Cook County Board Finance Committee Mid-Year Budget Hearings
​July 30, 2024

9:30 am Cook County Treasurer - Maria Pappas and staff
Highlights:

• 70% of all tax bills have been paid as of today with a due date of Aug. 1
• Each cycle about 200,000 pins are not paid on time
• Overall there is a 98% collection rate countywide 
• There are those pins that are chronically delinquent - many are vacant land - an example was given that Ford Heights has 1400 pins that have not paid in 30 years
• The tax system needs to be changed and she has a Policy Group that is working with Springfield to see what changes can be made.
• Her office has done several studies that can be accessed on their website that are about the problems with the present tax structure. She encouraged everyone to read her studies.
• Many taxpayers do not understand the system or the exemptions. She has a Refund Project that will refund about 10,000 individuals this year. 
• Interest on late payments has been reduced from 18% to 9% (she took credit for this) and now has implemented a payment plan process for those who cannot pay all at once. 
• The office does outreach to all communities and has information available in a multitude of languages. 
• At the tax sale approximately 54,000 pins are offered and about 7,000 are actually sold. Most of those will end up being redeemed. 
• Setting up an AI unit that she hopes will be used to analyze date. Needs to assemble a team that will be able to mine the data

10am Cook County Sheriff - Tom Dart and staff
Highlights:

• Slowed civilian hiring to make budget
• Taking away more guns from those with revoked FOID cards.
• Doesn’t like to ticket for vehicle equipment problems. Likes to work with owners to repair the vehicles instead.
• 80% of inmates in some type of program. EX. Dog training program helps with aggression control. Agribusiness program for learning about a business. 
• Comm. Britton asked about dealing with Mental Health (MH) issues. Sheriff stated that about 40% of inmates have MH issues. Cermak deals with those who have severe issues but they didn’t have the capacity to deal with everyone so he started his own program. Talked about a possible day program at the Boot Camp for those with low level MH issues but concerns with funding and not sure if this is continuing. 
• Comm. Britton also asked about why with the jail population down there has not been a reduction in the budget for salaries - fewer personnel needed. Sheriff stated that they are still short staffed (240 positions open) and the reason the budget is not down is because of the salary increases approved by the CC Board.
• Comm. Anaya asked about licensure of those on staff working with the MI and about insurance coverage for services rendered. Sheriff stated that staff was in appropriate roles and that while services may be covered by Medicaid the sheriff does not have the ability to bill. All billing is done by Cermak. 
• Anaya also asked about Electronic Monitoring. Sheriff state that there are about 1400 now on his EM program. The number has been slowing decreasing. Any violations due to a change in the law now go to a judge who makes a determination but the judges “do not violate very many”. 
• Comm. Quezada had questions about the Co-Responder model for MH calls and questioned the Sheriff’s Treatment Response Teams (TRT) for MH calls. The Sheriff stated that getting trained professionals to respond to calls with officers proved to be too expensive so their teams use tablets that can connect someone in crisis to a MH professional. The program has resulted in a decrease in calls from some households. The sheriff also said he is tired of hearing about programs that are all talk and no action - he wants to get the right people to the door and thinks they are doing that pretty well.
• Quezada also asked about the number of inmates housed elsewhere and the cost to the county. The Sheriff stated that there are 27 inmates in other jails right now - not for capacity reasons but for safety reasons - and there is about $500,000 budget for that with about $200,000 spent to date. 
• Comm. Stamps raised the concern that the facility is not conducive to rehab for young people and wanted to know if they do research on best practices and how do they track success. Sheriff Dart said he is always looking for new ideas and success is measured by the number that do not return and the number that continue after release with the services they get connected with while in his custody. She also suggested that he consider an apprentice program with Chicago Public Schools to encourage employment at the Jail and that could help with the employment situation. Dart liked that idea. 
• There were more questions about billing for services, MH treatment for jail personnel as well as for the inmates, technology updates and the new helicopter. Sheriff said he would provide metrics on the helicopter use and the ongoing cost of housing and maintaining the helicopter. 

