Category: Cook County Budget

No Expected New Taxes or Fees Projected for 2020 Cook County Budget

7/26/2019

Mid-Year Budget Hearings of the Finance Committee of the Cook County Board
July 17 and 24, 2019

Over these 2 days, the Finance Committee (composed of all 17 members of the Board and chaired by John Daley) met with each elected official, bureau chief and major department head to go over the expected revenues and expenses at the end of the 2019 budget year (Nov. 30, 2019), and what was expected for 2020.

Highlights from these meetings:

Overall: It is expected that the County will end this fiscal year in the black, and no new taxes or fees will be needed to balance the budget for the upcoming 2020 fiscal year.

Projections are that the General Fund will have a $14.9 million net favorable. Currently, there is a projected deficit of $103 million in the Health Fund; however, Cook County Health has a plan to eliminate that deficit by the end of this fiscal year.
Looking to the 2020 fiscal year, the current projections of revenues and expenses would result in a gap of $11.9 million for the General Fund and $6.8 million for the Health Fund, or a $18.7 million deficit. Very small compared to past years.
Over the next several months, the Budget Department will be working with all areas to eliminate that deficit and produce a balanced budget from the President, as required by law.

Cook County Health (CCH):

Commissioners had many questions for CCH representatives. Message was that CCH needs to do a much better job of providing information to Commissioners, who stated that they want to help CCH, but cannot do so without accurate information. A separate hearing is being held on July 25 with CCH representatives, and they were told to provide clear and accurate information.
Plan to eliminate 2019 projected deficit of $103 million involves receiving funds from Medicaid to provide graduate training ($77.3 million in revenues) and not filling some positions ($26 million in reduced expenses).
CCH providing health services for more uninsured patients than in past several years; about 45% of the patients; Medicaid enrollment down across Cook County; State has been slow to process applications, but seeing an uptick.
Long-standing issue of CCH not getting full reimbursements from insurance companies for those patients who are insured continues; continuing issue of not coding properly. More and better information wanted by Commissioners.
Commissioner Moore had questions about providers of County Care (the Medicaid HMO run by CCH) not being paid because those providers not coding properly according to CCH.

Chief Judge: Asked to respond to Chicago Supt. of Police’s claim that too many people are being arrested for violent crimes and being released on electronic monitoring, Chief Judge Timothy Evans provided these statistics:

In the 15 months since judges began using the new assessment tool:
37,233 people have come before the court
30,466 have been released
only 70 have been subsequently accused of violating the order of release (less than .2%)

Sheriff: Questions raised as to why, with significant reduction in daily jail population (from 11,000/d a few years ago to 5,600 to 5,900/d now) there hasn’t been more cost reductions in Sheriff’s budget for the jail.

State’s Attorney:

SA Kimberly Fox stressed that office using data to make decisions on staffing and prioritizing work. Top priority are cases involving violent crimes, which are up 1% this year. Convictions for crimes involving guns up 9% this year.
Now available on www.cookcountystatesattorney.org/dashboard is information regarding number of felony cases initiated, disposed of, and sentencing results, which you can get by year and by Commissioner district, along with other information. This is updated every day.
Highest number of potential felony crimes by far is retail theft. Largely because threshold for felony is $300 in Illinois, much lower than surrounding states. To keep focus and resources on violent crimes, most of these lower value retail theft cases are instead being dealt with as misdemeanors.
SA Fox said that 770,000 prior convictions in Illinois for cannabis usage may be eligible for expungement under new law; 72% of these in Cook County. Not sure how to staff to take care of this.

Public Defender: While will not exceed budget for 2019, PD Amy Campanelli said that will be pushing for more money than President’s Office wants for 2020, in part to start an immigration unit with 4 new staff members. These would represent those charged with crimes (whom they are representing anyway in State courts in Cook County) at Federal immigration detention hearings. Cites statistic that have a 90% chance of no detention if have a lawyer and 90% chance of detention if do not. Would not work past detention hearing, but leave to pro bono immigration attorneys to handle the rest of Federal cases.

