Cook County Board Finance Committee Continues with Midyear Budget Hearings

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