Cook County Board Finance Committee – Mid-Year Budget Hearings
July 26, 2023 –

Cook County Health  - Israel Rocha, CEO.    
2024 Preliminary Budget:  $4,034.9 Billion Revenue

Mr. Rocha began by stating that Strategic Plan mission is to compete head on with any health care system in the world.  The primary issues discussed during the two-hour hearing were:

• Dental Care             -   Nurses Hiring & Reduction of Agency staff       
• Abortion Care        -    Asylum Seekers and the Undocumented

Dental Care

• CCH currently has six clinics outfitted to provide dental care.  Blue Island is the latest at a cost of $236,000 for space preparation and equipment.  The issue is finding staff to provide the dental services at all the locations.  Mr. Rocha said the System is look at options and may start sharing staff.   

Abortion Care

• Commissioner Britton asked about out of state patients seeking abortion care.  Mr. Rocha said that the CCH has seen an increase in services needed, particularly with complications.

Hiring & Reduction of Agency Nursing Staff

• Mr. Rocha noted that year to date, 800 hires have been made, and turnover is down.  The System’s 6.1% turnover is lower than the industry average, but he noted that the average age of the workforce is 51 years. The number of current vacancies is 2,314.  When asked about when the use of agency nurses would be reduced, Mr. Rocha talked about the HR’s recruitment efforts for nurses including the very successful job fairs with same-day conditional offers, signing and retention bonuses, and the increased emphasis of benefits such as pension, health, personal leave, and full tuition coverage after one year of service.  
• Later in the discussion, Commissioner Gainer said that the CCH will always have to rely on agency help, particularly for nurses.  Her point is that a realistic number should be set each year for needed agency help to which budget numbers can be assigned.  

Asylum Seekers and the Undocumented

• As a reminder, the System serves all residents of Cook County regardless of their citizenship or ability to pay.  The influx of Asylum Seekers over the last 6-8 months has resulted in unbudgeted expenses.   Belmont Cragin is the entry point for health care screenings.  Mr. Rocha said that the cost to date has been about $1-$1.5 million per month, but total costs for 2023 are projected at $26 million. Commissioner Morrison asked if the cost of the Asylum Seekers and the Undocumented could be separated for future budgets.  Mr. Rocha said that patients are not asked if they are in the US legally to avoid a chilling effect. on seeking care.  Some of the undocumented cost is covered by Medicaid and the rest falls under the Charity Care expenses line.
• Overall, commissioners were very complimentary of Mr. Rocha’s leadership and progress.  Commissioner Miller said that CCH has gone from being a model of reactive care to a model of preventive care.

Observer:  Diane Edmundson

Cook County Board Finance Committee – Mid-Year  Budget Hearings
July 25, 2023 - Afternoon Meetings

Inspector General – Steven Cyranoski, Interim IG.  
$2.3 million Preliminary 2024 budget

• At midterm, 15% below 2023 budget.  Year-end projection:  Under Budget
• Budgeted for 19 FTE’s.  Currently: 3 vacancies [IG, Deputy IG, Investigator]
• No commissioner questions

Public Administrator – Louis Apostal.   $1.7 million self-funded 2024

• 738 investigations to find rightful inheritance ownership
• 70 properties under management
• 15 full-time staff – unionized office.  5 outside attorneys
• 2024 budget will increase by $137,000 – primarily increased compensation costs

Cook County Clerk – Karen Yarborough.   $20.6 million Preliminary 2024 budget

• Chief Election Officer and responsible for maintaining and providing vital records
• No longer under Shakman and received several compliments for achievement
• Increased vacancies of between 25-30 due to retirement and termination
• Elections:  Additional language ballots will be offered along with information sheets in that language.
• Commissioner Aquilar asked why a pension deduction was taken out of Election Judges checks. Ans:  there is a glitch in the system which is being addressed.  
• Availability of Election Judges was a question:  Ans:  The shortfall has been filled by veterans, community college students that can earn a credit for taking a course on being an election judge, civics, and cyber security.
• Question:  Security of elections and voting by mail.  Ans:  Election ballot drop boxes are located at early voting sites and are monitored.

