Cook County Board of Commissioners Health and Hospitals Committee
September 26, 2019
This hearing was requested by the Cook County Board of Commissioners to note and understand discrepancies between the Inspector General (IG) Report and the rebuttal of Cook County Health (CCH) and the firm—Deloitte—hired by CCH to analyze the Inspector General's Report. The IG Report generally stated that CCH’s insurance program, County Care, was unsustainable and was being subsidized by Cook County taxpayers. The IG report looked at ALL of the CCH finances, not just County Care. CCH disputed this and hired Deloitte to analyze the IG report —mainly the viability of County Care—and report to the Cook County Board. Deloitte did NOT do an audit as this was done previously by another division at the firm. It also only looked at County Care and not all of CCH.
There was a lot of confusion by the Board on what was being stated by both the IG Office and Deloitte. Mainly this was because of the Accounting Systems used by CCH and the various ways accounts receivable, payable, assets, etc. can be interpreted. All parties are looking at the financials and cash flow differently. The main question of the Cook County Board was “Do we have any concerns about the stability and viability of CCH?”
Here are the basic findings as this Observer understood them:
Inspector General Report
Dr. Shannon (CEO of CCH) Statements:
Cook County Budget Office:
Observer : Karin Hribar Length of Committee Hearing: 2 hours and 20 minutes
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.
Cook County Health (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:
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.
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):
County Clerk and Recorder merger in December 2020:
Observer: Priscilla Mims
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.
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.
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
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
Two other amendments:
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
Cook County Board Finance Committee - Departmental Budget Hearings - October 29
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:
Cook County Board Finance Committee - Departmental Budget Hearings
October 25, 2018
Commissioners present: Boykin, Goslin, Deer, Morrison, Schneider, Tobolski, Silvestri, Daley
Chief Judge - Tim Evans
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.
Individual authors are credited at the end of each post.