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Negative Financial Impact on Cook County Health Budget Expected Due to Migrant Health Care and Medicaid Redetermination

4/28/2023

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Cook County Board of Commissioners Committee Meetings
Wednesday, April 26, 2023

Finance Committee:

Comptroller Laurence Wilson presented the January Revenue report for Cook County Health (CCH), which was mostly on budget and the 2022 year end report which had no significant variances.
State of Illinois is frequently late on reimbursement to CCH.
About $1billion will be spent on immigrant health; the question is “Who Pays?” —County, State, Federal governments?
In addition all Medicaid recipients need to reapply (redetermination). About 1 million more residents are on Medicaid now than before the pandemic due to expanded program and not being required to re-enroll during that time. There will be a monthly rolling basis of redetermination with letters going to current Medicaid recipients. It is expected that County Care (the Cook County insurance program) will lose members and thus money due to fewer being qualified.

Audit Committee:

Auditor Mary Modelski gave an update of Open Recommendations from the Auditor’s Office to various departments regarding large projects and department practices.
Human Resources Dept. disagreed with many recommendations, particularly with on-boarding new employees and trainings, and so declined to follow them. The Auditor can recommend, but not require these to be followed. It would be up to the Cook County Commissioners to follow-up/change rules, etc.

Environment and Sustainability Committee:

A resolution calling for further federal action and accountability in connection with Norfolk Southern Corporation’s Operations (Agenda Item 23-1939) was passed in committee. This relates to the recent derailing in Ohio which released toxic materials. The sponsor, Commissioner Quezada wanted “to demonstrate solidarity with Ohio and ensure safety of rail systems.”

Technology and Innovation Committee:

The Technology Department presented updates on several large projects.
The IPTS Property Tax Project (which has been a source of controversy and blame) will “go live” in October or November if the property tax bills go out on time. There will still be two separate systems (Assessor and Board of Review) but with an interface so that the same data is seen by both departments. The future goal is for both these offices to be on the same system (Odyssey or Tyler) and off the main frame computer which is about 40 years old.
Getting off the main frame system is the main goal for the Technology Department for numerous County depts.
The Criminal Justice BUS computer system works and has been ready to go. This system computerizes the CJ data and information for easier access and reliability. However, it was noted that paper carbon copies are still being used. The solution (BUS System) is there; but not all departments are using it.

Observer - Karin Hribar

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Cook County Board Gets Financial Update

3/22/2023

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Cook County Board of Commissioners - Committee and Board Meetings
March 15 and 16, 2023

Finance Committee March 15

The Comptroller gave a report. (#23-1270) The state of Illinois owes Cook County $318 million. Commissioner Sean Morrison noted that the State is slow to distribute sales tax revenue from the Local Government Distribution Fund. Commissioner Brittan recommended organizing a lobbying effort with the State to improve the distribution.
Dean Consentino of the Independent Revenue Forecasting Commission gave a long term forecast of Cook County revenue and expenses in the General Fund. It is projected that there will be sustained slow economic growth. The projected inflation could impact sales tax revenue. While the revenue will grow less over the next five years, the expenses will increase at a higher rate. In the Health Fund, the Medicaid re-determination will decrease the number of recipients, increasing the costs to the Health System. Their projections did not include continuing the current programs being funded by ARPA funds.
Cannabis tax revenue goes to the Equity Fund.

Contract Compliance Committee- March 15

Agenda Item 23-0936 - Nicole Mandeville, Director of Contract Compliance, presented the proposed changes to the Minority and Women Business Enterprise (MWBE) section of the Procurement Ordinance. They are to extend the ordinance until 3/31/28 and change how the net worth of a woman business owner’s wealth would be calculated. Some illiquid assets would no longer be counted. After initial certification, the business would have to confirm its financial condition and submit tax returns. They would not have to be certified every year. The changes came from a disparity study that is done every five years. Public speaker Mary Kay Moynihan, Women’s Owned Construction Group, expressed concern the ordinance might be challenged once some current cases at the Supreme Court are settled. Ms. Mandeville and the Contract Compliance lawyer, Laura Lechowitz stated that the goals in the ordinance are legally defensible. MWBE goals are set for each individual contract.
The Committee recommended approval. The Board of Commissioners approved.