County Clerk (elections):

More registered voters in Cook County than ever before.
New voting equipment tried in 3 townships in April local elections was very well received. Will be used throughout suburban Cook County in 2020 primary and general elections.
Assured Commissioners that confident that election security in place.
In change from past practice, Clerk’s office will not allow people on ballot who do not have the requisite number of petition signatures. Previously, allowed people on ballot unless someone successfully challenged.

County Clerk and Recorder merger in December 2020:

Working groups formed to deal with various issues that have to be addressed.
After merger, Clerk expects to be able to provide recorder services at 2 satellite locations closed by utilizing existing Clerk’s personnel through cross-training.
Both Clerk and Recorder said they understood the need for Recorder’s office to come into substantial compliance under Shakman cases prior to merger.

Observer: Priscilla Mims

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Cook County Health (CCH) Focus of Cook County Board Mid-year Budget Review

7/26/2019

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Cook County Board of Commissioners - Finance Committee Meeting
Mid-year Budget Review - July 17, 2019

What did the Board decide?
Several commissioners requested follow up numbers from Cook County Health (CCH) on a number of issues.

Other Discussion:
Debra Carey (in the absence of Dr. Shannon, CCH CEO) presented the review of the budget and stated there is a projected shortage of $103M this year. She said they expect to be able to eliminate the deficit. They just received a payment of $77M from Medicaid for County Care and the rest they hope to cover by budget tightening and not filling open positions. Charity care is up for the first time since the implementation of the Affordable Care Act (ACA). This was blamed on a problem in Springfield because there is a backlog of eligibility determination and Medicaid is down 7%. The state is addressing this but it will take time.
It seems that coding and documentation is a big issue both for collecting revenue and the outside coding agencies are the delayed accounts payable cited by OIG. There was a lot of discussion on how this is being addressed.

Additional observations:
Commissioner Tobolski asked if there is a structural deficit for the hospital and wants CCH to pay more attention to the business aspect.

Observer - Lisa Slankard Observed for 1 hour

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Cook County Board Approves $5.9Billion Budget for 2019

11/21/2018

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Cook County Board and Finance Committee Meetings - November 15, 2018

By unanimous vote (15 to 0, with Commissioners Butler and Garcia absent), the Cook County Board approved the budget for fiscal year 2019 that begins on December 1, 2018. Prior to that vote, the Finance Committee (a committee composed of all the Commissioners) approved 16 amendments which are incorporated into the final budget.
These amendments include one which increased the Revenue for the General Fund amount by $11.4 million based on (1) higher surplus in TIF accounts released by Chicago, (2) higher projected revenues by the Treasurer, and (3) projected increases in reimbursements from other governments. This additional $11.4 million was disbursed by several amendments which

Increase General Fund expenditures by $5.6 million through a “Technical Amendment.” In the past, these Technical Amendments generally did not increase the total expenditures, but simply moved amounts around from what had originally been proposed. The League thus far has not been able to identify where the additional funds are to be spent.
Add 10 employees to the Board of Review for $661,102 for the purpose of defending assessments before the Property Tax Appeals Board. During the meeting with the Board of Review, Commissioners were told that such additional employees would more than pay for themselves with the savings achieved by successfully defending assessments.
Add 43 new positions to the Sheriff’s area to add patrols to help stem violence on the south and west sides of Chicago and in the southern suburbs, for a total of $1 million.
Use $1 million to provide and coordinate reentry services for formerly incarcerated. Such services will include mental health and substance abuse services.
Add 16 Assistant State’s Attorneys and a clerk for $1.4 million for the Civil Division of the State’s Attorney’s office. Again, it is expected that this expenditure could pay for itself by enabling the County to seek damages/amounts owed in civil cases and/or to do more work in-house at a lower cost than hiring outside counsel.
Utilize $500,000 to fund services for pregnant and postpartum individuals awaiting trial.
Utilize $1.25 million to fund outreach marketing efforts to increase participation in the 2020 census. Obtaining an accurate count is critical to the County and State obtaining their appropriate share of government funds based on population, as well as appropriate Congressional seats.
Utilize $70,000 to increase funding for the office of the Commissioner who will serve as President Pro Tempore.

