Cook County Board Of Commissioners’ Finance Committee
       Midyear Budget Hearings - July 21, 2020

Cook County Health - Debra Cary
Revenues as of May 31, 2020: General information from report available on Legistar 

• Medicaid Expansion up 21% from $798 million budgeted to $965 million actual            
• Patient Fee Revenue down 21% from $332 budgeted to $262 actual

Expenses: 

• $1,665 billion actual versus $1,303 billion budget = 28% higher 

Holdback Target:  Reported as N/A 

Highlights of Presentation and Discussion::

• As of 7-21, $154 million Cares Act monies have been received plus another $40 million for COVID-19 contact tracing.
• 70 positions were eliminated and another 200 agency positions identified to bring in house as a cost savings.
• Charity and unpaid care continues at 42% to date but expected to rise.
• Commission Daley stressed that the System has to reverse the large percentage of County Care MCO patients using other providers.
• System is expanding use of Telehealth but it is not considered to be an expense saver.
• Stand alone, ambulatory dialysis services at Provident to open in late 2020.
• Patient numbers are slowly rising at the hospitals and community centers as accommodations are made for social distancing.
• Cary said System needs to be prepared for COVID-19 resurgence and continued extra services at the Jail.
• Artificial intelligence being used to reduce claims rejection by ensuring pre-approval is received.  This new approach is operational for radiology and underway for oncology.  Next 2-3 months will provide more information on success.
• It is expected that the County will use tax dollars in the amount of $82 million to help offset Jail and Public Health Expenses and will pick up another $30 million In pension costs.
• Commission Sean Morrison asked for value of denials and billing errors for years 2018-19.  Also wants capital funding expectations from Cook County CFO.
• Projecting a $187 million deficit for 2021 due to personnel, overtime, and pharmacy costs.
• The new Medicare enrollment plan, More Care, is expected to help increase Medicare revenues by $7.4 million.
• Provident Hospital rebuild on hold until new CEO in place.
• CCH Board President expects CEO search to produce 1-2 finalists in the next few weeks.

Independent Inspector General -– Patrick Blanchard
Revenues – N/A
Expenses - $1,043 million YTD budgeted vs $882,545 actual.  Down 15.3%
Holdback Target:   $120,824.  met.
FY 2021 Budget Target:    $1,726,849

Information of Interest

• Did not hire 2 investigators as part of his hold back target and another new hire will start in August.
• Provides services to Cook County, Forest Preserve, and the MWRD.  Exceptions: States Attorney, Chief Justice, and Clerk of the Court
• Used Micro-Soft Teams to good advantage and will incorporate in future operations.  May save on space.
• Noted that since its inception the IG office has consistently had its staff reduced from a high of 20 to the current number of 14 including 2 MWRD investigators.  Blanchard is now doing the complaint triage work previously handled by his deputy who left and has not been replaced.
• Complaints are up about 25% from 2019.  Projecting 800 for 2020 [includes MWRD].
• With the projected cuts in the 2021 budget, Blanchard does not expect his office can be prepared to provide the coverage needed.
• Produces 60 OIG summary reports a year and receives 350 inquires/complaints.
• The OIG has one full-time harassment investigator who is busy but not “crushed” with work.

Public Administrator -– Louis Apostol
Revenues – Up $539,328 or 82.9%.  YTD Budget $650,000 vs YTD Actual $1,189,328
Expenses -  Down $7,129 or 1.07%.  YTD Budget $666,922 vs YTD Actual $658,922
Holdback -   No.
Fiscal 2021 Budget Target:   $1,259,749.    2020 Budget is $1,344,605

Information of Interest

• In explanation of the holdback:  “The office will have generated over $2,865,112 in fees, interest, court costs, and funds for unknown heirs.  Our 2020 budget is $1,344,605.  At the close of Q3 2020, the fees alone will have generated $1,169,933 to the county treasurer.  This office estimates a year-end total of $1,827,331 in revenue which represents $527,331 over the expense amount appropriated for FY 2020.”
• The office assists the public in administering probate estates when a CC resident passes away without family to manage the liquidation and distribution of his/her assets.  It also aids the public and the Medical Examiner’s Office in location of family for unclaimed remains and homes that would otherwise be abandoned.
• The office has a staff of 15 plus the Public Administrator who is a 1099 employee.