Technology & Innovation Committee March 15

Agenda Item 23-1334 The Chief Information Officer’s annual report was recommended to be received and filed. There was no discussion, but committee members had met individually with the CIO.
The Board of Commissioners voted to receive and file.

Legislation and InterGovernmental Relations Committee March 15

The Committee met with Sukemeke Watkins and Lizbeth Leanos of the lobbying team from the Office of the President. They reviewed various bills that the County is supporting at the State and Federal levels and discussed arrangements for the County lobbying day in Springfield.

Cook County Board of Commissioners Meeting
March 16 10:30 AM to 1:10 PM

The Board of Commissioners approved previous Committee recommendations with little discussion. Several public speakers complained about the steep increases in property taxes in the Pilsen area. Commissioner Anaya has organized programs on how to appeal the taxes and request exemptions.

The Board honored Secretary of State Jessie White on his retirement. Most of the Commissioners spoke to his service to the County and State and his Jessie White Tumblers Program which has served 18,000 kids over 65 years.

Board Action:

Agenda Item 23-1606 The Board approved ARPA funds to subsidize installation of solar technology for residents.
Agenda Item 23-1609 The Board approved ARPA funds for the Housing Authority of Cook County and the Justice Advisory Council to aid people getting out of prison in obtaining housing.
Agenda Item 23-1647 The Board referred the Report on Major Technology Projects to the Technology Committee.

Observer: Kathi Graffam

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Cook County Board Committee Meetings

3/22/2023

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Cook County Board of Commissioners Committee Meetings
March 14, 2023

Pension Committee - Chair, Bridget Gainer
Agenda Item #23-1178. Was the only item of significance and covered proposed CC Pension Legislation changes currently in the IL General Assembly. This resolution called for a hearing of the CC Pension Committee to discuss the financial implications of this pending legislation. The statute change if passed will do the following:

Codifies the current practice of allocating extra funding via an intergovernmental agreement to ensure the Fund is fully funded by 1047.
Provides flexibility by lifting source restrictions - thereby allowing the County to use any funds available that could be used to make additional contributions to the Pension Fund.
Health Care Annuitants already covered out of CC pension assets would obviously benefit by a fully funded pension fund.
Adjusts employee Salary Cap on retirement contributions to be in line with Social Security compensation cap.
Expands eligibility to receive up to 2 years of credit for military service.
Enhances Pension Board Membership - Currently the President appoints the Treasurer and the Controller of the Pension Board. The other members (currently 5) are elected from the workforce. Two additional members would be appointed with actuarial and/or accounting experience and perhaps two more elected. Commissioner Gainer wanted to have even more management appointments to have an even split between workforce and management. That does not appear to have the support.

It was noted that the Board does not have the authority to approve or reject the legislation. The Bill putting forth the tenants of the proposed legislation is on its 2 reading in both the house and senate committee process.
After discussion, Commissioner Gainer said that this resolution calling for this hearing would be deferredpending information on the fiscal impact of the expanding the military service eligibility provision.

Health And Hospital System Committee - Chair Dennis Deer

Agenda Item #23-0469. Dr. Hasbrouck, Chief Operating Officer of CC Public Health, gave a brief slide presentation covering the monthly COVID 19 update. He noted that the both the County and City's transmission rates are categorized as LOW - although less than 20% of the CC residents are not fully vaccinated.
The Public Health Department's Public Relations contractor has refreshed its ad campaign slogan to: Don't wait, Vaccinate.
The COO also covered the 20 grants for a total of just under $16 million dollars that were recently announced for three behavioral health initiatives covering mental health, positive youth development, and opioid addiction. The grants cover a four-year period. Commissioner Miller asked for Metrics and geographic location of services. Dr. Hasbrouck said location information is available now but said that reliable metrics would not be available for 6-8 months as the grantees need time to ramp up and have not yet received the first-year funding.
Commissioner Daley asked for an update on AIDS metrics in suburban Cook County, specifically the south suburbs.
Agenda Item # 23-0311. Deferred at the Request of Commissioner Anaya without comment. Covers a proposed CCH Severance policy to come into compliance with state law and also updates the positions eligible to match the current titles.