Board of Review [BOR] – Cardenas, Steele, Rogers.  
$18 million Preliminary 2024 budget

• Currently, analysts are working 20 hours mandatory overtime to get appeals processed and sent to the next office for mailing out the 2022 tax bills which are already late.
• The BOR asked for money to bring each of the 3 Districts to 50 analysts.  Currently a total of 105 analysts.  Daley asked if granted, could the Board guarantee that the tax bills will go out on time.  Ans:  No as there are too many other offices involved in the process.  Said it is anticipating 400,000 appeals in 2024.  The previous analyst ratio was 1-1200 appeals.  Now 1-1600 appeals.
• Steele, who has 17 years in the Assessment Industry including the CC Assessor’s office, noted that the Assessor looks at properties in comparable groups while the BOR reviews each property individually.  
• Steele published a BOR report for 2022 and is in the process of working on a Standards Manual.
• February’s request for a cost comparison between switching to or fully integrating with the Tyler system should be ready in late August.  Cardenas noted that the BOR has just two IT employees.
• Cardenas said that transparency is at the front of the BOR’s mission, and that it has already reduced the appeal time by 6 weeks.  He also said the website has been improved as have FOIA responses

Land Bank – Jessica Caffrey, Executive Director.  Primarily self-funded
Ms. Caffrey is relatively new to the Land Bank having worked for the County in previous roles including coordinating the development of the Old Stroger Hospital and the building of the Cook County Health’s Administrative Building on Polk.

• The Land Bank’s goal is to “create the market” by acquiring 4-5 houses per block in a blighted area which can change the entire block and market
• It acquires vacant, available property through tax sales and other means
• 96% of all its properties are resold to homeowners
• $9.8 million in real estate value has been created in Inglewood
• Created $2.5 million in revenues as of May 1, 2023
• Reduced aged inventory which is property that is on the books over two years
• Staff:  13 positions including 3 vacancies.

​Observer:  Diane Edmundson

Cook County Board Finance Committee
Mid-Year Budget Review Meetings on July 25, 2023

Budget Overview

• Revenue will decline next fiscal year because the State has changed the statutes on sharing the Personal Property Tax (part of the corporate income tax) and Cook County will see a change from $133M this year to $75M next year.
• Sales tax will remain level
• Income from County Care at CCH will decline because participants have to go through Medicaid redetermination post Covid and it is projected there will be less members.
• Labor costs will increase $27M  and IT costs will increase $20M next year.

Cook County Health (CCH)

• FY 24 will have a shortfall of $3M due to the redetermination and increased labor costs. The union agreements included retroactive COLAs.
• Asylum seekers medical costs have been $26M this year.
• CCH has managed $265M of ARPA funds in 70 programs.  They provide monthly reports on the programs to the Board.  There is a sustainable working groups looking at how to continue the programs after 2026 and the end of ARPA funds.

Office of the President

• Cook County reporting of ARPA funds is good according to Results for America.
• $281M of medical debt of individuals has been paid by Cook County.
• $110M has been spent for reducing gun violence.  Cook County is working with the City and the State on this issue.
• Technical help has been provided to 13,000 small businesses.
• Commissioner Sean Morrison asked for more detailed reporting on the medical debt elimination—how are recipients chosen, which hospitals and locales.
• Commissioner Gainer asked if HR hiring process is improving.  Ms. Turner said that was being reported in the Performance Management website.

Chief Judge - Tim Evans

• The court system now has a permanent hybrid process.
• The courts will need more employees to support the Safe-T act for night and weekend shifts.
• Judge Evans explained the operation of the restorative justice program and its success in decreased recidivism of its participants compared to people who go through the regular court system.
• Commissioner Gainer asked for more reporting on the residents in the Juvenile Detention Center, particularly in education.   There have been reports that special needs students are not being accommodated.