Secretary to the Board of Commissioners - Matthew DeLeon       
Revenues:  N/A
Expenses:  Down $90,636 or 10%.   YTD Budget is $932,617 vs YTD Actual of $84,981
Holdback:   $112,707.  Met.
Fiscal 2021 Budget Target:  $1,745,747

Information of Interest​

• A new Manager of Archives has been hired, and the Secretary intends to bring an Ordinance governing the archives in the fall.
• January 2021 is the 190th Birthday of the County for which the board has instituted a flag design contest for the students of the county.  The contest deadline has been extended to September 2020, and the semi-finalists will be picked in October.  The presentation of the flag is projected for spring/summer 2021.
• The Secretary stated that the Board is not likely to be coming back to the conference room any time soon.
• Sims reminded the Board and the Secretary that the current board room needs to be made ADA accessible.  
• Secretary hopes to significantly expand the conference room in addition to making it ADA accessible when resources are available.

Cook County Sheriff - Tom Dart
Revenue: $6,797,999
Expenses:$284,937,121
Holdback:$25,413,144
Target Holdback;$38,884,424

Sheriff Dart appeared early and ran late at the Midyear Budget Hearings. Some Commissioners called it “extra innings” and other baseball analogies. But the Sheriff had much to say and the Commissioners had many questions. His session ran approximately 2 hours and 40 minutes. Although there was some repetition, the Sheriff and the Commissioners are very concerned as his department might be facing $90 million in cuts from his current $600 million budget.

Some Highlights from the Sheriff’s Remarks:

•  The Sheriff began his remarks by stating he was perfectly “on budget’ until March when Covid hit.
• In March, due to Covid, he had to hire new people  (he said about 200) to open up , clean and staff long closed divisions in order to spread out the population. He also tests each detainee upon entry and quarantines them for 2 weeks. All of this has increased his need for personnel costs, including overtime.
• He also has 1000 more people on Electronic Monitoring (EM) as judges are trying to not put more people in the jail.  His jail population is about 4900, and his EM population is about 3300, both are up from
• He also has about 500 Illinois Dept. of Corrections’ inmates who have been sentenced, but are not being placed in prisons, due to Covid. On the positive side he has freed up some sheriff’s deputies who have not been serving evictions. But as the courts reopen, these deputies may go back to those duties.
• The Sheriff also talked at length about the other duties he has taken on recently. He named 3 South Suburbs that his police have been working with in a supplemental capacity (Dolton, Harvey, and Riverdale). He has also been supplementing the CPD on the West and South sides of Chicago during the protests.
• In addition he runs many mental health programs, mentoring programs for youth, job training programs, and opioid addiction treatment programs both in and out of the jail. He has trained his officers in crisis intervention and in the use of naloxone treatments, he said. For these reasons he will be having trouble cutting his budget.

Some Highlights from the Commissioners’ Questions and Comments:

• Many Commissioners congratulated him and asked detailed questions about testing, distancing and tracing. He said that as of July 20 he had only 16 cases that were positive, 10 of which came in that way. All detainees are tested upon entry and isolated for 2 weeks, no matter what the test results may be.
• Commissioner Suffredin asked for a list of all of the programs that sheriff’s deputies are involved with and the costs of each. The Sheriff said he would get that information.
• Commissioner Anaya asked about how the Sheriff planned to cut $90 million from his budget. He mentioned 3 ways: 

1. He hoped to cut staff through attrition. But he warned the board not to be too generous in the next          union contract talks since he is not part of those negotiations.
2. Branch courts could be closed (like Bridgeview and Rolling Meadows). He would then need to staff less officers in the court houses.
3. He could cut all transportation from the jail to the outlying courts for simple hearings that take 1 or 2 minutes. These could be done remotely. He would save the transportation costs for trials, plea bargaining, sentencing, etc.

• Commissioner Johnson asked about administrative costs. The Sheriff said a full review took place a few years ago in order to cut these. It was unclear if more could be cut. The Commissioner also asked for a list of school related programs that the deputies are involved with and their costs, such as those at Proviso and Richards high schools.

