Cook County Board of Commissioners Finance Committee
Tuesday, July 29, 2025, Afternoon

Cook County Health (“CCH”)
Appearing for CCH:  Pam Cassara (Chief Financial Officer), Craig Williams (Chief Operating Officer), and Robert Reiter (Member of the Board and Finance Committee Chair)
Presentation by Ms. Cassara:

• Known cuts in funding/patient care reimbursement:  An estimated $111 M yearly loss due to Illinois ending the Illinois Health Benefits for Immigrant Adult Program as of July 1, 2025, with 8,000 CCH patients losing that coverage.  Unless Congress takes action, there will be a $120 M loss due to the Federal Disproportionate Share Hospital (“DSH”) funding slated to be cut as of October 1, 2025.  
• Based on the recently passed Federal Budget Bill, effective on January 1, 2027, Medicaid work requirements to be implemented, resulting 10% of individuals losing Medicaid coverage and an estimated reduction of reimbursement to CCH of $88 M each year.  Medicaid eligibility redeterminations are also to be changed from yearly to every 6 months.  The result will be loss of coverage for an estimated 5-12% of individuals, though they may be eligible to re-enroll.  That could result in a $50 M reduction in reimbursements to CCH.
• Compounding effects of all these reductions are (1) more uninsured patients treated by CCH, (2) more cuts to other social service programs that negatively impact community health, leading to (3) greater demand for care at CCH, (4) access to care as other safety nets reduce service or close, and (5) more charity care costs at CCH.
• Earlier this year, CCH projected that it would have a budget gap of almost $120 M for 2025.  CCH then took action and has reduced the gap to a little over $8 M.
• There has been a decline in use of workers from agencies at CCH.  At the beginning of FY2025 there were 1,380 positions filled with agency workers.  That has been reduced by about 1/3 to 968.  With new initiatives, hope to reduce by another 1/3, which the COO explained is likely the lowest can reasonably go.  One of the big successes is converting agency employees to CCH employees,

Almost all the Commissioners had questions related to understanding a contract with Guidehouse, which contract is currently the subject of a labor grievance and an upcoming arbitration hearing. After a number of questions and different responses, this observer’s understanding is

• The contract is to provide consulting services and actual workers for billing and collecting from entities providing coverage for patients who have received CCH services.  There are about 287 workers under the contract, with 140 of them doing entry level work in coding and related services.  Of these, 72 are the subject of the grievance by the union which says that they should be union jobs.  
• The complications for replacing the 140 with CCH employees include the specialized knowledge/training needed for proper coding to be able to collect on bills and that the 72 coders are located outside the U.S., which means that they cannot easily train their replacements.  
• CCH management said that even if all the workers provided by Guidehouse were to be replaced, there would still need to be some of the management consulting services under this or a new contract with another entity because of the expertise required that keeps changing. In fact, the current contract is coming to its end and an RFP is out for bid.
• CCH management also said that they are in the process of going through all their contracts to see if there are other positions that could be otherwise covered by the union contracts.  At this point, they are not sure that Guidehouse is the only instance,

Other information provided in response to Commissioner questions:

• There are 10 to 15% of appointments that are no-shows all across the system, but this is nothing new.  There has been an 80% reduction in new arrivals (immigrants), which resulted in a reduction of 37,000 appointments with the closing of Belmont-Cragin for that service, but overall the total appointments across the system is only a reduction of 6,000.  So thus far, there does not appear to be a chilling effect on people coming for service.  Mandatory staff training has been done for all employees to know what to do if ICE agents come onto CCH facilities. (Comm. Anaya and Degnen questions)
• CCH works hard to make sure there is sufficient staffing across all facilities.  Absences and unfilled positions are often staffed by agencies, but the process for filling staffing needs has been changed to include the Bureau of Human Resources to ensure that departments do not automatically call for agency workers without appropriate review.
• There are 19 interpreters on staff that are deployed across the system as needed, but in addition, a number of staff people are bi-lingual and there are separate job classifications for that.  In addition, there are translation services provided through hand-held devices.   (Comm .Anaya question.)
• Comm. Degnen asked if there was a tech solution to help with Medicaid redeterminations.  The COO explained that redeterminations are done on the State level in accordance with Federal requirements.  CCH can assist people in complying, but not change the way they need to apply.
• Comm. Stamps asked how CCH was ensuring that equitable care is provided across Cook County and no “health deserts” exist?  The response was that care is not being cut anywhere; the concern is that there will be a large increase in uncompensated care as a result of Federal and State actions.  The costs for that care would have to be covered by Cook County and its taxpayers.