Observer - Diane Edmundson

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Cost Comparison of Integrated IT Systems vs Separate System for Cook County Property Tax Appeals to be Undertaken

2/14/2023

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Cook County Board of Commissioners (CCBC) Meeting
February 9, 2023

Board Action:

CCBC approved resolution from the Technology and Innovation Committee for Cost Comparison Assessment and Action Plan from Bureau of Technology and Board of Review on Technology Software. This will provide a comparison to calculate cost to County of creating an integrated automation platform technology to transfer data. The written report of cost comparison will describe and prepare an action plan based on the report’s results. Report is due within 90 days of enactment of resolution. Several Board members commented on the discussion in committee and that members recognized it could be helpful in resolving a long-time issue. Com. Degnan noted that extra time could be provided should Bd of Review require it (23-1174). Approved.
Cook County Covid-019 Response Financial Report passed to Receive and File. The report serves as an update on Coronavirus Relief Fund (CRF), FEMA PA, Emergency Rental Assistance, and American Rescue Plan Act Grant allocations, 3/1/2020-1/20/2023. Per the Report, the County’s CARES Act allocation is 100% expended with final report delivered to US Treasury last month. (23-1268)
Cook County Promise Guaranteed Income Pilot Status Update passed to Receive and File. Potential participants were evaluated and interviewed for eligibility and a lottery was used to select the 3250 persons participating. Surveys of participants, data collection, and update reports will continue for this 24-month pilot program. (23-0469)
Cook County Department of Transportation and Highways reported on projects including an intergovernmental agreement with Metra for improvements to Chicago State University Metra station. County will reimburse Metra for its share of construction and construction management costs. Both items referred to the Transportation Committee. (23-1063, 23-1074)

Of Interest:

Resolution honoring Jesse White was deferred. (23-0992)

Observer - Carolyn Cosention

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Guaranteed Income Pilot and Board of Review Technology Discussed at Cook County Board Committee Meetings

2/11/2023

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Cook County Board of Commissioners (CCBC) Committee Meetings
Feb. 7-8, 2023

Finance Committee

Cook County Health: Cook County Comptroller, Lawrence Wilson, reported Dec. 2022 balances. A net favorable revenue balances of $52 M in General Fund and $49M in Health Fund. State payments to Health Fund with $206M owed, including Medicaid, state direct and pass-through grants have been competed for 2022. CCH Chief Financial Officer, Pam Cassara, reported a net favorable net balance for expenses and revenues for Dec 2022. Receive and File, approved (23-1209).
Cook County Promise Guaranteed Income Pilot Status Report: Slide presentation of highlights and discussion with commissioners was led by Dom Tocci, Deputy Bureau Chief, CC Bureau of Economic Development, Pete Subkoviak, Director of Guaranteed Income and Economic Mobility, CC Bur. Of Ec Dev., Sarah Moran GiveDirectly, US Country Director, and Misuzu Schexnider, Program Director for Univ Chgo Inclusive Economy Lab. They represent the main components of this 24-month guaranteed income pilot. It is funded through AARPA. Of the $42.5M total for the county program, $39M goes to participants, $2.5M (8.5%) goes to administration, outreach, and evaluation costs. Prior to this committee meeting, each commissioner met with these groups.
Here are some details from the presentation and discussion: A total of 3,250 households in Cook County are receiving $500 a month for 24 months. A manual review of 12,000 applicants was conducted; a full list of instruments used for the verification process can be provided. 83% of participants live in the suburbs. If their income status improves during this period, they remain in the program. Application assistance, outreach, and benefits counseling are provided by GiveDirectly throughout the county in multiple languages. There is a control group comprised of applicants who were eligible but not selected to receive funds. Monthly, they conduct a 2-question survey to ensure participants received payments and to check for accuracy of accounts. Payments began Dec. 2022 through either direct debit or loadable debit accounts. Working Credit, a national non-profit, provides education on credit for participants and 1-1 credit-building counseling for 1 year, more if requested. All participants, including those in control group, are eligible for financial counseling. The data from the pilot is being compiled by the Univ. of Chicago Inclusive Economy Lab; they are also processing data from the Chicago pilot. The County’s 2-year collection of data is expected to give more reliable results than the typical 12-month pilots. Commissioners requested that results include information from detailed breakdown of race and ethnicity of participants. Commissioners were also assured that data at the end of the process would be quantitative, not just qualitative. Motion to Receive and file report was approved (23-0548). Video of this meeting is available.