Sheriff - Tom Dart

• The jail will be within budget for FY 2023.
• Sheriff Dart explained why there was a need for a new helicopter, particularly for use in carjackings.
• The sheriff office provides back up for many suburban police departments. They are the only police in Ford Heights, Dalton, and Harvey.
• The office implemented a mental health incident support program.   Responders are trained on de-escalation procedures and provided a tablet that they can use when dealing with a mental health crisis.   The tablet connects them with a mental health expert to help them deal with the issue.  This has been implemented with 15 communities.

​Observer:  Kathleen Graffam

Cook County Finance Committee Meetings on the Budget
October 26, 2022, 9 am to 2:30 pm

The Sheriff said there should be little impact on the jail population in Cook County as a result of the SAFE-T Act going into effect on January 1, 2023.  The Chief Judge explained the differences between the criteria for holding people in jail prior to trial in criminal cases now and after January 1.  

Following are more details of the meetings with these two officials, as well as the meeting on the Capital Budget.

Office of the Sheriff -– Presented by Sheriff Tom Dart

• Because of the changes in the way bail has been set in Cook County courts since 2018 he expects that the SAFE-T Act will have little impact on the jail population.  Estimated maybe 100 current detainees will have their bail reviewed, and thinks there may be some more people accused of domestic violence ordered detained.
• Says that he still thinks there are more people being released (mainly on electronic monitoring, “EM”) than should be because there is not enough distinction among those charged with gun violations.  (See more on this below in the Chief Judge’s section.)
• Wants to have budget amended to fund purchase of a new helicopter to help in fighting crime across the County.  Says only have 2 now (from 1994 and 2006), with the ability to borrow another from the County’s Homeland Security department at times.  Another helicopter would reduce dangerous, high-speed pursuits.  Contrasted the larger number of helicopters for New York, LA, and Harris County, Texas.  The Budget Department is analyzing the request and looking where money could be found.
• Explained that jail population has changed.  Majority now are there accused of violent crimes, rather than substance abuse, as in the past.  Many of the past efforts and programs were directed to helping those released from jail to successfully go back to their communities.  Now, however, most of the detainees are leaving the jail after trial to go to prison and not back to the community.
• Says that 2 main proximate causes of violence now are (1) availability of guns, and (2) social media where people’s rhetoric escalates and there is no cooling off period.  (These causes apart from all the social issues.)
• In addition to policing the unincorporated areas and Robbins and Ford Heights, and providing services for a number of other suburbs pursuant to agreements, the Sheriff has focused on violence in Chicago.  Since opening an office in Austin on the west side of Chicago, there has been a 20% reduction in shootings in that neighborhood.  More recently, opened an office at 500 N. Clark, and will be moving into larger quarters at State and Chicago.  Besides providing a police presence, also have a unit to deal with homelessness, another to deal with people in crisis, and a K-9 unit to help patrol El platforms.  Roll call for eviction and service of process has been moved from the Daley Center to Chinatown to provide a greater police presence there.
• Has about 400 vacancies.  Recently went to Kentucky and North Carolina to recruit military veterans with some success.