County Clerk- Monica Gordon
Clerk Gordon’s presentation:

• Ran a successful 2025 Consolidated Election in April: results posted within 2 hours of polls closed, with all precincts opening on time.
• Implementing a new election management system.
• Installed the first “Smart Drop Box” for mail-in ballots at the headquarters at 69 W. Washington that will allow voters to track the processing of their ballots. Will expand to other locations.
• Implementing a new Clerk Recording System that was totally built in house, saving approximately $7 M.  Includes a mail-tracking system.
• Implemented a new queue system for Vital Records with ability to make appointments and also get texts that your place “in line” is approaching.  Has also reallocated resources to help. As a result, the long lines waiting to access Vital Records should be gone.
• The process for implementing the new Integrated Property Tax System being developed by Tyler Technologies has been challenging.  Significant problems, especially with the tax redemption services, has caused the Clerk to create a manual system until the new system is operational. 

Commissioner questions and responses:

• Comm. Lowry and Stamps:  how do you get more people voting, especially young people?  One new pilot program will have early voting sites at 14 high schools run by student election judges for a few days prior to election. Clerk is adding 2 new early voting sites in Bridgeville and Countryside.  Clerk also wants to do more education of what government does at local levels so people understand why their votes matter to their daily lives.
• Comm. Anaya:  Why the additional overtime this year?  Due to transition to Real I.D. which resulted in a huge demand for birth certificates.  Clerk had employees doing other jobs help with that, with those employees then working at night or on weekends to do their normal work.  Do not expect that in 2026.
• Comm. Stamps and McCaskill:  Clerk clarified that those incarcerated after being convicted are not eligible to vote.  Upon release, the State is supposed to be providing a packet of information that includes that they can now register to vote in Illinois. Those in Cook County jail awaiting trial are able to vote and the Clerk works with the Sheriff to both register detainees to vote and provide early voting.

​Observer:  Priscilla Mims

Cook County Board of Commissioners Finance Committee
July 28, 2025, afternoon

Land Bank Authority - Jessica Caffrey, Executive Director and Daniel Taylor, Finance Manager 
Began with slide presentation - Highlights include:

• They have already met their revenue goal of $5M for the year
• They received no ARPA funding
• Maintained their rate of 88% of properties sold going to homeowners which is a focus of their efforts
• So far this year they have generated $29M of their goal of $30M in Community Wealth
• They have acquired 254 properties this fiscal year with a goal of 500 for the year.
• Working to reduce aged inventory which is 2086 properties and they have reduced by 6% so far this year. 
• Have one open position with an allocation of 19FTE’s - looking for a Planning Analyst to work on a plan for dealing with delinquent tax properties

Commissioner Comments and Questions:

• Comm. Gainer explained that Community Wealth is measured by the increase in property value after rehabilitation of the property. This will lead to an increase in tax revenue for the County. She also commended Ms. Caffrey for her excellent leadership in managing the Land Bank and restoring it to its pre-pandemic level of being self-sustaining. 
• Comm. Anaya asked about the Land Bank using modular homes. Ms. Caffrey says this may happen in the future but the ones done so far were not done on Land Bank properties. Also she asked about working with small developers and their outreach services were described. The Land Bank hosts sessions for small developers and non-profits to see how they can work together to develop vacant properties. 
• Comm. McCaskill asked about the selection process for the properties. Once properties are acquired the Land Bank is responsible for the upkeep so they do not take all available properties. Also working with municipalities to deal with vacant land. 
• Comm. Vasquez asked about Affordable Housing projects. Ms. Caffrey said they don’t see themselves as creating affordable housing projects but as ensuring there is naturally occurring affordability.  
• Comm. Stamps asked whether the housing was being developed and purchased by persons in the communities and Ms. Caffrey said yes they were. 
• Comm. Britton asked for a breakdown of city/suburban development. Ms. Caffrey stated she would get that information to him. He would like to see the Land Bank come to his area to perhaps expand the possibilities of affordable housing. Comm. Gainer stated that a way was to get someone to donate land and work with the Land Bank to find a developer. 
• Comm. Trevor asked about possibilities for vacant commercial properties. Donations are accepted by the Land Bank and the criteria are listed on their website. 
• Comm. Lowry thanked the Land Bank for their work and Comm. Daley commended Comm. Gainer and Ms. Caffrey for their work and Comm. Gainer said the Land Bank team is what makes this work as this is not “a philosophy job but an execution job” and they do great work. 

