Cook County Board Finance Committee Mid Year Budget Hearings​
July 20, 2021
Presentations - Office of the Cook County Treasurer and Cook County Health

Highlights of Presentations:

Treasurer

• The office is currently under budget with regard to expenses, but expects to come in at budget by year-end.
• The office has received $4.9 million over budgeted revenues thus far, mainly due to higher than expected people paying delinquent taxes
• Purchased two vans to re-purpose customer service employees to enable them to serve taxpayers in their communities rather than in the CC building.
• Also go to community events at churches, festivals, etc. to assist taxpayers with tax related issues.
• Treasurer touted the studies done by her staff and noted that she is hiring to establish a kind of "think tank" section in her office to conduct more studies, concentrating on the inequities within the tax system.
•  The office has a staff of 58 employees.  Continued concentration will be in technology hiring.

Cook County Health

• .  In total, Cook County Health (CCH) currently has $2.4 M more in revenues than expenses.
• .  There are 1,284 vacancies among the 6,802 budgeted positions.
• .  Most of the questions centered around Covid and the Delta variant, which will not be reported here.  There was emphasis on providing guidance to suburban school districts.  CEO Rocha said that for now they are waiting for the CDC to provide guidance.  If necessary, the CC Public Health Department will step in to do so.
• .  Commissioner Degnan asked about grant funding and the potential to increase it.  CEO Rocha responded that for a public hospital system we do a good job, but the goal is to have "extraordinary" results.  CCH will be making investments to develop an institute for grant funding.
• .  Commission Sean Morrison asked if CCH has established a dollar value for requested 2022 funds from the county.  Answer:  not yet, but should have by the August preliminary budget presentation.
• .  He also asked about efforts to improve the revenue cycle.  CEO Rocha stated that a new Chief Revenue Officer is now in place and noted that through the first quarter of 2021 revenue retrieval has increased to 30% and can be expected to move to the mid-30's by year end.  Interim Budget Director Gibson noted that the System is looking at non-direct patient care to improve.
• . In March 2021, a "patient homecoming" project was launched to promote the return of patients to the ambulatory care centers.  He stated he is very excited about the progress to date.
• . Daley asked about outreach to retired nurses.  CCH noted that a few came back for the mass vaccine sites and that the system is definitely open to more coming back to the system.

Observed by:  Diane Edmundson         

Cook County Board - Health and Hospitals Committee Meeting
April 13, 2021

Cook County Health (CCH) has been working hard to get people vaccinated.  The following improvements to the system were cited

1. 5 mass vaccination centers opened including the new site in Matteson which is the largest and is in an abandoned Target store.
2. 13 PODS (point of distribution) sites opened to target school personnel.
3. Worked with 145 organizations for other sites
4. Changes made to improve the vaccination website including adding a waiting room. 1.4 million people have scheduled through the site.
5. Expanding hours for the telephone hotline for scheduling appointments for non computer users. Hours are M-F 7am-10p and Sunday 8am-10p. Average of  30,000 to 50,000 calls per day. When new shipments arrive calls can exceed 100,000 per day
6. CCH is committed to equity and has identified 32 communities needing attention and will be doing temporary priority PODS 
7. Current limiting factor is still supply but the sites are capable of a ⅓ surge if supplies increase.
8. Paramedics will be making visits to vaccinate homebound people 
9. Organizations can request pop up sites
10. There will be drive through sites opening now that the weather is improving.
11. Research indicates that the most hesitant to be vaccinated are 18-34 year olds. A My Shot campaign has trusted voices for this demographic recommending shots.

In addition to vaccinations, the CCH Contact Tracing initiative now has 187 tracers and 63 investigators. 90% of newly identified Covid patients are contacted and 71% responded. Funds are available to help quarantining patients with food, home supplies and lost income.

The number of new cases is rising but they can still keep up for now.
The BinaxNow rapid antigen test is in use.

The meeting had been delayed while CCH CEO Israel Rocha, and Drs Joshi and Rubin from the Cook County Department of Public Health, and Mr Barnes were handling the problems caused by the temporary hold on Johnson & Johnson vaccines.  All patients who were to receive the J&J vaccine will be offered either the Pfizer or Moderna vaccine.  Anyone with a scheduled appointment can still be vaccinated. Only 27,000 J&J vaccines have been given in suburban Cook County and no issues with blood clots have been reported.

Several commissioners spoke - some had questions but most were just complimentary comments.

Observed by: Lisa Slankard                                           Length of Meeting - 1 hour

Cook County Board of Commissioners 
Health & Hospitals System Committee Meeting
March 16, 2021

Following two public comments urging that additional vaccination sites be set up in the western and southern suburbs, coincidentally, the presentations by both the Department of Emergency Management & Regional Security and the Department of Public Health (“DPH”) focused on the criteria that has been used in establishing County-sponsored vaccination sites in the suburbs and how this is changing.  Both Departments acknowledged the need to provide more vaccination opportunities in the southern and western suburbs and said that they expect, with the promised increase in vaccination doses, to be able to do so.