Environment and Sustainability Committee

Resolution in Support of Environmental Justice: Resolution affirms CCBC will assess internal policy and procedures to ensure environmental justice, prioritize projects that will help address past harms in communities impacted by environmental injustice, and work with environmental justice leaders and organizations to adopt a Cook County Environmental Policy by the end of 2024. Motion to accept 23-1092 as substituted. Passed

Technology and Innovation Committee

Resolution Requesting Cost Comparison Assessment and Action Plan from Bureau of Technology and Board of Review on Technology and Soft Solutions: This resolution is intended to address replacing the 40 year old mainframe system with an integrated appraisal and tax administration software solution. Resolutions states the report to Commissioners will be due within 90 days of passage of resolution. Officials from Bd of Review, Bureau of Technology, and Assessors Office were present to answer questions from commissioners. The concerns by CCBC had been expressed in the Jan. 2023 meeting. The resolution is intended to provide numbers for the comparison. Discussion extended over an hour. Tom Lynch, Bureau of Technology, stated 60 days was adequate to complete their portion of the comparison. Board of Review Com. Cardenas, incoming Chair, has been in office 2 months. He stated he has held meetings in his district and within the department; he stated he is aware that with technology there are always better ways to work. The Board of Review has 2 IT workers to address operational issues in the department of 150 analysts working on appeals. He stated that IT would not be able to work with new technology and at the same time respond to analysts’ needs, including new employees, and equipment issues that occur as they work with appeals. Com. Rogers from Board of Review ( BoR) stated many times that the timeline was not realistic since tax bills are now being processed. Appeals are being conducted. He stated tax bills will be late this year and that as of Feb. 1, the BoR has received 22 of 38 township assessments. So late billing will be the result of not receiving all the assessments from Assessor for appeals. Normally, he stated, all assessments would be with BoR by early December. Currently, they are hearing appeals. BoR Com. Steele stated all commissioners were invited to see the draft of the resolution; she apologized if Rogers did not receive a copy of the draft when it was distributed. Scott Smith of Assessor’s Office stated they have met with new commissioners and have a tentative agreement over a calendar for the next round of assessments. He also stated that the BoR had by now (2/8/23) received all the township assessments. Com. Morrisson asked whether BoR would have all the information needed from Assessor’s Office to complete all assessments if it was off the mainframe and interfaced with the system it used. “Yes” was the answer from the Assessor’s Office. Com Degnan stated multiple times that the intent of the resolution was to shine a light on costs when comparing use of 2 systems vs 1 system. She stated that the CCBC could take a request for more time if a reasonable explanation is provided. She stated that the CCBC could not force the BoR to join the interfaced system used by 3 departments involved in the process. Resolution was approved with vote of 6 Aye, 1 Nay, 2 Present. (23-1174) Video is available.