Veterans Assistance Commission - Elizabeth Soto, Director - Grant Jacobson, Deputy Director
Highlights from presentation:

• Ms. Soto stated that they were under budgeted expenses at the present time due to slow hiring. They have 15 positions allocated and 5 vacancies.
• They would like to hire a Veterans Service Officer (VSO) for each district. 
• Outreach to veterans has been a focus of their work as well. 

Commissioner Comments and Questions:

• Comm. Anaya asked about how they coordinate with other veerans’ organizations and if they have a constituent that requests service where should they send them. Mr. Jacobson held up a new booklet that contains all the information for veterans and it was distributed to all the commissioners. He said that all veterans should be sent to them for coordination of services.
• Comm. Trevor stated that she has lots of veterans in her district and would gladly offer her office for any outreach they would like to do. Mr. Jacobson stated that they are soon opening two new locations for veteran services - one at 69 W. Washington and the other at the Rolling Meadows Court House. 
• Comm. Aguilar inquired about a federal grant that was cancelled and wanted to know if they were going to reapply. He was informed that they saw no need to reapply as the new restrictions on the grant would preclude them from getting it. 
• Comm. Degnan asked about the services they provided. She was informed that they help with disability and pension claims and can can help get them to partner institutions such as the Jesse Brown Medical Center and Hines VA Hospital. There are 141,000 veterans in Cook County. 

Assessor - Fritz Kaegi
Key points from his presentation to the commissioners:

• His office has been working on Transparency and Outreach.
• He attended the meeting of National Association of Counties (NACo) last week and the assessors from other large counties were there. They drafted a policy recommendation concerning data sharing that was approved by NACo.
• Have been able to fill many of their vacant positions and anticipate only 9 vacancies by the end of the year. 
• He is advocating at the state level that the Senior Freeze become an automatic renewal. 
• He states that he is on track with his part of the Road Map that was developed for making the tax process more fair in Cook County.
• He states that what is still needed is: 1. Making  commercial assessments more fair and 2. Enacting a Tax Relief Program (Circuit Breaker)

Commissioner Comments and Questions:

• Comm. Degnan asked about tax rates and Mr. Kaegi stated that part of the Road Map deals with this and he says that is the most important recommendation in the report. They need to work with the Board of Review (BOR) to refine their methodology and determine how the tax rates are going to be used. Tax rates in Cook County are volatile and this needs to be addressed. She also asked about hiring and he stated they have hired 40 people and anticipate only 9 vacancies by year end but he is proposing 21 new positions for next year to increase the number of commercial analysts. 
• Comm. Aguilar asked about how the transition to the Tyler system is progressing. Mr. Kaegi referred him to the dashboard and said they did the hard work of switching in 2021 and now the other offices (the BOR and the Treasurer) have to do the hard work and he supports them in their efforts. 
• Comm. McCaskill asked about what can be done to help the southern area of Cook County which just can’t keep up with the increasing assessments. Mr. Kaegi again referred to the Road Map that was developed in December and outlines what needs to be done by those involved and what can be worked on with legislative action. He said that Certificates of Error (for those who overpaid) will be issued as soon as the Treasurer’s Office goes live on the new system. 
• Comm. Stamps wanted to know why tax rates vary, Mr. Kaegi said that the tax rates are a reflection of house value as the formula is levy/value of property in the tax base. To help equalize this he thinks that the Homeowners Exemption should be increased and the proposed Circuit Breaker program in the state legislature should be approved. It would provide assistance for those homeowners that get a spike in their tax bills. 
• Comm. Trevor was concerned with the income levels that determine eligibility for the Senior Exemption. They perhaps need to be adjusted. 
• Comm. Daley asked about the appeal rate of success. Kaegi stated that 1 in 4 are successful at the Assessor level and you are better off to apply on your own than use a lawyer. 
• Comm. Britton stated that his district has lots of appeals. Mr. Kaegi stated that 90% of reductions are in commercial properties. 