Observers - Diane Edmundson and Jan Goldberg 

Cook County Board of Commissioners Meeting
December 19, 2019

The Board devoted the first 2 hours of their meeting to the honoring of retiring employee Martha Martinez, former Commissioner Jerry Butler, and the late Reverend Clay Evans. Testimonials lauded Martinez for thirty-four years of exemplary service.  Former Commissioner Jerry Butler received a touching tribute from the Board. HIs career as a popular vocal artist and member of the Rock and Roll Hall of Fame was noted. Commissioner Butler sang one of his hits, “Let It Be Me” to the delight of all present. The late Reverend Clay Evans was honored as an icon of the black community and for his work on civil rights with Dr. Martin Luther King.

Action Items:

• Agenda Item 20-0016- The proposed amendment to the Inspector General ordinance regarding reports and public statements was referred to the legislative committee. It requires that the IG share a statement with the head of the affected department and not issue a public statement for ten days. If the department has a response, this must be attached to the public statement. The Civic Federation supported  this amendment during the public comment period.
• Agenda Item 20-0735- The Board unanimously passed a resolution supporting federal universal background checks for firearms. It is hoped that this will add pressure for passage of gun control legislation in Washington.
• Agenda Item 20-0721- The Board unanimously passed a resolution to support refugee resettlement efforts in Cook County. Several agencies testified to the challenge of working under current punitive federal policy.
• Agenda Item 20-0437- Approved an intergovernmental agreement between the pension fund and Cook County. In 2016 the pension was 54% funded. $306.2 million will be contributed for 2020. This infusion of funds has now raised the percentage funded to 68%, one of the highest in the state.
• Agenda Item 20-0732 - Changes in committee chairmanships were approved. These new assignments will give greater responsibility to the newer members of the Board.
• Agenda Item 20-0658 - Proposed tax on cannabis was referred to the finance committee.
• Agenda Item 20-1831- Board approved a commission chaired by Britton to create a new design for the county flag. The deadline is 2021 when the county celebrates its 190th anniversary. High school students will be asked to submit designs in a competition.
• Agenda Item 20-0726 - Board approved a resolution to support Cook County Health’s construction of a new Provident Hospital. It also provides for the Cook County Board Health & Hospital Committee to hold a hearing to receive an update on the project.
• Agenda Item 20-0712 - Board approved a resolution to discuss the Cook County Health Formulary Program. The resolution describes how insurance companies use “step therapy” in an effort to control drug costs. Step therapy is when patients first try the less costly drugs to see if they work. This can delay patients getting the treatment they need.
• Agenda Item 20-0011 - Proposed ordinance regarding zoning for recreational cannabis was referred to committee.
• Agenda Item 20-0579- Board approved authority for Public Defender to accept $500,000 grant to aid data analytics.

Commissioners Daley, Deer, Suffredin, Arroyo, Sylvestri, Gainer and Moore thanked Dr. Shannon (CCH) for his service to Cook County Health. Dr. Shannon was present and acknowledged their kind words. 

Observer - Georgia Gebhardt               Meeting Length: 3 hours, 20 minutes (includes 40 minute lunch break)

Cook County Board of Commissioners - Finance Committee
Departmental Budget Hearing
October 30, 2019: 