• Executive Director of Emergency Management William Barnes explained that the County started by looking at large sites in order to be able to get as many shots in arms as possible.  Convention Centers were looked to, such as the one in Tinley Park.  Began rethinking as heard from communities wanting their own sites, as well as the Federal and State governments now also wanting to be involved.
• Currently looking at large commercial sites, such as big box stores, which are located all over the County and are very flexible (can use large or small areas as required), have lots of parking, generally are easy to locate, and often accessible by public transportation (all key factors).
• But also looking at other alternatives:  know that while about 40% of people happy to go to large sites, the rest prefer smaller sites.
• CEO of Cook County Health Israel Rocha, Jr. said that currently there are more people wanting the vaccine than those needing more education about it.  He touted the number of contacts from residents to the vaccine web site, www.vaccine.cookcountyil.gov, and the vaccine hotline, 1-833-308-1988.
• Dr. Kran Joshi reported that 18% of suburban residents have received at least 1 vaccine shot and 9% have received 2. 
• A Mobile Vaccination Strategy is in place to help reach more places, with a pilot successfully conducted in Maywood recently.  More are scheduled.
• Dr. Rachel Rubin reported that the DPH finally has a significant workforce in place to do contact tracing.
• DPH presented its 1st quarter report (Item 21-0798) which focused on its grants of $5 million to 42 community organizations to help educate and vaccinate people and of $1 million to 5 worker centers to help reach temporary workers over the 6-month period from Dec. thru May.  With more funds coming, DPH expects to continue the efforts through the end of 2021.

DPH also told the Commissioners that it had received reaccreditation in Feb. for the next 5 years.

Priscilla Mims, Observer

Cook County Board of Commissioners Committee Meetings 
February 24, 2021

Cook County Health and Hospital  Committee 

• In a public hearing, CEO Israel Rocha, of Cook County Health and Hospital System, and Dr. Rachel Ruben, of the Cook County Department of Public Health, gave updates on the COVID vaccine program.  Information included website improvements for scheduling vaccines, locations to get vaccinated, the distribution of vaccine system, and current numbers of those vaccinated in Cook County.  There are 11 large and 145 small vaccine locations in Cook County.  These include major sites in Tinley Park, Triton College and newly opened New Trier High School.  There is also a partnership with Walgreens, Osco Drug, and Mariano’s Grocery pharmacy.  The call center receives about 12,000 calls per day.  In the last month about 105,000 residents have been vaccinated with at least one dose.
• Cook County Commissioners’ questions and concerns were addressed. Regarding Chicago residents using Cook County locations:  this is a reciprocal arrangement designed to quickly vaccinate as many people as possible; about 30% of Chicagoans and 30% of suburban residents have been vaccinated by the other entity.
• Numerous  programs and outreach have been developed to encourage minorities and other hesitant residents to take the vaccine.  About half of these communities are not inclined to be vaccinated.  There is no charge to anyone for vaccines and tests, but insurance companies may be charged an administration fee.  Group 1c (those 16-64 years of age with co-morbidities) will likely be added mid-to late March in Cook County.
• In other business, the committee passed a Resolution to Assess Needs and Improve the Quality and Effectiveness of Behavioral Health Care Provided by Cook County Government (21-1189).  A 2015 study found that behavioral health visits to emergency departments (ED) in Illinois are the largest growth category of ED visits.

Finance Committee Meeting--

• Cook County CFO Amar Rizki gave an overview of the property tax levy levied by Cook County government.  The base levy has not changed since 1994 ($720,000,000).  That and other revenue sources make a total of $784,214,215 for the 2021 budget.  Because of the tough budget year (COVID and business closures), two of seven categories will not be funded this year—Corporate and Capital.

Finance Subcommittee on Litigation 

• Regarding the Inspector General’s recommendations for the Board of Review:  the issues related to Shakman-type practices have not been resolved by the Board of Review.  There will be a special meeting next week to discuss these problems.  It is not known if this will be a public meeting.

Observer -  Karin Hribar

Cook County Board & Finance Committee Meetings
November 24, 2020

The Board

• Unanimously passed the $6.9 billion budget, as amended (Agenda Item 20-4595).
• Unanimously passed an amendment to the Property Tax Relief Ordinance which provides that late fees will not be assessed for any payments of the 1st installment of the property tax bill, still due by March 2, that are made on or before May 3; and that late fees will not be assessed for any payments of the 2nd installment, still due by Aug. 2, that are made on or before Oct.1.  This amendment is in recognition of the pandemic and the financial toll it has taken on many residents and businesses (Agenda Item 20-5643).