Secretary to the Board - Lynne Turner
Highlights from her presentation:

• This office has 13 allocated positions and hiring has been going well with only 1 vacant position for a Legal Counsel which she hopes will be filled soon. 
• Office’s primary goal is to provide support to the Board and Tim Casey is the Legislative Director. Responsibilities  of the Legislative Unit include managing legistar, ensuring that notices meet requirements, creating agendas and minutes, videos, dealing with comments etc.
• The new Board Room will have electronic voting so they will be dealing with that change.
• Victoria Sockwell is in charge of the Archives Unit for the office that will preserve and provide records. Now doing an inventory of all items and planning for a new facility. Eventually will digitize paper records. Discovered a Time Capsule from 1906. Planning for Bicentennial in 2031 and will have a new Time Capsule. 

Commissioner Comments and Questions:

• Thanks from Comm. Daley, Lowry, Britton, Trevor, Aguilar and Stamps for the assistance from her office and for their great work.
• Comm. Anaya also expressed thanks and then asked about the timeline for the new Board Room and the Commissioner’s Offices. Ms. Turner says her understanding is that there will be substantial completion of the Board Room by December. A representative from Asset Management indicated that his understanding is that offices will be ready by September. She also asked about the County Historian. Ms Turner stated that the ordinance is for a volunteer and at present that position is not filled. 
• Comm. Anaya also asked about an ordinance recognizing the female commissioners. Ms. Turner stated that they are researching to be sure they include all women and hopefully an ordinance will be introduced in September. 

Observer - Cynthia Schilsky

                          County Pension Funds Compare Favorably to Peers
Pension Committee
The Executive Director of the Cook County and Forest Preserve District Pension Funds updated the Committee on where thing stand.  Both funds are doing well as compared to most of their peers at the State and Chicago levels.  (Item 23-1176)

• Cook County’s Fund is currently 65.9% funded and is on track to be fully funded by 2047.  It currently has a return of 9.54%, with a 10 -year return of 7.2%.  The goal is to have a 7% return annually.  There are now more people receiving payouts (the annuitants) than those paying into the Fund (the current employees).
• Forest Preserve’s Fund is currently 54.6% funded and is on track to be fully funded by 2054.  It currently has a return of 9.09% with a 10-year average of 6.8%, again with a goal of 7% return annually.  The ratio of current employees to annuitants is about 1 to 1.
• Cook County’s Fund has done better because of the extra payments the County made as a result of the Sales Tax increase that took effect in 2016 (voted on in 2015).  In response to a question from Comm. Daley, the Executive Director said that, but for those additional contributions, the Cook County Fund would likely be only 50% funded now.
• Both funds will continue to do better as a result of the 2023 legislation that was passed by the State which now allows increased payments to the funds based on actuarial estimates.  The Executive Director said that both Funds are now paying out more than taking in, but for the additional contributions now allowed by that State Statute.
• The Executive Director said that the biggest risk for the Funds now is the antiquated pension administration system, but a new system has been selected following a Request for Proposal, though that will take 3 to 4 years to fully implement.
• Comm. Sean Morrison asked that a breakdown on which assets are performing better than others be provided to the Committee.

