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Cook County Health Mid-Year Budget Hearing

8/6/2023

Cook County Board Finance Committee – Mid-Year Budget Hearings
July 26, 2023 –

Cook County Health - Israel Rocha, CEO.
2024 Preliminary Budget: $4,034.9 Billion Revenue

Mr. Rocha began by stating that Strategic Plan mission is to compete head on with any health care system in the world. The primary issues discussed during the two-hour hearing were:

Dental Care - Nurses Hiring & Reduction of Agency staff
Abortion Care - Asylum Seekers and the Undocumented

Dental Care

CCH currently has six clinics outfitted to provide dental care. Blue Island is the latest at a cost of $236,000 for space preparation and equipment. The issue is finding staff to provide the dental services at all the locations. Mr. Rocha said the System is look at options and may start sharing staff.

Abortion Care

Commissioner Britton asked about out of state patients seeking abortion care. Mr. Rocha said that the CCH has seen an increase in services needed, particularly with complications.

Hiring & Reduction of Agency Nursing Staff

Mr. Rocha noted that year to date, 800 hires have been made, and turnover is down. The System’s 6.1% turnover is lower than the industry average, but he noted that the average age of the workforce is 51 years. The number of current vacancies is 2,314. When asked about when the use of agency nurses would be reduced, Mr. Rocha talked about the HR’s recruitment efforts for nurses including the very successful job fairs with same-day conditional offers, signing and retention bonuses, and the increased emphasis of benefits such as pension, health, personal leave, and full tuition coverage after one year of service.
Later in the discussion, Commissioner Gainer said that the CCH will always have to rely on agency help, particularly for nurses. Her point is that a realistic number should be set each year for needed agency help to which budget numbers can be assigned.

Asylum Seekers and the Undocumented

As a reminder, the System serves all residents of Cook County regardless of their citizenship or ability to pay. The influx of Asylum Seekers over the last 6-8 months has resulted in unbudgeted expenses. Belmont Cragin is the entry point for health care screenings. Mr. Rocha said that the cost to date has been about $1-$1.5 million per month, but total costs for 2023 are projected at $26 million. Commissioner Morrison asked if the cost of the Asylum Seekers and the Undocumented could be separated for future budgets. Mr. Rocha said that patients are not asked if they are in the US legally to avoid a chilling effect. on seeking care. Some of the undocumented cost is covered by Medicaid and the rest falls under the Charity Care expenses line.
Overall, commissioners were very complimentary of Mr. Rocha’s leadership and progress. Commissioner Miller said that CCH has gone from being a model of reactive care to a model of preventive care.

Observer: Diane Edmundson

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Mid- Year Budget Hearings

8/6/2023

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Cook County Board Finance Committee – Mid-Year Budget Hearings
July 25, 2023 - Afternoon Meetings

Inspector General – Steven Cyranoski, Interim IG.
$2.3 million Preliminary 2024 budget

At midterm, 15% below 2023 budget. Year-end projection: Under Budget
Budgeted for 19 FTE’s. Currently: 3 vacancies [IG, Deputy IG, Investigator]
No commissioner questions

Public Administrator – Louis Apostal. $1.7 million self-funded 2024

738 investigations to find rightful inheritance ownership
70 properties under management
15 full-time staff – unionized office. 5 outside attorneys
2024 budget will increase by $137,000 – primarily increased compensation costs

Cook County Clerk – Karen Yarborough. $20.6 million Preliminary 2024 budget

Chief Election Officer and responsible for maintaining and providing vital records
No longer under Shakman and received several compliments for achievement
Increased vacancies of between 25-30 due to retirement and termination
Elections: Additional language ballots will be offered along with information sheets in that language.
Commissioner Aquilar asked why a pension deduction was taken out of Election Judges checks. Ans: there is a glitch in the system which is being addressed.
Availability of Election Judges was a question: Ans: The shortfall has been filled by veterans, community college students that can earn a credit for taking a course on being an election judge, civics, and cyber security.
Question: Security of elections and voting by mail. Ans: Election ballot drop boxes are located at early voting sites and are monitored.