Office of the Chief Judge -– Presented by Chief Judge Timothy Evans

• Said that under current law, the State’s Attorney must file a petition to hold a criminal defendant in jail prior to trial.  Then the judge at the bail hearing has to hold there is at least one of these situations to grant the petition: (1) that the proof has to be evident or the presumption is great that the preponderance of the evidence points to the defendants and that they pose a clear and present threat to a person or community and there are no mitigating factors; and/or (2) there is clear evidence the defendants are a flight risk.
• Under the SAFE-T Act, there are certain felonies that are excluded from consideration of the first situation, and in those cases, defendants can only be held if a current flight risk.  The other difference is that if there is a petition to hold, there is a separate hearing on whether to detain presided at by a second judge.
• Responding to Comm. Sean Morrison’s questions, said that approximately 86% of those defendants that go to trial are found guilty.  The average sentence for murder is 35 years.  As a result, the overwhelming number of cases end in a plea deal.  Said would provide data from the last 12 months on the number of murder and attempted murder cases where the charges are downgraded.
• Comm. S. Morrison also provided some statistics from the Sheriff that of the over 2,000 people on electronic monitoring, 970 are accused of gun offenses.  Comm. Morrison asked whether there should be some kind of blue-ribbon commission to review these cases to see if policies regarding electronic monitoring should be changed.  Judge Evans said that many of these defendants are charged with “unlawful use of a gun,” but that charge does not mean that the gun was actually used. It could be that the person had a gun without the proper permit.  So Judge Evans would welcome such a commission and would like to revise the terms used to distinguish among the different situations.
• Because of the Early Resolution Program to help deal with eviction cases, there has been no huge number of evictions as the Judge feared at last year’s budget meeting.  Under this program, there are mediators and legal advisors to work with both sides to try to resolve the situation, including find other housing since in some cases the landlords want to get rid of the tenant as opposed to getting back rent.
• Provided some codes that can be used to generate reports on continuances, including whether the state’s attorney or defense counsel sought them.  Commissioners Miller and Daley noted they have been seeking this information for the last year.  Judge Evans said that his office will work with the Clerk of the Court to add codes for general reasons on why a continuance is sought. Expects to start on this after the Odyssey System is fully operational, which should be by the end of Nov.
• There was discussion concerning confinement/isolation of juveniles at the Juvenile Temporary Detention Center.  Commissioner Gainer asked that the following be considered as the policy continues to be fleshed out:  (1) more clarity on how someone ends up in confinement; (2) clear direction that confinement is the last resort; and (3) mental health sign-off by a professional before someone can be confined (like in NY and LA).

Capital Budget Overview – Presented by Acting CFO Lawrence Wilson, Bureau Chief of Asset Management Elizabeth Granato, Director of Transportation Jennifer Killen, and Deputy CIO Adam Clement.

The 2023 Capital Budget is $505.2 M composed of 

• $248.4 M (49.2%) for capital improvements for County facilities; 
• $136.2 M (27%) for County maintained road, bridges, and highways; and 
• $120.6 M (23.8%) for capital equipment for County departments that includes primarily information technology (71% composed of costs for hardware and implementation), plus the remainder for vehicles, fixed plant assets, institutional equipment, furniture, and medical lab equipment.  
• Note:  some of these expenditures show up in the overall budget as expenditures from special purpose funds (including the Transportation and Highways fund), and grants.  As a result, these sources of revenues for capital projects are not included in the Capital Improvement Budget, which is $352.6 M (just about the same as 2022).

Part of the presentation focused on the process of determining how much could be directed to capital projects, including how much debt to incur, as well as how the County prioritizes projects.  The County currently has investment grade bond ratings of A2 from Moody’s; A+ from S&P Global Ratings, and AA- from Fitch Ratings for General Obligation Bonds; and AAA from Kroll Bond Rating Agency and AA- from S&P Global Ratings for Sales Tax Debt. 

Among the projects included in the Capital Budget are

• Renovation and consolidation at the County building, including making the 5th floor Board Room ADA accessible and adding technology improvements (the entire 5th floor, which also houses the President’s and Commissioner’s offices are expected to move to the 10th floor in Nov. or Dec.)
• Major renovations at Stroger Hospital
• Completion of the Court Utilization Study for the civil division (the criminal division has been completed0
• More work on the Integrated Property Tax System
• The State’s Attorney’s Case Management System
• A number of transportation projects
• Continued work as part of the Green Buildings Program, which is reducing the County’s carbon footprint, but also reducing energy costs

​Observer:  Priscilla Mims

Cook County Board Finance Committee Meetings on the Budget
October 25, 2022

Cook County Health (“CCH”) – Presented by CCH CEO Israel Rocha. Jr.

• Addressing Payroll expenses, particularly for nurses, has been devasting for the System and remains its top priority.  Agency contract rates have declined but still historically high. President Preckwinkle has approved the System's new Retention and Recruitment Plan.
• COVID has led to the wide-spread adoption of telehealth and telemedicine.
•  The System's new Change Institute priorities are cancer, stroke, diabetes, behavioral health and mental health. Food and housing insecurity programs will be added and expanded.
• Provident Hospital - $5 million has been budgeted for early conversations with institutions that are interested in partnering and funding a new Provident Hospital.
• The System has already served close to 2,400 undocumented people aged 42 and up; and the CCH Foundation has supplied needed clothing, diapers, etc. for the newly arrived undocumented persons.

