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
Several Contracts Questioned by Commissioners at Cook County Board Meeting Especially for Clerk Of Court Brown
Cook County Board of Commissioners - Meeting - September 26, 2019
Absent: Commissioner Tobolski
Items referred to Committees for future discussion and consideration:
Committee Recommendations Approved:
Very quickly and without much explanation the following committee items were approved by the Board of Commissioners (I may have missed some that were bundled with other items and approved):
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
Individual authors are credited at the end of each post.