Board of Review [BOR] – Cardenas, Steele, Rogers.
$18 million Preliminary 2024 budget

Currently, analysts are working 20 hours mandatory overtime to get appeals processed and sent to the next office for mailing out the 2022 tax bills which are already late.
The BOR asked for money to bring each of the 3 Districts to 50 analysts. Currently a total of 105 analysts. Daley asked if granted, could the Board guarantee that the tax bills will go out on time. Ans: No as there are too many other offices involved in the process. Said it is anticipating 400,000 appeals in 2024. The previous analyst ratio was 1-1200 appeals. Now 1-1600 appeals.
Steele, who has 17 years in the Assessment Industry including the CC Assessor’s office, noted that the Assessor looks at properties in comparable groups while the BOR reviews each property individually.
Steele published a BOR report for 2022 and is in the process of working on a Standards Manual.
February’s request for a cost comparison between switching to or fully integrating with the Tyler system should be ready in late August. Cardenas noted that the BOR has just two IT employees.
Cardenas said that transparency is at the front of the BOR’s mission, and that it has already reduced the appeal time by 6 weeks. He also said the website has been improved as have FOIA responses

Land Bank – Jessica Caffrey, Executive Director. Primarily self-funded
Ms. Caffrey is relatively new to the Land Bank having worked for the County in previous roles including coordinating the development of the Old Stroger Hospital and the building of the Cook County Health’s Administrative Building on Polk.

The Land Bank’s goal is to “create the market” by acquiring 4-5 houses per block in a blighted area which can change the entire block and market
It acquires vacant, available property through tax sales and other means
96% of all its properties are resold to homeowners
$9.8 million in real estate value has been created in Inglewood
Created $2.5 million in revenues as of May 1, 2023
Reduced aged inventory which is property that is on the books over two years
Staff: 13 positions including 3 vacancies.

Observer: Diane Edmundson

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Cook County Board Approves Programs to Help Communities

8/2/2023

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Cook County Board of Commissioners Meeting
July 20,2023

Board Action:

Approval of the use of $1.2 M in ARPA funds for projects in the Proviso and North Lawndale areas to house recently released prisoners. Besides housing, residents will be provided with wrap-around services. It is estimated 300 people will be serviced. (Agenda Item 23-2303)
Approval of $333,000 to help Cook County communities build emergency readiness. (Agenda Item 23-2677)
Approval of up to $18M in ARPA funds to be awarded to the MWRD. The MWRD will manage 16 projects for stormwater management. The program will help communities implement current projects and also help them plan for future needed projects. (Agenda Item 23-3566)
Approval of an appropriation of $7.7M for the Invest in Cook County Program for 2023. This grant program contributes to Cook County communities’ transit, pedestrian, and roadway improvements. Since its initiation, Invest in Cook County has given grants of $56 M. (Agenda Item 23-3911)

Observer: Kathleen Graffam

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Cook County Board Committee Meetings

8/2/2023

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Cook County Board of Commissioners Committee Meetings
July 19, 2023

Legislation & Intergovernmental Relations Committee

Item 23-3320 Recommended for approval The Committee approved an amendment to the Inspector General selection ordinance which required a bipartisan committee of equal number of Commissioners from different parties. Since there is only one Republican commissioner now, the ordinance had to be changed. The change was that if there is not enough representation of both parties, the President can appoint another commissioner.
Item 23-3719 Recommended for approval Amends the ordinance covering sick leave to add that it may be taken for mental health issues.

Finance Committee

Item 23-3116 Deferred The item was for the approval of the use of $20 M in ARPA funds to assist suburban Cook County residents pay water bills. Money could go to pay directly for a person’s water bill. The plan was to use CEDA (The Community and Economic Development Association) as they currently help individuals with their water bills. CEDA is about to lose its federal funding. The funding would also go to help a municipality with a high-water burden. That program is to be managed by Elevate, a private company. Elevate would need to negotiate with the municipality to ensure that the funds would go to pay for water, that fees and rates would be modified for residents, and that resident water would not be turned off. At this point it is not known which suburbs would participate and what the conditions would be. Commissioner Daley asked what suburbs would be targeted and what reports would there be. Commissioner Degnen suggested a smaller amount be authorized to initiate the programs and when more details were available, more money could be given. Since there were so many unknowns the item was deferred.
The second part of Item 23-2116 was authorization of $1.24M to implement a Community Information Exchange Program to share client profiles among healthcare and social services. This would allow more holistic care to an individual and build connections among providers.

Transportation Committee

Item 23-3259. Recommended for receiving and filing. This was a report on a pilot program in South Cook, The Fair Transit Program, that is subsidizing fares on Metra and Pace to encourage the use of public transportation in the south region. The Metra Electric has seen ridership return to pre-Covid levels. The Commissioners approved the continuation of the pilot.

