Mid-Year Budget Hearing: Cook County Health System

Cook County Health System
JULY 21, 2026

 The meeting began with the President of the CCH board, Raul Garcia, commenting on the efforts made over the last year to reduce the expense outlays of Cook County Health in anticipation of a 2027 budget gap and in preparation for the impact of the Federal Government’s cut in Medicaid coverage.  CEO Eric Mikaitis then took over and he, interim CFO Scott Spencer, and HR Chief Win Buren made the following points:

• Eliminated more than $350 million across the health care system since 2025 with very little left to cut.  Investments, new revenue sources, and combining the two current revenue cycle systems into one yet this year are looked to for revenue to help close the budget gap this, next year, and even larger projected gaps in 2028 and 2029.
• The 2027 budget as of two weeks ago had a projected gap of $42 million.
• In 2023, Charity Care ran $123 million; in 2026, it is expected to rise to $380 million; and the 2027 budget has projected $500 million – all in anticipation of Medicaid-cuts, the possible removal of special status for Haitians and Cuban immigrants, and the removal of Ukrainian asylum seekers currently in the system.
• Ninety-two thousand individuals have been dropped from the Marketplace Insurance Program and ten thousand immigrants are expected to lose Medicaid which is expected to result in about $138M less in reimbursements from our State and Federal Governments.
• One final point of reference on the impact of the Medicaid cuts:  In 2021, Medicaid reimbursements amounted to 61% of the payer mix (revenue).  Now it is 49%.
• It is critical to get the information out to Medicaid patients to protect their eligibility.  Mikaitis noted that the media reports that as many as 55% of Medicaid recipients don’t know that changes are coming.

Commissioner Questions
Lowry, Chair of the CC Health & Hospital Committee and the Vice-Chair of the CCH Board of Directors used most of his time to recognize the work of the CCH leadership over the past year and to thank them for always being accessible and helpful.  He noted that the collection rate for accounts receivables is now 96% and that there has been a 40% reduction in the use of agency personnel against a goal of 20% given to CCH by the Cook County Board of Commissioners in 2025.   He had one question:

• To date, what have you had to do to reduce the budget gap and what is expected?
• Ans:  There have been no layoffs or cuts in services.  The System is expecting the streamlining of the revenue cycle to produce more savings (projected to produce as much as $100 million going forward).

Degnan noted that the CCH has reduced the contracted personnel cost from $500M to $100M
And from 1500 agency hires to 800 in the last 18 months.

• She wants to see an increase in the capitalization of the work force – meaning reduce outside vendors by working with the unions and departments to allow CCH employees to do the work.  Degnan noted that she expects to see the effects of this goal projected in the 2027 budget.
• She also wants the 2027 budget to include the $2M Reproductive Equity Grant as it is a critical measure used for women to feel that they are cared for.  She noted that funding, although small, should not be limited to just Cook County residents but all uninsured women that come looking for reproductive health services.
• Degnan also asked about the remaining $36M of ARPA funds that are yet to be spent before the end of 2026.  She was assured that the monies are on target to be spent.

Stamps asked about the System’s recruiting efforts at S. Suburban high schools and community colleges.  ANS:  Several schools and students are already in partnership with CCH for summer internships and externships with more expected as the CCH ramps up the program.

• She emphasized that it is important to invest in young people and prepare them for work.  She noted that she has heard complaints about representatives at job fairs not talking with job seekers.
• She asked if it is time for CCH to put together a task force to look at the System’s future sustainability including the increase in charity care costs and how the hospital will handle.
• While noting that she did not know what could be done, Stamps stated that the Blue Island Community Health Center has outgrown its space and is expected to see even more patients as hospitals in its surrounding area close.  Dr. Mikaitis said valet service is now being provided.  He also confirmed that a large number of services are being offered in a small space.

Cook County Finance Chair Daley thanked everyone and asked one question:

• Has CCH reached out to the hospitals that have closed and are closing to fill openings?
• ANS:  Mikaitis said that CCH has enacted an expedited hiring process for these laid off employees but has received little response.

Observer:  Diane Edmundson