12:17pm Cook County Clerk - Cedric Giles and staff
Highlights:

• Now have a GPS tracking system for all election equipment in November
• New voter check-in system for November that will allow voters to update their signatures
• Sample ballots will be posted on their website
• The Recording Division has a new cashier system and they are in the process of digitalizing all records from 1871-1974.
• Commissioners were excited about the Pilot Program of partnering with the township offices for access to records of the Clerks office. Trial is running in Palatine and it may expand although no plans as of now. Also questions about using the City-Key card as an ID which at present is not okay. 

1:09 Cook County Health - Pamela Cassara, CFO, and staff
Highlights:

• CCH is presently in a favorable financial position
• 25% of the ARPA funds that CCH were allocated have been distributed and are on track to have all the funds allocated by the end of the year
• Comm. Trevor asked if CCH had the capacity to take on new patients with the present staffing shortages. Hiring is a top priority with nursing at the top of the list.
• Reproductive Health Issues - At Stroger the nursery is being removed so that they can increase capacity since newborns are now in the rooms with their moms and the nursery is no longer needed. 
• Migrant Health Services - fluctuating need as the numbers change. Can ramp up rapidly if necessary. Are providing health assessments and immunizations. 
• New outpatient facility will be opening in Bronzeville that will include Behavioral Health services.
• Comm. Stamps asked about the marketing of CCH services so that the communities know about where clinics are and what services are available. Stated that some facilities need to be upgraded (Austin Clinic). Also asked about relationship with nursing programs and asked why there was not a “direct hire” program with local high schools and colleges. CCH indicated that there is is a strong connection with the Malcolm X College nursing program. 
• Touted “My Birthday Health Program” that promotes early detection screenings for prostate and breast cancer.

3:31pm - Board of Review - Commissioners Steele, Rogers, and Cardenas
Highlights:

• 2023 Tax bills went out on time this year
• IT has been upgraded and a patch to the mainframe is no longer needed.
• Processed 246,000 appeals (some include multiple pin numbers) with a 46.9% decrease in their assessment.
• 45,000 PTAB cases covered
• Have open positions and recruiting is a challenge - hiring process is a long process.
• Comm. Cardenas emphasized that the mission of Board of Review is to correct assessments - focus primarily on residential properties - not their fault that taxes are increasing.
• Comm. Degnan wanted to know about having separate budgets for each of the Commissioners office which led to confusing discussion of how the BOR allocates their finances and other resources. Per the Budget Director in 2025 budgets will be separated for non-personnel budgets. 
• Comm. Anaya asked about the outreach process to let people know that there is an appeal process and how to do it. BOR says they are doing outreach and asked the CC Commissioners to help with the outreach. 
• Dispute over the assessing, appeal and tax process is ongoing and not new. President’s office is doing a study to determine the best process according to Comm. Steele. 
• A lot of concern expressed over the amount of OT and what that does relate to. Is it the type of work or the number of appeals or something else. Comm. Britton said they need to know so that they can allocate resources appropriately. 
• Comm. Britton also wants to know why there is such a discrepancy in the number of appeals that come from various areas in Cook County - stated that he sees this as an equity issue. Further expressed desire that all involved (Assessor, BOR, and anyone else necessary) get together and work out all these data, communication, equipment etc. issues that seem to be causing a lot of contention. 
• Comm. Kevin Morrison reviewed all BOR minutes for past few years and asked that the BOR commissioners figure out how to get along. 
• There is now a process for pre-filing an appeal so appeals can now be filed anytime and anywhere in Cook County. Comm. Stamps asked for clarification and how this is being communicated to the residents of Cook County. BOR says they don’t have a communications budget so the efforts are minimal.
• Comm. Rogers says there have to be concerted efforts to get the numbers right in the beginning so there is less need to appeal. Comm. Steele said the appeal rate in Cook County is 33%.

Observer: Cynthia Schilsky

Cook County Board Committee Meetings
April 16 and 17, 2024

The following are key items from the Committee Meetings:

Finance Committee:
Resolution to redirect $70 M (out of $100 M in the Disaster Response & Recovery Fund) from new arrival health care to reimbursing Chicago for food service for new arrivals (Item 24-2103)

• Approved after significant discussion with the caveat that any modification to the grant agreement with Chicago (such as change in vendors or use of the funds) would have to come back to the Board for approval.  
• Normally, the Chief Financial Officer and the Director of the Emergency Management and Regional Security (DEMRS) would be able to approve such changes as long as the purpose fell within the scope of the resolution:  “food service or other new arrival operating costs throughout calendar year 2024.”  
• Commissioners Bridget Gainer, Sean Morrison, and Donna Miller led the call for the greater oversight by the Board given the great interest the public has in these expenditures.