Observer:  Priscilla Mims

           Commissioners Hear Updated Immunization Recommendations
Health & Hospitals Committee
Dr. Joshi, COO of the Department of Public Health presented Federal updates on immunization recommendations from the CDC Advisory Committee on Immunization Practices (item 23-3815) 

• For children, vaccination is now advised through shared clinical decision-making between families and healthcare providers
• Adults encouraged to receive COVID-19 vaccination based on risk
• For adults over 65, two COVID-19 vaccine doses annually are now officially recommended.
• Maternal COVID-19 vaccination removed from the recommended schedule, despite compelling evidence of benefit for infants under 6 months
• Recommendations against flu vaccines containing thimerosal issued, despite the lack of evidence of harms
• Commissioner Trevor asked if the Dept. of Public Health was going to continue to provide vaccines despite the Federal recommendations and whether Medicaid/Medicare would continue to cover them.  Chair Lowry answered that these issues would be discussed at a September Committee meeting with Dr. Joshi and the Chief Administrative Officer of CountyCare attending.  Dr. Joshi said he is working with Illinois Dept of Public Health, as well as with a number of National medical organizations on this issue.

CCH Semi-Annual Utilization Report:

• Cook County Health (“CCH”) is required to file this Report on the CCH utilization of Agency (temporary workers) as a % of budgeted Full Time Equivalents (FTE) personnel for each job classification approved in the annual budget by the CC  Board.  Goal is less than 20%. This report for the 6-month period ending May 31 shows that 14.3% of budgeted FTEs were Agency.  Chair Lowry noted this was due to the success of  the new CCH Agency Use hiring process. (item 25-3055) This item was approved.

All the semi-annual reports on behavioral and mental health were received and filed:

• CCH Office of Behavioral Health semi-annual mental health report, April 2025.  (item 25-3013)
• Cook County Office of the Chief Judge: Semi-annual Behavioral Report (Item 25-3109)    
• Cook County State’s Attorney Report: Behavioral Services 12-1-24 through 5-31-25. (item 25-3111)    
• Cook County Public Defender’s Office, Behavioral Health Report, December 2024—May 2025  (item 25-3094) 
• Cook County Sheriff’s Office Report: Semi-annual Behavioral Health Report ;Dec. 2024—May 2025 (item 25-3026)

Observer:  Susan Kern

   Commissioners Raise Need for South Suburban Violence Intervention Services
Finance Committee
The primary discussion dealt with several items allocating ARPA (the Federal American Rescue Plan Act) and Equity Funds for violence prevention and wrap-around services for gun-violence victims, and evaluation of programs.  (Items 25-0703, 23-0704, 25-0705, and 25-3154)  All were approved.

• Comm. Anaya noted that investments in these areas appear to be working with the falling levels of violence.  In response to her question, Avik Das, the Executive Director of the Justice Advisory Council (“JAC”), explained that the ARPA funds are being reallocated among programs to ensure that all the monies are spent by the end of 2026, an ARPA requirement.  This reallocation was not based on merit, but on the program’s ability to spend the dollars by the deadline.
• Comm. Miller and McCaskill both lamented the lack of any entities receiving funding for violence prevention and services in the South Suburbs.  Mr. Das explained that the JAC is not receiving requests from entities to provide such services.  Comm. McCaskill suggested that one impediment is that there is a $500,000 operating budget threshold before an entity can apply.  Mr. Das explained that experience has shown if an entity is too small, they spend much of the grant in trying to administer it, rather than in providing services.  One possible solution to build up an entity’s administrative capacity is the program that began this year to provide block grants for such smaller entities.  Comm. Miller also suggested that there may need to also be a task force to get existing entities to extend their operations to the South Suburbs.  
• In response to questions by Comms. Lowry and Stamps, Mr. Das explained that there is a pool of reviewers for each grant from the community and the JAC, with 3 reviewers from the pool for each grant.  The JAC also discusses needs identified by the Criminal Justice officers and takes those into consideration when determining the grants.
• Separately, Comm. Gainer asked where the 2nd quarter report from the Equity Fund was.  Chair Daley said he would pursue that.
• The Comptroller reported that through the 6 months ending May 31, the General Fund is showing a favorable result (revenues minus expenses) of $107.4 M as compared to budget.  Cook County Health reported an overall unfavorable result of $66 M on an accrued basis. (Items 25-3322 and 25-1171)