Commissioners Absent: Deer, Gainer, Tobolski, Sean Morrison 

Clerk of the Circuit Court:  Dorothy Brown

• Clerk’s office is still working on transfer of court case system to digital with Tyler Technology.  Veterans Day 3 day weekend will go live with Crimiinal Courts, MLK weekend 2020 will be Civil Courts, and Kasamir Pulaski weekend will be Traffic Courts.  Electronic Court Order System will occur in Spring of 2020.
• Shakman update includes the Clerk’s filing of an interim employment plan in July with an exempt employee list filed.  All 1400 employees have been trained on Shakman.  They are in the process of training management on how to interview based on the interim plan.  Their remaining job is to agree on the final employment plan and hire a Director of Compliance.  
• Clerk’s budget request is $8 million more than the President’s budget at $100 million.  Most of the increase is due to the need to hire more court recorders since they are an aging workforce and have an absentee rate of 20% every day!  They can only promote from within and need to hire more people to fill the lower positions. Much of this absenteeism is due to leaves of absence.  She also needs more floaters for Cannabis Expungement paperwork, since the Public Defender plans to expunge 150,000 cases in 2020. They must inform police departments and individuals by mail.  Contractual services will cost $359,000 more mostly for postage.  New case filings have slightly increased and the number of e-filings has increased from 750,000 in 2018  to 2.7 million this year since it is now mandatory,
• The clerk is trying to get all Cook County police departments to become E-sophisticated and issue electronic traffic tickets, although there is resistance due to the need for printers in police cars. There are 28 departments doing e-tickets with 16, including Chicago, yet to switch to electronic. The Clerk’s office has invested nearly 37,000 hours of training on electronic systems.  
• Com. Britton, an attorney, complained that e-filing at his office experienced 3 outages in 6 weeks.  The Clerk explained that as they migrate to the cloud (called Odyssey) there are still glitches in the bridge programming with Tyler Technologies.  Com. Anaya asked  the Clerk to keep them abreast of Shakman developments.  Com. Miller asked about negative balances in the Special Purpose Funds and Tanya Anthony explained the County is working at eliminating all these funds in each department’s budget.  Com. Degnen asked very detailed questions about why Expungement help had to be full time, not temporary, how going electronic was supposed to eliminate headcount, not expand it, and why are there more cashiers, not fewer, since the County is increasingly going to electronic filing and payment with credit cards.  The Clerk responded that the process was so complex in going digital that they have been trying to reduce people but for so many reasons, have been unable to.  
• Electronic kiosks will be available in all courtroom areas to help people find cases and courtroom numbers.  Information will be available in Spanish, Polish, and English.

Recorder of Deeds:   Ed Moody

• Recorder Moody believes that the office will soon have Shakman compliance.  Employees have been trained, they have job descriptions, and they have annual performance reviews.  There is an Employment manual in place.  His new Director of HR was head of the County’s Compliance office previously, so has much needed experience.
• He believes the Recorder of Deeds office is fully ready to be merged with the County Clerk’s area within 2 months.  He is ready for “lights off” in December of 2020.
• ​The Recorder’s office has increased revenue and reduced costs, with 108 FTEs in 2019 versus 120 in 2018.  He is requesting a budget 3% lower than 2019 and will  bring $1 million back to the county this year.  He believes he is on track to bring his actuals in at 15% below 2019 budget.
• Outside expenses incurred for Professional Services are for converting the old Deed books from 1871-1959 to digital format (scanning) and moving microfilm deeds from 1959-1971, likewise to digital.  These were emergency expenditures but 2020 needs will go through RFP process.
• Coms. Anaya, Britton, Miller, and Degnen complemented Recorder Moody on a good job.

County Clerk:  Karen Yarborough

• Now voter signatures for filing petitions can be viewed on-line at various offices rather than having to come downtown to check.  Birth certificates can be obtained on-line. The new voting machines have been universally praised by everyone who has tested them.  They come in an easy-to-handle carrier.
• Com. Anaya asked why the $1.5 million increase in special purpose fund, to which the response was, the election in 2020.  Com. Degnen told the Clerk that her office was there to help in whatever way she could to make the merger with the Recorder go smoothly.  Coms. Britton and Kevin Morrison thanked the Clerk for helping to get passed the Voter Participation Ordinance in time for the November 2020 election.  There will be 7 early voting sites in jails next year.
• Deputy Clerk of Elections, Ed Mikalowski said that due to a much better relationship with Chicago Board of Elections, voting records and communication will be much easier.  He praised the LWV Cook County for helping to bring certain awareness and insight to the choice of voting machines. 

Office of Inspector General:  Patrick Blanchard

• This office has 16 employees, with 2 at Metropolitan Water Reclamation District (MWRD) and 1 at Stroger.  It handled 551 complaints in 2018 vs. 554 complaints so far in 2019.   A 9% increase in salaries for 3 positions with a long standing salary disparity are included in this budget. MWRD services are billed on an hourly basis. They have done outreach and 70 trainings on filing internal complaints for MWRD employees (4 times more headcount than the Forest Preserve District).  Quarterly reports of billing and complaints can be found online on the MWRD site and Cook County.  This office also looks at employment plans on behalf of the Shakman rules to make sure departments are within compliance.

Observer - Amy Little