Commissioner Questions:
Miller:  Addressing the issue of the new Change Institute, said that she was pleased to see more focus on "preventive vs reactionary" care, and noted the increase of 44 new positions in this new Department.  She particularly asked for goals and metrics from each of the Institute's funding sources [ARPA, Grants, County] and any other new programs using ARPA and County funding.

CEO Rocha responded to a question about the behavior health goals using ARPA funding stating that there are two big categories:

• External:  The System will create an organization to expand the safety net for the Behavioral Health community and its services to secure in the long term all elements of Behavioral Health needs.  Will use impact funds to do an analysis of the current community safety net.
• Internal:   The System will expand "trauma informed" outpatient therapy and will create a 16-bed inpatient unit and crisis stabilization unit.

Responding to Miller's inquiry and support for more emphasis on equity and inclusion across the System's services, Rocha said that he is hiring a Chief Equity Inclusion Officer, and two Associate Inclusion Officers - one responsible to/for the System and one to/for the Public Health Department.

Next came Miller's question on the Juvenile Justice Care Coordination Program to be funded by ARPA.  Two Care Coordinators will be hired for reentry and transition stabilization.

When asked about the ongoing long-time issue of low patient satisfaction ratings, Rocha noted that the HIV Core Center has a great reputation and rhetorically asked "how can we use its experience?"

Degnan:  Wants the system to communicate more broadly that CCH is a safe home for reproductive health.  Said that a specific brochure is needed focusing on the System's services.  Rocha responded that he would send her the communication tools currently in use.

Anaya:  Responding to Anaya's concern about the length of the hiring process, Rocha said that the System has hired 350 individuals in the last 150 days and that turnover is at its lowest level in 18-20 months.

Several other Commissioners noted that their questions had been covered by previous colleagues and also commended CEO Rocha on his command of the System's needs and his vision for CCH.

Assessor’s Office -– Presented by Assessor Fritz Kaegi

• The biggest news is that the office expects to be found in “substantial compliance” with Shakman by mid-November.
• Assessor Kaegi next noted that the North suburban counties’ reassessment will be completed by the end of the year, and the office is waiting for the Board of Review to be in a position to accept the data.  
• 2023 priorities includes a new implementation phase of the Tyler technology system to ensure an on-time assessment cycle; the office needs to continue to maintain in parallel the old main frame system until the Board of Review transfers to Tyler; and it will implement new tools for tracking exemptions.  Expects March 2023 assessment data transfer to be on time.
• To date in 2022, hired 31 employees to fill vacancies due to retirements - 25% of new hires are customer service positions, and added strategic hires to build capacity in HR and Legal.  The office is not using temporary help; is hiring data science and evaluation majors, and also hiring from real estate schools. 
• Commissioner Gainer wants to work with the Assessor’s office to reset outstanding taxes on scavenger sale properties to zero thereby helping properties to be sold and neighboring properties to maintain their values.  She also wants to work with the FHA to change the rules so that Land Bank developers can get access to the FHA uniform appraisal data base and qualify for FHA loans.     

Carrying over from the meeting with the Assessor earlier, court oversight of the offices of the Clerk of the Circuit Court and the County Clerk under the Shakman cases (which prohibit political considerations regarding most County personnel) was raised during these two meetings.  

• Circuit Court Clerk Iris Martinez said she has been working closely with the court-appointed administrator, and expects her office to be found in “substantial compliance” with Shakman by November, 2022!  
• Cook County Clerk Karen Yarbrough criticized Shakman oversight of her office as not being necessary, and she has filed to end such supervision, expecting it to also end in November.  