Carolyn Cosentino, Observer

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Cook County Board Approves New Chief Financial Officer and New Chief Administrative Officer

1/31/2023

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Cook County Board Meeting
January 26, 2023

The Board approved:

President Preckwinkle’s appointment of Tanya Anthony as the County’s Chief Financial Officer. Ms. Anthony has been serving as the County’s Chief Administrative Officer and head of the Bureau of Administration. (23-0442)
The appointment of Zara Ali to replace Ms. Anthony as Chief Administrative Officer. Ms. Ali was previously serving as the Deputy Chief Administrative Officer. (23-0556)
The appointments of Mia Webster Cross and Tanya R. Sorrell to the Cook County Health Board. (23-0586 and 23-0595)
The County’s levy of property taxes in 2023. (Note: the Observer Report for the December 15 Board meeting mistakenly stated that this levy was approved then. It was actually referred to the Finance Committee, which then recommended Board approval at this meeting.) Commissioner Daley stressed that the County’s base property tax levy has been in place since 1994! (Item 23-0392)
The Justice Advisory Council’s acceptance of a grant of ARPA funds from the State of Illinois and use of that grant to enter into agreements with 39 entities for gun violence prevention programs: $5 Million to be received and used from Feb. 1 thru June 30 (the State’s fiscal year); and $25 Million from July 1, 2023 thru June 30, 2024. (Items 23-1174 and 23-0767)
The Public Health Department using up to $1 Million of the County’s ARPA funds to implement a Suburban Cook County Worker Protection Program that will provide information to workers to help prevent the spread of diseases, such as Covid. (Item 23-0937)
Authorizing the Chief of the Bureau of Economic Development to enter into a 3-year agreement with the Chicagoland Workforce Funders Alliance to establish a program called “Grow the Talent Solution Ecosystem.” The purpose is to provide employers with channels to meet their talent needs and to provide a directory of career pathway opportunities to employees and job seekers. $300,000 will be used from this year’s budget, and the Bureau will seek to use $300,000 in the 2024 budget and $125,000 in the 2025 budget. (Item 2023-0937)
A 5th amendment to an intergovernmental agreement with the Metropolitan Water Reclamation District for the Sheriff to continue to implement a prescription drug take-back program. (23-0786)

The Board referred:

An update on the County’s Guaranteed Income Pilot Program to the Finance Committee. (23-0546)
The 2022 Annual Ethics Report to the Legislation& Intergovernmental Relations Committee. (23-0709)
Commissioner Degnen’s resolution to the Technology Committee that requires a cost comparison by the Board of Review and Bureau of Technology regarding having an interface between two systems vs. moving the Board of Review to the County’s Property Tax System. (23-1174).
Commissioner Gainer’s resolution to the Pensions Committee to discuss the financial implications of possible future pension legislation. (23-1178)

Public Comments included:

Several urging that the County replace the Columbus Day holiday with an Indigenous Peoples’ Day. Many of these same comments were given at the Legislation Committee meeting on Wednesday.
Audra Wilson, Chair of the Cook County Women’s Commission, highlighting the report for 2022 on the “Continued Support of Survivors of Gender-Based Violence” that was received and filed as recommended by the Legislation Committee. (Item 23-0563)
A Chicago resident who complained of the increase in rats near the area of the construction of the Obama Presidential Center. Commissioner Lowrey during the meeting reached out to people at the Center and he reported that they had assured him that steps were being taken to mitigate the increase in the rat population in the area.

Observer: Priscilla Mims

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Negative Financial Impact on Cook County Health Budget Expected Due to Migrant Health Care and Medicaid Redetermination

Cook County Board Gets Financial Update

Cook County Board Committee Meetings

Cost Comparison of Integrated IT Systems vs Separate System for Cook County Property Tax Appeals to be Undertaken

Guaranteed Income Pilot and Board of Review Technology Discussed at Cook County Board Committee Meetings

Cook County Board Approves New Chief Financial Officer and New Chief Administrative Officer

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