Commissioner Fritchey gave a warning about using these potentially one-time funds for creating positions, even as he voted for the amendments and resulting budget.
Two other amendments:

Would create up to 11 analyst positions at the Board of Review for assessment appeals, but only to the extent there are actual receipts from the newly enacted Board of Review Bulk User Fee to cover the costs.
Would allow newly elected officials (the Recorder, Clerk, and 5 new Commissioners) to create new positions by transferring amounts from other accounts within their budgets (so no overall increase in their budgets).

The Finance Committee meeting lasted less than 1 hour, the shortest budget amendment meeting since the League began observing in the mid-2000’s.
Observer - Priscilla Mims

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Capital Budget Reviewed at Cook County Board Budget Hearings

10/31/2018

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Cook County Board Finance Committee - Departmental Budget Hearings - October 29

Public Hearing
Capital Budget

Commissioners Present - Suffredin, Daley, Boykin, Gainer, Schneider, Morrison, Moddy, Arroyo, Silvestri, Moore for the majority of the meeting. Sims arrived at 10:15, Deere arrived at 11:10. Most of the relevant probing questions came from Boykin, Suffredin, Gainer, and Daley.

Public Hearing: Comments from the Public:

Aleisha Hill, a patient from Woodlawn Health and Hospitals talked about her wonderful, supportive care.
Dr. Maurice Lemon, from Access to Care board, testified that Cook County Health does a heroic job giving care to uninsured folks. There are 500,000 uninsured folks still in Cook County, and increasingly high deductible but insured patients make up a substantial portion of clients. Suffredin asked what ACESS is doing to raise other funds. $750M comes from private donors, and about $3M from Loyola.
Lawrence Msall from Civic Federation spoke in favor of the 2019 budget. He complimented the county on no increase in taxes, and their responsibly paying supplemental pension contributions even though it was not mandated by law. The Civic Federation recommends pension payments be mandated by law so that future administrations could not cut it, they support County Care, suggested that the Oak Forest Health property be shut down, and suggested that more data was needed from the criminal justice system to be able to understand how the jail population had decreased by 40% but that expenses were not commensurate. Suffredin asked if it might make sense to break up the county budget into thirds: Cook County Health, criminal justice, and the rest of Cook County? Msall thought it might shed more light on things. Boykin asked if there was an ability to correlate criminal violence with public health. Msall did not know of a measurement that currently exists. Gainer asked the Budget Director why there are no ratios for inmates at the jail versus employees. She responded that closing three divisions within the jail will reduce employment and redeploy manpower. Cook County is doing a study on the entire jail campus, including assets and operations, which should be finished in the next couple of months. 2018 overtime has been reduced by $70M, due to reduction in managing home checks by staff, according to the sheriff. Msall offered that Washington DC and Winnebago county have greatly reduced criminal justice costs and recidivism, and would make sense to study these examples.
Esther Corpus, the CEO of Alivio Medical Center, which handles 85,000 visits per year at six offices spoke. 7,000 of their patients have insurance or County Care but the rest have no insurance. Suffredin asked how County Care worked with Alivio compared to BlueCross/BlueShield (BCBS). Corpus said that County Care was involved with every step of the illness and treatment while BCBS was distant, uninvolved, except at the end for billing.
Craig Rosenbaum, attorney who represents Court Interpreters, asked for an increase in the budget to hire more full time interpreters. He said Polish interpreters are particularly unavailable. There are only 27 FT interpreters and his bargaining unit is asking for 39 FT within this 2019 budget.
Ruby Pinto, from the Chicago Community Bond Fund, spoke about how reforms in bond court are having a positive effect. But she complained that the Sheriff’s budget has increased per capita per inmate from $24 K to $59 K. Chicago Community Bond Fund is funded by donations while the organization is sustainable because the bonds that are fronted are repaid. Suffredin asked what reforms the group would recommend. Ms. Pinto suggested a more proactive Pre-Trial services group could greatly reduce recitivism. She also suggested the County look at Washington DC court system reforms. Gainer asked if the group could provide specific proposals for reform, and Ms. Pinto agreed to do that.
Donny Anderson representing the blind vendors complained that they were being cut out of contracts. Jessica Caffrey of Capital Budget Department agreed to work with them on inclusion.