Public Comment

• The lone commenter pointed out the settlements on the agenda for Freedom of Information Act Violations.  The commenter urged that such settlement payments come out of the applicable department/official’s budget.
• The following settlements were on this agenda (and approved):  $5,500 for the Sheriff’s Office; $31,500 and $29,500 and $41,537 for the State’s Attorney’s Office.

Comptroller’s Report (Item 24-2587) for 1st quarter of 2024

• $140 M favorable balance for the General Fund
• $37 M favorable balance for the Health Fund (cash basis)
• $126 M favorable balance for the Health Fund on an accrual basis

Legislation & Intergovernment Relations Committee
Approved amendment of Ethics Ordinance (Item 24-2057)

• Modified language to prohibit only County officials who are candidates for the upcoming election from using County funds for newsletters, brochures, public service announcements or advertisements up to 60 days prior to the election.
• Previously, the prohibition applied to all County officials, not just those running in the upcoming election.

Health & Hospitals Committee
Heard a report from Dr. Lamar Hasbrouck, Chief Operating Officer of the Department of Public Health (Item 23-3815)

• Up to 64 cases of measles state-wide; 58 in Chicago and 2 in Suburban Cook; most of which related to migrant shelters.  Doing a lot of education on both measles and need for vaccinations in general.  
• Currently low transmission for Covid-19, both within Cook County and nationally.  Says now endemic (that is, present), as opposed to epidemic (spreading widely).
• Provided some information about Long Covid, which defined as either new or recurring symptoms 4 weeks after initial infection.  Most often seen 3 months after initial infection.  Most common after the first infection.  Symptoms do seem to be decreasing over time.  Much more study is needed.

Technology Committee
All County Officials provided reports on their major technology projects from Sept. 2023 thru March 2024.  However, written reports/presentations were not posted for the Board of Review or the State’s Attorney, though they did report at the meeting.  A few items of note:

• Bureau of Technology reported on the Integrated Property Tax System, saying the overall schedule appears to be back on track.  Hoping to go live with the automated tax bill by October 18, which suggests that the 2nd installment of the property taxes will not be sent out prior to then.
• The Board of Review has migrated from the main frame and data sharing with the Assessor is working.
• The Clerk’s office reported that the new recording system, which was done in house (!) went live in March of 2024.  
• The Clerk of the Court’s office reported that the case management system is off the main frame, though still looking up history from the main frame.  Expect to be completely off by July.
• The Chief Judge’s office expects to be completely off the main frame by December at the latest, but hopes earlier.  All courtrooms are now ready for hybrid proceedings.  A new web site was just launched.

Observer:  Priscilla Mims

Cook County Board of Commissioners
Committee Meetings
March 12, 2024

Health and Hospitals Committee. 1 pm
Vaccine Preventable Disease was the focus of the report from CCH. Dr. LaMar Hasbrouck, COO, made the presentation.  Boost Up Cook County has been the program title for the past year.  This year’s title is The Gift of Booster. Since currently school age children have the lowest vaccine rate in decades, immunizations awareness campaign is reaching out in a variety of ways and in multiple languages.  30 priority zip codes have been identified; outreach does extend beyond them. The goal for measles vaccines is 94%; there are concerns when it is under 90%. Shelters now have needs.  Some support is provided for efforts in Chicago and the CDC is also involved. Comm. Stamps moved and Comm. Lowry seconded approval of Item 24-1372. It was approved by the Committee.  Report can be viewed on the Legistar site for this meeting. Meeting adjourned at 1:45.

Environment and Sustainability Committee. 1:30 pm
A change in language to the Coal Tar Ban Ordinance was explained by Com Trevor to be a change from “asphalt based surfaces “ to “asphalt paved surfaces.” Committee Chair Degnan explained the item has been under discussion over months, that Com Trevor had spoken with business owners, lobbyists, and others. Details were explained in response to comments and questions from commissioners. A motion was made by Commissioner Trevor, seconded by Vice Chairwoman Morita, to accept as substituted and amended in the errata 23-5769. It passed in committee. Meeting began at 1:47pm and adjourned at 2:17pm.

