First Day of 2024 Budget Meetings with Departments

Cook County Board Finance Committee
Departmental Budget Hearings
Oct. 24, 2023

Finance Committee meetings with  

• Budget Overview
• Offices under the President
• Cook County Health
• Office of the Public Administration

Budget Overview (Tanya Anthony, Kanako Ishida Musselwhite, Dean Constantinou)

​Proposed 2024 Expenditures:    $9.14 B        2023:  $8.79 B
   Healthcare:                                              $4.37 B        2023:  $4.1  B
   Public Safety:                                          $1.56 B        2023:  $1.5  B
   Finance & Admin.                              $   958 M        2023:  $   862 M
   Capital Projects:                                 $   756 M        2023:  $   723 M
   Annuity & Benefits:                            $   439 M        2023:  $   513 M
   Debt Payments:                                   $   312 M        2023:  $   305 M
   Economic Development                  $   296 M        2023:  $   328 M
   Fixed Charges & Other:                    $   294 M        2023:  $   270 M
   Property & Taxation:                           $   144 M        2023:  $   132 M

Following are some key items from this meeting:

• Total budget recommendation: increase of 342M (4%) 
• FTE will decrease by sunset-ing 414 positions (no layoffs)
• Special Purpose Funds: recommends a $264M increase in ARPA spending to continue key initiatives; will create a separate ARPA Program Sustainability Reserve (not using ARPA funds) to extend some programs beyond 2026; Opioid Remediation and Abatement Fund (ORAF) has recovered $10.5M (in 1st of 15 years) from national settlements; will spend ARPA funds first, then settlements
• General Fund revenues are projected to increase by 6%. General Fund is sensitive to political and economic factors; creating reserves and more diverse revenue sources to manage budget in the event of a downturn; employing Moody’s Analytics to create forecast scenarios
• Pension Fund   should be at 100% beyond 2044    
• Contract compliance budget going up 25% due to community outreach to increase small business licenses
• Inflation Reduction Act: many environmental funding programs will publish grants applied for in monthly updates; will have a grants management unit by end of 1Q24 in the Offices Under the President (OUP)
• County is using excess reserves pursuant to policy to transfer into the following funds: Equity fund $70M; infrastructure and equipment fund $9.1M; ARPA Sustainability Reserve $1.66M

Offices under the President (Lanetta Haynes Turner, Chief of Staff)

2024 Total: $2.18 B        2023:  $2.10 B   
The Offices are the Bureaus of Administration, Finance, Human Resources, Technology, Economic Development, and Asset Management; Departments of Administrative Hearings and Human Rights & Ethics; Justice Advisory Council; and Office of the County Auditor

Following are some key items from this meeting:

• Ambitious budget: 13.6% of total Gen Fund Budget, including 21 new FTE
• ARPA budget is >$235M, including $74M for Behavioral Health, care for new arrivals, $44M for mental health, guaranteed income program, small business grants (new in 2024, $10k or $20k /grant), support for the pretrial Fairness Act, $110M for community-based violence prevention, and $5M supporting domestic violence prevention grants
• The Equity Fund is a special purpose fund that provides grants for initiatives including access to digital technology and sustainability of programs currently funded by ARPA 
• Justice Advisory Council: 100% increase (from $1.4 M to $2.9 M) in budget as grant monitors and analysts are hired to ensure small business grant compliance and federal reporting requirements for ARPA programs
• County is ~ 80% unionized; current collective bargaining agreements will terminate in 2025
• Property tax system will be overhauled over time; UIC and CMAP will be providing data for analysis

Cook County Health (Israel Rocha, Jr., Pam Cassera)

2024 Total:           $4.38 B        2023:  $4.12 B
   Health Enterprise:    $4.25 B        2023:  $3.99 B
   Special Purpose:      $0.05 B        2023:  $0.06 B
   Restricted (Grants)    $0.07 B        2023:  $0.06 B
2024 Total FTEs:    7,682            2023:  7,988
   Health Enterprise:    7,326            2023:  7,634
   Special Purpose:          176            2023:     115
   Restricted (Grants)       180            2023:     239

Following are some key items from this meeting:

• Recommended budget represents a 6.6% increase; 66% of the increase is for contract services and personnel services
• Many positive results are happening in the CCH system, especially in patient services, e.g., cardiovascular care, imaging, full spectrum of pediatric specialty services (partnering with UIC)
• Change Institute ($125M) investing in nephrology testing and cardiac procedures to increase organ transplant eligibility, save lives, and reduce the disparity in life expectancy for underserved populations
• Very strong year: have hired >1000 employees in 2023, eliminating 308 unfilled positions in 2024 (2000 funded CCH vacancies in total in 2023); Chief Recruiting Officer is being hired to build a sustainable pipeline of applicants through programs with and hiring fairs; offer comprehensive tuition reimbursement program through graduate or medical education
• $200M (20% of total staffing) is for registry services to meet the needs of current FTEs (e.g., those employees out due to Family Medical Leave Act), make up staff deficits, and hasten onboarding of long term employees; several Commissioners voiced concern about continued reliance on agency staff
• Budget risks: prescriptions filled and cost, Medicaid remediation, nursing and clinical staff salary increases
• Uncompensated care: 2023 forecasted a 30% increase but have seen 20% increase; offering assistance with the Medicare reenrollment application process
• Building medical, surgical, and nursing services for reproductive health, family planning, and abortion access going forward: have used agency services to ensure that patients’ needs are met.
• Level 2 trauma center funding or reallocation of funds is needed on the south side
• Mental health treatment capacity is not meeting the need. Resources from every level of government are needed. Conducting campaigns to get people to come in are ongoing while we build capacity.
• Need to coordinate public awareness about Arlington Heights care facility through open houses and presentations

Office of the Public Administrator (Louis G. Apostol)
2024 Total:        $1.72 M        2023:  $1.7 M
2024 Total FTEs:    15            2023:  15

Following are some key items from this meeting:

• The PA’s Office is a zero-based budget (start from $0 and build); annual revenues far exceed its budget appropriation; proposed budget increase is 8.6%.
• The office operates entirely from funds it generates through statutory mandate and not from tax revenue. Funds are generated from estates of decedents who leave no will, or those named as executor and are incapable of serving, unavailable or disqualified. 

Observer:  Susan Gregory