Capital Budget

Ammar Rizki, CFO, discussed the accomplishments in 2018: CC has reduced its debt by $400M, CC has stopped funding what always should have been operating expenses (assets with less than a five year life, like computers) with long term debt. As a result the County has a much better bond rating and lower interest rates for AAA ratings have significantly reduced Cook County’s costs for debt. Debt has been reduced 11% from 2011 to 2018.
The Asset Manager described 210 unique properties of which 50 are leased. 2018 saw the demolition of Jail divisions 1 and 1A. The department assessed all 210 properties to determine priorities for maintenance and replacement. 45% of capital improvements will be for public safety (including jails), 38% will be for health systems, and 17% for corporate investments. In the past 2 years, the county has constructed a new 9 story healthcare facility, renovated bond courts using in-house trades to save money, relocated clerk and elections to a high efficiency space to Cicero, among its cost-saving projects. The budget for 2019 is $2,041M.
The Transportation and Highways Department has a budget of $183M. Cook County decided several years ago to stop diverting the Motor Fuel Tax to other programs to direct it back to highways and transportation. This means that the county has been able to secure federal and state matching grants of $53M, and has also worked with townships and local authorities to plan better for projects that enhance Cook County’s role as North America’s freight capital. The Cook County Transportation and Highway dept has become the coordinating lead agency to work with state, federal and local groups on projects, apparently a greatly-improved position from previous years, according to all the accolades from commissioners for John Yonan, the superintendent. Boykin asked about correlation of transportation dollars to jobs created. Yonan said the rule of thumb is 13 jobs created for every $1M spent.
The Chief Information Officer Tom Lynch, echoed the better accounting practice of financing computers and cell phones with operating funds rather than long term debt. Major IT systems like the Clerk of the Circuit Court system, were financed by debt. Suffredin said that according to Clerk Brown, the new system was a disaster, and Suffredin agreed that it was awful for attorneys to e-file. Lynch said it was the learning curve, and that it was particularly cumbersome for pro se filers (individuals) because the language is many times obscure Latin, and not presented in layman’s terms. Suffredin worried that attorneys could choose to file in other counties like DuPage and Lake, rather than having to deal with Cook County’s back-up. Apparently self-filers are slowing the system down and attorneys can’t file quickly. Suffredin worried if suits were filed in other counties it would adversely affect county finances.

Observer - Amy Little Meeting Length - 3 hours

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Chief Judge Asks for $259M in 2019 Cook County Budget, $3.2M more than President's Proposed Budget

10/29/2018

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Cook County Board Finance Committee - Departmental Budget Hearings
October 25, 2018

Chief Judge

Commissioners present: Boykin, Goslin, Deer, Morrison, Schneider, Tobolski, Silvestri, Daley

Chief Judge - Tim Evans
Remarks:

The Judge asked for $259 million which is $3.2 million higher than the President’s budget for 2019.
Expects to close two branch court houses in early January: Belmont/Western and 51st and Wentworth. Transportation vouchers will be provided to defendants for about 30 days after the closings to allow them to get to the new court location.
Has not received the Court Utilization Study yet but says that he has received recognition for reducing the jail population, using the safety assessment tool, and use of specialty courts.
Stated that the jail population as of October 25, 2018 stands at 5,991
Responded “yes” to Commissioner Daley’s inquiry about having answered the LWV Cook County’s Electronic Monitoring questions, but did not elaborate.

Commissioner’s Questions:
Silvestri: Q: Where will the defendants of closed courts go. Ans: Grand & Central will pick up the Belmont cases and 111th Street will pick up the 51st and Wentworth cases.

Boykin: Urged more Restorative Justice Community Courts beyond the one in Lawndale.
Ans: A second court will be coming to Austin followed by Englewood. Evans noted that a courtroom isn’t needed. A room with a circular chair set up and good security are the two main facility requirements.
Boykin asked how many teens are in the Juvenile Temporary Detention Facility. Ans: 189 of which 21 to 25 are female.
Boykin then asked if the Judge had everything needed for the electronic monitoring system (EM). Ans: Evans noted Sheriff Dart’s objections to some releases to EM but reminded the Commissioners that the law calls for pre-trial release unless there is a “clear and present danger”. Dart had said that 9 people charged with murder were put on EM. Judge Evans said that 1-2 were police officers and the other 7 were higher risks but presumed innocent and put on EM because they were not assessed as a clear and present danger. He went on to say that he has received a pledge from stakeholders to stand behind judges when [not if] a released defendant commits a major crime while released and awaiting trial. He stated that 9 out of 10 on EM to date commit no crime during release or fail to appear in court.

