demographics)

  Is this data final or provisional? Provisional
 
CATEGORY
Miscellaneous Data BY RACE		 Total All Races White Black or African American American Indian or Native Alaskan Asian Native Hawaiian or Other Pacific Islander More than one race reported Other and Unknown Specific Reporting Year
All children 0 through 19 2004 
Percent in household headed by single parent 2004 
Percent in TANF (Grant) families 2004 
Number enrolled in Medicaid 2005 
Number enrolled in SCHIP 2005 
Number living in foster home care 2004 
Number enrolled in food stamp program 2004 
Number enrolled in WIC 2005 
Rate (per 100,000) of juvenile crime arrests 2004 
Percentage of high school drop-outs (grade 9 through 12) 2004 
 
 

HSI #09B - Demographics (Miscellaneous Data) Infants and children aged 0 through 19 years in miscellaneous situations or enrolled in various State programs enumerated by ethnicity.(Demographics)

 
CATEGORY
Miscellaneous Data BY HISPANIC ETHNICITY		 Total NOT Hispanic or Latino Total Hispanic or Latino Ethnicity Not Reported Specific Reporting Year
All children 0 through 19 2004 
Percent in household headed by single parent 2004 
Percent in TANF (Grant) families 2004 
Number enrolled in Medicaid 2005 
Number enrolled in SCHIP 2005 
Number living in foster home care 2004 
Number enrolled in food stamp program 2004 
Number enrolled in WIC 2004 
Rate (per 100,000) of juvenile crime arrests 2004 
Percentage of high school drop-outs (grade 9 through 12) 2004 
 

 

Form 21
Health Status Indicators
Demographic Data
State: WI
 
 

HSI #10 - Demographics (Geographic Living Area) Geographic living area for all resident children aged 0 through 19 years old. (Demographics)

  Reporting Year: 2004     Is this data from a State Projection? Yes     Is this data final or provisional? Provisional
 
GEOGRAPHIC LIVING AREAS TOTAL
Living in metropolitan areas
Living in urban areas
Living in rural areas
Living in frontier areas
Total - all children 0 through 19

Note:
The Total will be determined by adding reported numbers for urban, rural and frontier areas.
 
 
 

Form 21
Health Status Indicators
Demographic Data
State: WI
 
 

HSI #11 - Demographics (Poverty Levels) Percent of the State population at various levels of the federal poverty level. (Demographics)

  Reporting Year: 2004     Is this data from a State Projection? Yes     Is this data final or provisional? Provisional
 
POVERTY LEVELS TOTAL
Total Population
Percent Below: 50% of poverty
100% of poverty
200% of poverty
 
 
 

Form 21
Health Status Indicators
Demographic Data
State: WI

   
 
 

HSI #12 - Demographics (Poverty Levels) Percent of the State population aged 0 through 19 at various levels of the federal poverty level. (Demographics)

  Reporting Year: 2004     Is this data from a State Projection? Yes     Is this data final or provisional? Provisional
 
POVERTY LEVELS TOTAL
Children 0 through 19 years old
Percent Below: 50% of poverty
100% of poverty
200% of poverty
 
 

Form Notes for Form 21
HSI#07A: Demographics - live births by age/race/ethnicity...using 2004 data. In Wisconsin, all live births were classified by race or Hispanic origin of mother into one of six categories: non-Hispanic white, non-Hispanic black/African American, non-Hispanic American Indian, Hispanic/Latino, non-Hispanic Laotian/Hmong, and non-Hispanic other (which are mostly Asian). For this table, Asian includes: Asian - other (561) and Laotian/Hmong (1144) = 1705.
HSI#08A: Demographics - deaths for children by age/race/ethnicity...using 2004 data.
HSI#09: WIC data are for 2005. Enrolled and participation reprot, WIC 801 for the month ending 08-31-05. WIC data are for children, ages 0-4; these data include Hispanic ethnicity as a race and not as an ethnic classification.
Field Level Notes
1. Section Number: Indicator 09A
Field Name: HSIRace_SingleParentPercent
Row Name: Percent in household headed by single parent
Column Name:
Year: 2007
Field Note:
Source: American Community Survey, 2004. More than one race includes two or more races. Other and unknown includes some other race.
2. Section Number: Indicator 09A
Field Name: HSIRace_TANFPercent
Row Name: Percent in TANF (Grant) families
Column Name:
Year: 2007
Field Note:
Source: US Department of Health and Human Services, Administration for Children and Families, Office of Family Assistance, Temporary Assistance for Needy Famlies (TANF), Sixth Annual Report to Congress, November 2004. Table 10:1: Temporary Assistance for Needy Families - Active Cases Percent Distribution of TANF Households by Number of Persons Living in the Household, FY 2002. Table 10:8: Temporary Assistance for Needy Families - Active Cases Percent Distribtution of TANF Families by Ethnicty/Race FY 2002.
3. Section Number: Indicator 09A
Field Name: HSIRace_WICNo
Row Name: Number enrolled in WIC
Column Name:
Year: 2007
Field Note:
Source: Enrolled and Particiaption Report, WIC 801 for the month ending 8/31/05. WIC data are for children, ages 0-4, these data include Hispanic ethnicty as a race and not as an ethnic classification.
4. Section Number: Indicator 09A
Field Name: HSIRace_JuvenileCrimeRate
Row Name: Rate (per 100,000) of juvenile crime arrests
Column Name:
Year: 2007
Field Note:
Source: Wisconsin Department of Justice Assitance, Statistical Analysis Center. Wisconsin Crime and Arrests, 2004. Uniform Crime Reporting Program.
5. Section Number: Indicator 09A
Field Name: HSIRace_DropOutPercent
Row Name: Percentage of high school drop-outs (grade 9 through 12)
Column Name:
Year: 2007
Field Note:
Data for SY2004-2005 are not available from the Wisconsin Department of Public Instruction until late 2006.
6. Section Number: Indicator 09B
Field Name: HSIEthnicity_SingleParentPercent
Row Name: Percent in household headed by single parent
Column Name:
Year: 2007
Field Note:
Source: American Community Survey, 2004.
7. Section Number: Indicator 09B
Field Name: HSIEthnicity_WICNo
Row Name: Number enrolled in WIC
Column Name:
Year: 2007
Field Note:
Source: Enrolled and Particiaption Report, WIC 801 for the month ending 8/31/05. WIC data are for children, ages 0-4, these data include Hispanic ethnicty as a race and not as an ethnic classification.
8. Section Number: Indicator 09B
Field Name: HSIEthnicity_JuvenileCrimeRate
Row Name: Rate (per 100,000) of juvenile crime arrests
Column Name:
Year: 2007
Field Note:
Data are not available by Hispanic ethnicity.
9. Section Number: Indicator 09B
Field Name: HSIEthnicity_DropOutPercent
Row Name: Percentage of high school drop-outs (grade 9 through 12)
Column Name:
Year: 2007
Field Note:
Data for SY2004-2005 are not available from the Wisconsin Department of Public Instruction until late 2006. Hispanic may be of any race.
10. Section Number: Indicator 09A
Field Name: HSIRace_FosterCare
Row Name: Number living in foster home care
Column Name:
Year: 2007
Field Note:
Cases open as of 12/31/04; excludes adoptive home and voluntary kinship cases. Source: Wisconsin Department of Health and Family Services, eWiSACWIS.
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