Observer:  Carolyn Cosentino

Cook County Board of Commissioners
Health and Hospitals Committee Meeting
February 27, 2024                        1 hr. meeting

Dr. Erik Mikaitis, Interim CEO of CCH and Dr. Rami Doukky, Chair of Cardiology & Interim Director of Heart Institute at CCH presented Health Disparities Semi Annual Report, June 2023-December 2023. The slide show from this presentation is available online at
 cook-county.legistar.com/calendar.aspx. Look on the Attachments for this meeting’s entry.

The Heart Institute is developing its scope of care from prevention to critical care. CMS shows the heart failure rate of readmission within 30 days which is better than the national average, in the 10th percentile. Com. Trevor noted that is especially impressive since they see patients further along in the disease. The statistic indicates good care. In 2023, the American Heart Association awarded them twice with Gold Plus recognition in heart care. These start the list of recent accomplishments at the Heart Institute.

Outpatient services expanded, including outpatient cardiology care and palliative care. Three new clinics have been added. They have introduced the CardioMES, a pulmonary care tool that transmits data every night relative to pulmonary pressure.  A team can intervene and contact patient; decreased need for readmission when in use has been proven here. 

Access to testing and timeliness of results have increased.  Comprehensive ECHO lab has been accredited by a national organization.  Cardiac CT and Cardiac MRI have been introduced. Cardiac PET will be added in Fall, 2024.   Referrals for services are now coming from UChgo Medicine. Patients are now being sent to CCH because of the services and care available, rather than solely as the resource for uninsured patients. Connections with other hospitals are being developed.

 A list of less invasive procedures introduced since 2021 was given. Minimally invasive procedures have helped grow cardiology services. A steady increase of 10% yr. is expected. These are examples of access to a higher standard of care now available to patients. 
Examples: 
-Transcatheter Aortic Valve Replacement (TAVR).  Prior practice would have been to send the patient elsewhere for this or perform open heart surgery with all its risks. 45 cases have been performed.  This TAVR option provides access to an equitable standard of care, with less time in hospital, less cost, less morbidity, reduced risk of adverse events.  
-Left Atrial Appendage Occlusion (Watchman). This is superior to blood thinners which are associated with bleeding.
-Trans Catheter Mitral Care (MitraClip).  This clip is used for leaking valve which if left untreated can lead to heart failure.  It is especially valuable for patients who are not candidates for open heart surgery.  Introduced in 2023, 20 procedures have been performed so far.

A new clinic program, Heart Disease in Women, will be opening will opening in Fall, 2024.
24-0403 was received and filed.

Slide show of presentation is available online in Attachments for Meeting Details.

Observer: Carolyn Cosentino

Cook County Board of Commissioners Health and Hospitals Committee
​Public Hearing
​February 27, 2024                                         Meeting Length: 1 hr. 25 min. 

Dr. R. Garza CCH Board of Directors Chair introduced Brian Barton and Dr. Greg Vaughn. They were representing the firm Spencer Stuart, which is conducting the search process and were present to hear priorities and address questions. Many of the points of concern, they stated, had also been expressed to them by the Cook County Health (CCH) Board.  Commissioners agreed on these and many others.

The discussion included the following points of concern:

• The 9% of agency hires is a financial burden and discouraging to employees who see agency coworkers earning higher salaries. Staffing is a responsibility and must be seen by next CEO as an important priority.
• Susan Avala, representing 7th Dist. Health Task Force, stated concerns over turnover in leadership, need for staffing using fulltime employees so they have sufficient training to address medical needs of clients.
• Diane Palmer, SCIU union, pointed to the financial burden of agency workforce; CEO needs to recognize the needs represented by unfilled positions. Staffing goes beyond doctors and nurses. 
• Experience in public health systems is needed, showing a commitment to it.  Concern about the position as a steppingstone was repeated by many.  
• Prioritizing mental health/ behavioral health services is needed. Treatment is an important tool in many cases when police have become the only available option. 
• Christina Terell, mental health specialist at Cermak facility echoed this concern noting overreliance on agency workers has negative impact on workload for rest of staff.
• Julia Jacobs, for 25 yr. a mental health worker, stated new CEO must value developing technology so that patients have access to tools.
• Understand value of flexibility to address quickly shifting needs we confront. 
•  Understand systems interface with functions of others in Cook County
• Importance of equity needs in disinvested communities must be recognized 
• Background in business administration of healthcare is useful

 The following information is a portion of what commissioners were told when they asked about the process.