Deer: Thanked Evans for his work and his compassion and said he is impressed by the Juvenile Detention Center and the Lawndale Restorative Justice Courts.

Daley: Commended the Restorative Justice Court and said that more are needed.

Observer - Diane Edmundson Meeting Length: 45 min.

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Hospital System Responds to Cook County Commissioner Questions on $2.7B Proposed 2019 Budget

10/29/2018

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Cook County Board Finance Committee - Departmental Budget Hearings
October 25, 2018

Cook County Health and Hospitals System

Commissioners present: Boykin, Fritchie, Goslin, Morrison, Schneider, Silvestri, Suffredin, Daley

Cook County Health and Hospitals System (HHS) – Jay Shannon, CEO
Remarks:

The proposed 2019 budget is $2.7 billion of which $102 million or >3% is a tax allocation from Cook County. The $102 million is earmarked for correctional health at the Cook County Jail and the Cook County Dept. of Public Health. These are services that the County is required to provide but is unable to bill. [Note: HHS is generating 97% of its operating revenue]
For the last 3 years, HHS has assumed responsibility for its new capital expenses and for depreciation of current and new capital expenditures which amounts to approximately $25 million annually. Additionally, it assumed $30 million in pension costs in its 2018 and 2019 budgets.
The FY 19 budget is driven by the HHS 2017-19 strategic plan which includes investing in behavioral health, care management, social determinants of health, and addressing issues in the justice-involved population.
HHS partners with the Greater Chicago Food Depository to distribute more than 400,000 pounds of fresh produce that impacts 58,000 household members. These households are identified in the HHS clinics as “food insecure”.
Deaths related to opioids today in Cook County [avg. 3 per day], are more common than those attributed to guns or motor vehicle accidents. HHS is initiating programs to address some of the serious Public Health threats impacting Cook County communities.
“HHS is the linchpin of the county’s health ecosystem that could collapse without it”.

Questions/Answers

Suffredin: Is there a way to get the other 68 hospitals in Cook County to pick up a fairer share of charity care? The latest statistics from state government shows that Stroger and Provident handle almost 50% of the care while the other 68 cover the remaining 50%. In 2016, the system expended $265.7 million in uncompensated charity care. The next closest hospital, Northwestern, was listed at 7% in 2016. He also expressed the possibility “while draconian” to consider the county charging property taxes for those hospitals that don’t increase their share. Ans: Shannon said that the hospital can lead by example and "moral suasion". Legal incentives would be up to the county, city, and state.
Suffredin: How can the system grow its Medicare numbers? Ans: Each year 4% of the system’s Medicaid patients turn 65. HHS is reaching out to these members and encouraging retention within the system by promoting the benefits of continuity of care, the expansion of care management, and the specialty services available at the ambulatory clinics and Provident.
Suffredin: Do you have a target for increasing the percentage of County Care members that will choose to use the system’s services rather than go elsewhere: Ans: 18-20% based on aggressive meetings with other provider services, marketing, and improved care and specialty services being available at the ambulatory care centers.

Morrison: What is the definition of “charity care”? Ans: At HHS, charity care is lumped under Uncompensated Care with two subsets: 1) Individuals that cannot afford to pay and have completed the paper work for Care Link which qualifies them for 100%, 75%, or 50% forgiveness depending on their income situation. 2) Bad Debt includes charity individuals who cannot pay but did not fill out the Care Link paperwork.
Morrison: Asked for a breakout of the 243 FTE’s included in the 2019 budget. Ans: 101 due to the expansion of clinical care management required to serve FHN and Aetna member acquisitions as well as the expansion of care management such as health risk assessments, expanded operating room services at Provident and Stroger, and new hemodialysis services at Provident. HHS will also bring in house advanced imaging services and advanced cardiac rhythmic services; 50 nurses and techs to support the clinical staff; 30 for the Juvenile Detention Center [new for 2019]; 12 community health workers; and 55 for environmental service workers for the hospital and new professional building.
Morrison: What is the cost of the adding 243 FTE’s in 2019. Ans: $20 million.
Morrison: We have met with you over these past months to discuss the revenue cycle and uncollected receivables. Where do we stand? Ans: in 2018 HHS reduced by 25% the number of days a bill is in accounts receivable [AR]; it has reduced by 40% the time it takes between patient discharge and the bill going out the door; and it has reduced claim denials by 40%. These improvements have and will continue to occur because of the in-house hiring and training emphasis not only for clerical staff but also for doctors and technicians; the hiring of “at elbow” contractor employees to help train on 3rd party billing and denials management and other institutional and clinical coding, training, and process needs as identified.