Observer:  Priscilla Mims

                                    2004 Annual Audits Reflect Fewer Issues
Audit Committee

• Two outside auditors, RSM, and Washington, Pillman, and McKeeve reported on their findings on the annual audits of Cook County and Cook County Health financial reporting.   Both found the Cook County employees very helpful.   There were fewer findings this year than last and there were no repeat findings.   Errors were corrected and  action plans to improve procedures are in place or have a target date. All audit reports were received and filed:

25-2998:   Cook County Comprehensive Financial Report (annual audit) for fiscal year 2024.
25-2999:   Report to Audit Committee, President and Board regarding the Audit.
25-3000:  Report on Federal Awards and compliance.
25-3001:   Cook County Health Financial Report (annual audit) for fiscal year 2024.
25-3002:   Report to the CCH Audit and Compliance Committee and Cook County Board. 
25-2928:  (Maria Pappas, Treasurer) Fiscal Year 2024 Audit. 

• The Committee was given a review of the actuarial study done by AON Global on the projected reserves needed for liabilities from Workmen’s Compensation and other Cook County self-insured liability programs.   The reserve estimate for the claims filed for the 2024 fiscal year that remain outstanding was between $178.5 and $257 million.  Item 25-3003 was received and filed.

Observer:  Kathi Graffam

Projects for Sheriff, Chief Judge And Medical Examiner Recommended for Approval
Asset Management Committee
James Essex of the Real Estate Management Department presented two major construction projects to improve Cook County operations.  Both projects were approved.

• The County is purchasing property from the BNSF railroad which is adjacent to the jail to build a new facility to house the Sheriff’s vehicle maintenance department and offices to house the Chief Judge’s electronic monitoring operation.   Item 25-2994.
• A new up-to-date Medical Examiner’s Office (MEO)will be built close to the existing one in the Illinois Medical District (IMD) area. The current office does not have the technology or space that is needed for a county with our population.   Besides the technological upgrades needed,  private spaces are also need for decedent families, as well as facilities for law enforcement.  Item 25-2995
• The Real Estate Department proposes a land swap with the Illinois Medical District Commission (IMDC).   Cook County will be able to maintain operations in their current location, while building the new office and a parking structure.   The County will pay rent to the IMDC while the construction takes place.    The County will then tear down the old MEO and provide the IMDC with a clean site.  
• The Commissioners supported the need for a new facility.    Commissioners Britton and Degnen both questioned the proviso that the site turned over to the IMDC will be “clean” because that could entail significant work and costs. Commissioner Degnen pointed out that the level of remediation needed should be dependent on the future use.    If another building is put on the site with a concrete cap, less remediation would be needed.
• There is going to be a Construction Manager at Risk for this project and Commissioner Scott urged that local people be employed and diversity goals be met.

Observer:  Kathi Graffam

                           Commissioners Recommend Appointments
Legislation and Intergovernmental Relations Committee
Candidates for the following positions made statements to the Committee, which then voted to recommend them for approval at the July 24 Cook County Board Meeting.

• Jonathan Mark Currin to the South Cook Count Mosquito Abatement Board (3 yr term).  He holds a BS/Engineering from the UI-Urbana and has served as the Director of Field Services for the local gas company and as a process improvement consultant.  He stated that his priorities are to ensure a schedule of treatments with prior notification to residents and coordination between adjacent areas.  Commissioners requested direct communication with the District 6 Commissioner (Donna Miller) whose district is included in the Abatement District.  Comm. Britton will send out the North Shore Mosquito Board report as a standard to be followed by the other Mosquito Abatement Boards. Item 25-2855  
• Heath Wolfe as Head of the Cook County Auditor’s Office (5 yr term).  He stated that he has 34 years of Federal Audit experience.  There were no questions or discussion from the Commissioners. Item 25-3110  
• Shar Segal as member of the Cook County Board of Ethics (4 yr term).  She has a J.D. from Univ. of Chicago.  She stated that her priority is to ensure that decisions are made in the best interest of the people over any other reason.  There were no questions or discussion from the Commissioners.  Item 25-3112  

Observer:  Susan Gregory