Health & Hospitals Committee

Behavioral Services Reports from CCH, Sheriff, Office of the Chief Judge, State’s Attorney, and Public Defender were reviewed. The Committee recommended for receiving and filing.
Much of the conversation focused on substance abuse programs. CCH is finding that recovery coaches who continue a relationship with a patient after they leave the hospital have shown to help the patient stay clean. They are also implementing emergence naloxone vending machines in neighborhoods, where residents can get this to help with overdoses.
The Sheriff’s office reported that the jail does individual assessments on new inmates and it has its own substance abuse programs that are offered to the inmates. They also give released prisoners naloxone if indicated.

Asset Management Committee

Item 23-3313 Recommended for approval This contract contained several capital projects.
Earl Manning, Director of the Office of Capital Planning and Policy , has established a pre-qualified program for small minority firms to make it easier for them to participate in smaller projects. The businesses do not have to submit the paperwork for each potential job as in the past.

Contract Compliance Committee

Item 23-0820 Recommended for receiving and filing. This was the annual diversity report. Nicole Mandeville, Director of Compliance, reported on the past 4 years of county spending on contracts. 32% of contracts in 2022 went to M/W/DBE owned companies.

Audit Committee

Items 23-3381 & 23-3378 Recommended for receiving and filing Outside Audit of Cook County for fiscal year 2022. The auditors did see errors in accounting entries for CC and CCH which required adjustments for the financial statements. There were weaknesses in the controls on the Oracle accounting system such as not deleting terminated users. The auditor recommended allowing more time to close the books at year end to find needed corrections.
Item 23-3382 Recommended for receiving and filing Report on Federal Awards There were findings of non-compliance with Federal Grant Awards requirements. Commissioners Degnen and Daley noted this was more than usual. Commissioner Degnen will be meeting with the department to discuss improvements in process.

Observer - Kathleen Graffam

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Mid-Year Budget Hearings

8/2/2023

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Cook County Board Finance Committee
Mid-Year Budget Review Meetings on July 25, 2023

Budget Overview

Revenue will decline next fiscal year because the State has changed the statutes on sharing the Personal Property Tax (part of the corporate income tax) and Cook County will see a change from $133M this year to $75M next year.
Sales tax will remain level
Income from County Care at CCH will decline because participants have to go through Medicaid redetermination post Covid and it is projected there will be less members.
Labor costs will increase $27M and IT costs will increase $20M next year.

Cook County Health (CCH)

FY 24 will have a shortfall of $3M due to the redetermination and increased labor costs. The union agreements included retroactive COLAs.
Asylum seekers medical costs have been $26M this year.
CCH has managed $265M of ARPA funds in 70 programs. They provide monthly reports on the programs to the Board. There is a sustainable working groups looking at how to continue the programs after 2026 and the end of ARPA funds.

Office of the President

Cook County reporting of ARPA funds is good according to Results for America.
$281M of medical debt of individuals has been paid by Cook County.
$110M has been spent for reducing gun violence. Cook County is working with the City and the State on this issue.
Technical help has been provided to 13,000 small businesses.
Commissioner Sean Morrison asked for more detailed reporting on the medical debt elimination—how are recipients chosen, which hospitals and locales.
Commissioner Gainer asked if HR hiring process is improving. Ms. Turner said that was being reported in the Performance Management website.

Chief Judge - Tim Evans

The court system now has a permanent hybrid process.
The courts will need more employees to support the Safe-T act for night and weekend shifts.
Judge Evans explained the operation of the restorative justice program and its success in decreased recidivism of its participants compared to people who go through the regular court system.
Commissioner Gainer asked for more reporting on the residents in the Juvenile Detention Center, particularly in education. There have been reports that special needs students are not being accommodated.

Sheriff - Tom Dart

The jail will be within budget for FY 2023.
Sheriff Dart explained why there was a need for a new helicopter, particularly for use in carjackings.
The sheriff office provides back up for many suburban police departments. They are the only police in Ford Heights, Dalton, and Harvey.
The office implemented a mental health incident support program. Responders are trained on de-escalation procedures and provided a tablet that they can use when dealing with a mental health crisis. The tablet connects them with a mental health expert to help them deal with the issue. This has been implemented with 15 communities.