Boykin: What efforts are under way to increase the representation of black minority contractors, particularly prime contractors? Ans: Vendor fairs; work with President Preckwinkle’s outside provider to increase the roster of qualified minority owned businesses; and break bigger projects into sub-contracts. Shannon noted a 40% increase above 2017 in minority contracts awarded. Shannon also stated that HHS is one of the anchor institutions on the West side of Chicago whose goal is to improve economic health, physical health, and local hiring.
Boykin: Is there an opportunity for HHS to work with the sheriff on the west side where he has an interest in putting more officers? Ans: West side triage has a mobile health team that can go to a home or join the police at an incident site where there might be a mental or behavioral health issue. Shannon noted that the system is averaging 2-3 gun-shot patients a day at Stroger. “Gun violence and opioids are a symptom not the cause”.

Goslin: Asked if the Access to Care services in the northern suburbs is still a relevant model. Ans: More than 2/3 of the budget of Access to Care is funded by HHS. Shannon noted that it was set up prior to the Affordable Care Act and noted that it is not a registered provider required to provide information to the state and federal governments. He said he could not comment on the quality of care. He did mention the new Arlington Heights Ambulatory Care facility with state of the art services to be opened yet this year. Shannon went on to say that ophthalmology and mammography services are being expanded at Provident along with GYN, hand surgery, ENT surgery, and other elective outpatient services. Provident is also offering free Lasik surgery.

Fritchie: Was there any thought given to use outside contractors for the 55 new environmental worker positions rather than going with the Union and who made the decision? Shannon: “yes and I made the decision”. It came down to cost and local control. Fritchie asked if a comparison was done on internal vs external and wants any internal documents regarding the decision. He also asked if any staff had been contacted by Preckwinkle’s office. Shannon said he was not aware of any staff contact.

Schneider: Reflected on the idea of charging property taxes for hospitals that don’t take their fair share of charity care. What should Suburban Commissioners do to get the suburban hospitals to step up? Ans: Encourage Access to Care and other advocacy organizations to band together to encourage the hospitals; hold direct conversations with hospital administrators, and review relevant laws.
Schneider: Why was the Arlington Heights site picked for the new clinic? Ans: Demographics, transportation, other comparable services, affordable space, and the last hurdle is bureaucratic and political. Shannon took this opportunity to mention that the new 2018 transportation fleet set up to get patients to their doctor appointments has been very successful and popular. Cost is about $500,000 for 2018.

Silvestri: Why does the hiring process take so long? Ans: HHS has a very complicated hiring process accentuated by market competition; there is a shortage of specific skills and skill sets. Shannon noted that compensation for nurses is competitive when salary and benefits are combined. In the case of physicians, HHS is woefully not competitive with private hospitals in certain areas and specialties.

Daley: Urged continued improvement with in-house retention of County Care members and stated that it is incumbent on each Commissioner to meet with and urge hospitals in their districts to take on more charity care.

Observer - Diane Edmundson Meeting Length: 2 Hrs.

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No Expected New Taxes or Fees Projected for 2020 Cook County Budget

Cook County Health (CCH) Focus of Cook County Board Mid-year Budget Review

Cook County Board Approves $5.9Billion Budget for 2019

Capital Budget Reviewed at Cook County Board Budget Hearings

Chief Judge Asks for $259M in 2019 Cook County Budget, $3.2M more than President's Proposed Budget

Hospital System Responds to Cook County Commissioner Questions on $2.7B Proposed 2019 Budget

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