Cook County Board 2026 Budget Hearings Cook County Health

Cook County Board of Commissioners Finance Committee Meeting
October 28, 2025

Cook County Health (CCH) – Chief Executive Officer Dr. Erik Mikaitis and Chief Financial Officer Pamela Cassara
Proposed 2026 Budget:  $5.218 Billion              Proposed 2026 Positions:              7,866
Actual 2025 Budget:        $5.252 Billion              Actual 2025 Approved Positions:   7,817
Difference:                    ($     34 Million)                  Difference:                         +   48
Dr. Mikaitis and Ms. Cassara presented the budget, explaining how Cook County Health (CCH) has cut expenses by 10% this year and the concerns for the government funding decreases anticipated in the next two years.  

• They anticipate that the cuts in state and federal funding will result in $400M revenue loss over the next two years. This includes Illinois eliminating the Health Benefits for Immigrant Adults ($111M affecting 8,000 patients) and Federal changes in eligibility for Medicaid recipients. The ARPA funds for 2026 that CCH has already received cannot be clawed back by the federal government.
• Commissioner Trevor expressed concern that the potential stopping of Affordable Care Act subsidies will result in thousands of uninsured residents because health insurance will become unaffordable. She had an estimate that 33% could lose their coverage. These people will turn to CCH for services.  Dr. Mikaitis said that this group may not choose to have the preventative services needed and this will result in more serious issues.   Also, there could be a significant impact to smaller hospitals that may have to close.
• CCH has been able to reduce use of agency staff by 40% which has resulted in a $30M savings. They have improved and accelerated the hiring process and anticipate that they can continue to reduce agency staffing. They are also reviewing processes for improvement that result in savings such as supplies. They are also creating ways for people to use the health clinics rather than the emergency rooms.
• The ICE operations in Cook County have impacted CCH and several Commissioners had questions about it.  There has been an 83% decline in visits from new arrivals. Dr. Mikaitis said the decline is due to immigrants leaving the area and fear of ICE detentions. He is concerned that this population will not have preventative care and that will result in more severe issues seen at emergency rooms.  Several questions concerned the training for employees.  All CCH employees have taken online training on dealing with ICE agents and alerting security and legal.  ICE has not tried to enter buildings to arrest somebody, but they have brought detained people in for medical help.  The ICE agents can legally stay with the detainee in a hospital room (not in surgery) but cannot talk to other patients.
• Commissioner Anaya asked for an update in increasing bilingual staff. They have increased the Spanish speaking interpreters by 9.  They now have 14 Spanish and 3 Polish on-site interpreters.  They also have an online system for all languages which has proved to be very useful and patients are willing to use it. CCH Behavioral Health department is trying to recruit a Spanish speaking psychiatrist but, as yet has not been successful.
• Commissioner Britton asked about their policy on renting versus buying.  CCH is working with Real Estate Management on evaluating their space and trying to consolidate in county-owned property.  CCH is co-locating food help with medical help. It has food pantries and healthy meals programs.  They are working with other providers and philanthropy to plan for the potential SNAP stoppage.
• CCH has established a Pathways program to interest area students in medical professions working at CCH. They work with local high school, college, and graduate students.

Observer:  Kathi Graffam