Category: Cook County Health (CCH)

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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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

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