• The process generally takes 5-6 months from start to finish.  Discussions with CCH Board have begun. 
• Vaughn stated confidentiality is very important for candidates in the process.
• Asked what happens if you feel you don’t have the ideal candidate among the ones interviewed, Mr. Barton stated we want to bring. you the top candidate. If necessary, we relaunch the search. We are here until you are satisfied with the final candidate.

Observer : Carolyn Cosentiino

Cook County Board of Commissioners Committee Meetings
Cook County Health & Hospitals and Labor 
January 23, 2024

Health & Hospitals Committee
Public comments:

• Two ERT (Emergency Response Technicians, which the speaker said was equivalent to paramedics) from Cermak Hospital addressed the Committee to alert Commissioners about the staffing shortages for the ERT and CMT (Correctional Medical Technicians) at Cermak, which provides medical services for those working and staying at the Cook County Jail.  The speakers also said that they are not being allowed to perform the full scope of services their licenses would allow.
• Commissioners asked the speakers several questions, along with the COO of Cermak, who is to provide the number of vacancies in each position to the Committee.  He said that CCH (Cook County Health) is actively recruiting people for those positions.

Quarterly update on status of infectious diseases (Item 23-3815):

• Dr. Lamar Hasbrouck, COO of the Cook County Department of Public Health, said that the prevalence of Covid 19 was still low in Cook County, but climbing toward moderate.  Omicron and its variants still are what are being seen, and the current vaccine (introduced in the fall of 2023) is still effective in reducing the severity of the disease if you do contract it.  Dr. Hasbrouck also stated that it appears that the more vaccines you get (as the different ones become available), the less chance you have for developing Long Covid.  It appears that there has been no significant uptick in Covid cases this year, in contrast to last year, following the holidays (with the get-togethers and travelling).
• Flu cases are at the moderate level and increasing.  RSV appears to have peaked, but seniors and young children are still at risk.
• The measles outbreak in October has been squashed.  All those who contracted measles were related to each other and were unvaccinated.

Semi-annual Reports on Behavioral Health Services Provided by Cook County Offices from June 2023 through November 2023
(Item 24-0639, State’s Attorney; 24-0595, Public Defender; 24-0578, Cook County Health; 24-0523, Chief Judge; and 24-0020, Sheriff)
Presentations included the following information:

• All detainees at the jail are screened for mental health and substance abuse and treatment is provided to over 2000 a month (42% of the jail population).
• In Aug. of 2023, Cermak received full accreditation by the National Commission on Correctional Healthcare and its Opioid Treatment Program also is accredited, the only one in an Illinois correctional facility and one of only a few in the U.S.
• At the Juvenile Temporary Detention Center (JTDC), all detainees are screened and 64% receive mental health services.  When the young people leave the facility, they are provided with a folder containing information about obtaining a wide range of services.  Commissioner Degnen stressed that the Board is receptive to increasing the budget if there is a need for more personnel to provide services.
• Commissioner Stamps wants to see the curriculum used for the Partner Abuse Intervention Programs run by the Social Service Dept under the Chief Judge to see if they are culturally relevant to those participating, who are generally ordered by a court to do so. She also noted the low number of satisfactory completions of the 25-session program:  19 out of 174 clients served.  Commissioner Deer asked for recidivism rates, which he was told were being looked at now.  Commissioner Lowry asked why the information was last obtained in 2017 and only now is being compiled again.  He was told about the administrative difficulties in getting the information from the State Police.
• The Public Defemder provides some services and referrals for clients for mental health. The office is looking to collaborate more with CCH.

Labor Committee

• CCH reported on its implementation  of the Recruitment and Retention Bonus Program that began last summer.  In order to receive the recruitment bonuses, most of the new hires have to remain employees for 1 or 2 years.    (Item 23-3804)

Observer:  Priscilla Mims