Commissioner Sean Morrison focused on the failure of some County departments to respond to remedial recommendations, as required by County ordinances, during the meeting with the Inspector General.  
Following are more details from these meetings, along with the one with the Treasurer, who announced that she is expecting to receive the information for the 2nd installment property tax bills by November 11.  If so, she said she would have bills posted on her web site and available for downloading and payment by November 15.  
Treasurer -  Presented by Treasurer Maria Pappas 

• By posting the 2nd installment property tax bills on the Treasurer’s web site (hopefully by Nov. 15), this will facilitate payment prior to the end of 2022 for those wishing to take a deduction for property taxes on their 2022 income tax returns.
• Only 5% of the Treasurer’s budget is financed by taxpayer dollars.
• Says her workforce comes into the office - no working from home.
• Quickly went through her slide presentation, focusing on the many studies published by her office, included the latest one, the Sales in Error, which Comm. Gainer praised.  All of the studies are available on the web site, https://www.cookcountytreasurer.com/. 

Office of the Independent Inspector General -– Presented by Acting IIG Steven Cyranoski

• Responding to Comm. Morrison’s questions, Acting IIG explained that if an investigation results in remedial recommendations, the applicable department has 45 days to respond, with the ability to request 30 more days under County ordinances.  The department does not have to accept the recommendations, and Mr. Cyranoski said that there may be good reasons for not accepting.  In each quarterly report from the IIG, at the end there is a list of cases for which no response has been received.  These quarterly reports are submitted to the Board, which in turn can refer for further consideration by the Litigation Subcommittee.  Comm. Suffredin noted that the League of Women Voters has pointed out these failures to respond.
• When the open slots for the IIG and the Deputy IIG are filled, the office will have 19 FTEs, same as authorized for 2022.
• Over the last 5 years, there has been an 85% increase in number of complaints.  Have been able to handle because of the high quality of the personnel in the office and increased use of technology.
• 85% to 90% of the IIG’s recommendations have been adopted. 
• In response to Comm. Suffredin’s questions, Mr. Cyranowski explained that there are 2 investigators assigned full time pursuant to the intergovernmental agreement to provide inspector general services to the Metropolitan Water Reclamation District (“MWRD”).  The current agreement ends mid-2023.  The MWRD has gone to Springfield to obtain legislation that would authorize the MWRD to have its own IG in-house.  In anticipation of this happening, the current budget adjustment (called an “appropriation transfer”) has been reduced from $650,000 in 2022 to $250,000 in 2023.  Part of transfer is also due to the work the IG does for the Forest Preserve.

Clerk of the Circuit Court - Presented by Circuit Court Clerk Iris Y. Martinez

• Has hired more than 150 people to fill open spots this past year.  Currently there are 280 entry level union vacancies, many due to 200 promotions.  Cross training is now being provided so clerks can staff Criminal or Civil courtrooms as necessary.
• 2023 budget includes 30 more FTEs so that every court can be staffed to meet the needs of the new SAFE-T Act and the expected increase in the hours when domestic violence orders of protection can be obtained.  A pilot for extended hours is currently running through early Nov.
• Hopes to be fully integrated into the Odyssey system by the end of the year, reducing reliance on the County’s mainframe.
• Has launched a new call center for 200 different languages to make information more readily available.
• Overall, the budget has increased by 2%.
• In response to a question from Comm. Miller, Clerk Martinez said that the court documents can identify the number of continuances, but not the reason.  Comm Miller and Daley emphasized that they need a report on who is requesting continuances in order to understand (and potentially tackle) the issue of defendants being held in the jail for long periods of time.

County Clerk - Presented by Clerk Karen Yarbrough

• To help alleviate the critical need for Election Judges for the Nov. 8 election, the office reached out to retired military and had 2,000 respond.  More judges are still needed for the 1,439 precincts (which need 5 judges each).
• Early voting and vote-by-mail ballots accounted for 40.1% in the June primary.
• Said that Cook County is recognized nationally for its cyber-security for voting.
• Said that the bulk of revenues from this office is from the recording of deeds area.  A new cashiering system should be rolled out in 2023.  There is a help desk now for recordings.
• Land records from 1871-1974 will be digitalized.

Observers:  Diane Edmundson and Priscilla Mims