Observer: Kathleen Graffam

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Tax Bills, Vacancies, and New AI Unit Discussed on Second Day of Mid-Year Budget Meetings

8/1/2023

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Cook County Board Finance Committee
Mid-year Budget Meetings on July 26, 2023
with Assessor, Public Defender, State’s Attorney, Clerk of the Court, Treasurer, and Secretary to the Board

Assessor - Fritz Kaegi

Current priorities are to (1) finish reassessing the southern and western suburbs, (2) work with the other County offices involved with the property tax bills – Board of Review, Clerk, and Treasurer -- to get everyone off the main frame, and (3) execute the office’s hiring plan to fill vacancies. Regarding the latter, the office will have brought on board 43 people, but expects to have 39 remaining vacancies by the end of the fiscal year. It is taking the Assessor’s HR department about 70 days from the time of job posting to onboarding a person, which is significantly less than the Bureau of Human Resources under the President.,
Says that office will finish its reassessment work 2 months earlier than last year, though the office is still behind timeline from pre-Covid years. Bills are expected to go out by Nov. 1, a month earlier than last year, but 4 months later than the goal of July. Assessor said the working group of reps from the tax offices led by the President’s office has made a lot of progress and everyone is working diligently to get the timing of tax bills back on track for 2024.
One of the issues that remains is the interface between the Tyler system in use by the Assessor and the system on the main frame used by the Board of Review. To make the interface work requires extra time, which is why filling vacancies is so important.
Assessor touted the new system, saying processing appeals in the Assessor’s office is taking half the time it used to. Assessor said that the improvements the office has made in doing accurate assessments can be seen in the reduction in the number of appeals during the last 4 years from about 500,000/year to 300,000/year. Assessor also said that his web site has all the information as to how the assessments were arrived at.
Both Comm. Britton and Gainer raised the need for the Assessor and Board of Review to utilize the same criteria for assessment.

State’s Attorney- Kimberly Foxx

To deal with retention in order to eliminate vacancies, the office has a policy allowing remote work 2 days a week, retention bonuses have just started, and the parental leave policy in the office was just updated 2 weeks ago. In addition, for the first time, the office is doing exit interviews to understand why people leave. A salary study is underway, comparing internally as well as externally to other governments.
The State’s Attorney will provide the number of days from job posting to onboarding, but knows it is much less than the Public Defender’s office which takes 150 days. The Public Defender uses the Bureau of Human Resources; the State’s Attorney has its own HR department.
The expunging of criminal records for marijuana use has been completed. Over 15,000 records.

Clerk of the Court - Iris Martinez

Touted the accomplishments of being found to be in substantial compliance with Shakman; new web site receiving awards; fully implementing the Odyssey case management system as of December 2022; initiating a Customer Service Call Center as of June 2023, which is handling about 1200 calls/day; and the expected roll-out of an online case search in August.
Explained that revenues from the office are down due to the number of court fee waivers that judges are giving. But that means less burden on those going to court.
While vacancies are listed as 364, the Clerk said the true number is 207.

Treasurer - Maria Pappas

Treasurer started with good news: expects to have $35 M more in revenues for late payments over what were budgeted. The County’s payment plan for property taxes is 1.5% per month, which may be incentivizing late payments. The office is going to be issuing a study soon on who is paying late and why.
Treasurer announced the development of a new Artificial Intelligence Unit in the office. She will provide more details about that during the budget meetings in October to support the need for more programmers.
Comm. Britton asked about online payments because of people who have mailed checks for property taxes that have been stolen. Treasurer said there are about 75,000 online payments. When her office learns of stolen checks, it contacts the banks which often can discover through videos who cashed the check.

Secretary to the Board - Lynne Turner

Office has 12 positions, 6 of which are currently vacant (!) including the Archived Manager.
Nevertheless, the office is still supporting 102 public bodies, 1500 public speakers a year, and 500 meetings a year. Hope to roll out closed captioning on the videos/streaming soon.
The new Board room is likely still 2 years away. Would like to utilize electronic voting, but currently haven’t found a system that could accommodate Commissioners attending remotely. Secretary would like to implement because currently the office has to hand type all motions and votes into the online system after meetings.

Observer: - Priscilla Mims

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Cook County Health Mid-Year Budget Hearing

Mid- Year Budget Hearings

Cook County Board Approves Programs to Help Communities

Cook County Board Committee Meetings

Mid-Year Budget Hearings

Tax Bills, Vacancies, and New AI Unit Discussed on Second Day of Mid-Year Budget Meetings

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