The Board met immediately after the Finance Committee, which passed 19 amendments unanimously to amend the budget.  Many of these amendments were “technical” in that they simply made budget neutral changes to reflect either corrections to the Executive Budget or to reflect new information since the Executive Budget was presented in mid-October.  The following changes were the most substantive:

• As a result of identifying additional revenues from the State, 48 positions were restored to the Chief Judge’s budget, including positions in the Adult Probation Department, and 41 positions were restored to the Juvenile Temporary Detention Center (also under the Chief Judge).
• Funding to continue to operate the Morton East Clinic under the Cook County Health's (CCH) budget was found by making some adjustments to other line items in that budget.  Commissioner Anaya, one of the sponsors, stressed that this Clinic has been a vital health center for the high school and the surrounding community, and is an entry point for other CCH services.  Commissioner Anaya emphasized that there should not be a single model for providing health care within the County, but that different models are needed for different communities.  Key is to engage the public in each community to find out what their needs and preferences are.  Many of the other Commissioners thanked Commissioner Anaya and Commissioner Aguilar, the other sponsor, for finding the money to keep this clinic open.  During the public comments at the various hearings on the budget, this was among the issues raised the most often by those seeking its continuation.

Following the budget passage at the Board meeting, some of the comments included:

• President Preckwinkle stressed that the 2021 budget, which contains no new taxes or fees, was possible because of many years of hard work and hard votes by the Board.  The Administration and Board have stuck to a long-term financial plan, rather than look to one-time solutions.
• Commissioner Sean Morrison cited the past actions which included extra payments to the Pension Fund of $2 B (which led to a higher bond rating for the County;) the increase in the Fund Balance over the past years from $30 M to $479 M, which allowed this year’s budget to be balanced by taking some money from that Fund Balance; and the Board’s funding of technology which has allowed the County departments to continue operating remotely during this pandemic.
• Commissioner Kevin Morrison reminded everyone that the Administration presented a balanced budget after having to close a $400 M deficit.

Observer:  Priscilla MIms

Cook County Finance Committee Departmental Budget Hearings
November 4, 2020

Cook County Health (CCH)

Proposed 2021 Budget - $3,387B                             Proposed FTES for 2021 - 6743
2020 Budget Amount -  $2,824 Billion                   2020 Budget FTEs - 6601
Difference - Increase of $653M (20%)                     Difference - Increase of 142
​
Highlights of Presentation and Questions:

• The increase in the 2021 budget is primarily due to the increase in County Care membership which affects both revenue and expenses and the staff increase for the County Jail due to Covid-19 requirements. Layoff’s occurred in the summer of 2020 to reduce the year’s deficit. Any additional union job cuts will likely result in filling openings in other areas.
• The increase in the 2021 FTE's is due to Covid-19 requirements at the jail, managed care, and hiring 91 permanent employees to replace Agency temporary hires.  . Commissioner Degnan asked that the projected savings by bringing agency positions in house be tracked to include not only compensation but benefits.  
• County Care Revenues for 2021 projected at $2.2 billion due to increased enrollment due to Covid-19 and employer layoffs.
• Overtime costs are expected to come down from a 9% of payroll high in 2020 to 6% in 2021.  And Commissioner Suffredin highlighted the System’s focus on improving the “prior authorization process” to reduce denials and thereby increase revenues.
• During this four-hour meeting, there were surprisingly few questions about budget numbers.  Most of the Commissioners were very concerned about service impact to their constituents.  There is only one service elimination.  The in-patient pediatrics which averages a little over 2 patients per day is suspended for fiscal year 2021.  Originally, CCH said it would be eliminated, but has now changed to suspended, likely due to internal and external pressures.  Interim CEO Carey and Interim Budget Chief Gibson held their ground on the necessity for and the reasoning behind service cuts.  
• Most of the questions were about clinical care especially mental health services and the consolidation of south side’s two ambulatory clinics into the Provident Clinic affecting approximately 9,000 patients.  
• Interim CEO Carey gave a clarion call that something has to be done about charity care stating that CCH cannot continue to absorb the more than $312 million in charity care costs [$320 in 2020 due to COVID and people staying home].
• The reversal of the Affordable Care Act was also a topic  In its budget presentation, the System estimated a loss of approximately $600 million annually in County Care capitation revenue, another at least $100 million annually from other Managed Care providers, and an increase of $700 million annually in uncompensated care costs.  
• Regarding the public’s concern about the Morton School Clinic, Carey said the System is very close to closing on an agreement to transfer services.  And the Lurie Partnership is taking over the services at the Child Advocate Center.  
• All Physical Therapy services will be centered in space developed in Harrison Square, which is the name now given to the old Stroger Hospital Building.
• Of the approximately 5,000 inmates at Cermak, it is estimated that 2,000 are listed as having mental health issues.  Very little discussion on the COVID-19 contact tracing but a hearing has been requested I believe by Commissioner Suffredin on this issue.
• An unknown for 2021 is the potential impact on the CCH System if Mercy Hospital closes for both regular and charity care patients.

Observer – Diane Edmundson                                                     Length of Meeting - 4 hours