Mid-Year Budget Meetings of the Finance Committee

Cook County Board of Commissioners Finance Committee
Tuesday, July 29, 2025, Afternoon

Cook County Health (“CCH”)
Appearing for CCH:  Pam Cassara (Chief Financial Officer), Craig Williams (Chief Operating Officer), and Robert Reiter (Member of the Board and Finance Committee Chair)
Presentation by Ms. Cassara:

• Known cuts in funding/patient care reimbursement:  An estimated $111 M yearly loss due to Illinois ending the Illinois Health Benefits for Immigrant Adult Program as of July 1, 2025, with 8,000 CCH patients losing that coverage.  Unless Congress takes action, there will be a $120 M loss due to the Federal Disproportionate Share Hospital (“DSH”) funding slated to be cut as of October 1, 2025.  
• Based on the recently passed Federal Budget Bill, effective on January 1, 2027, Medicaid work requirements to be implemented, resulting 10% of individuals losing Medicaid coverage and an estimated reduction of reimbursement to CCH of $88 M each year.  Medicaid eligibility redeterminations are also to be changed from yearly to every 6 months.  The result will be loss of coverage for an estimated 5-12% of individuals, though they may be eligible to re-enroll.  That could result in a $50 M reduction in reimbursements to CCH.
• Compounding effects of all these reductions are (1) more uninsured patients treated by CCH, (2) more cuts to other social service programs that negatively impact community health, leading to (3) greater demand for care at CCH, (4) access to care as other safety nets reduce service or close, and (5) more charity care costs at CCH.
• Earlier this year, CCH projected that it would have a budget gap of almost $120 M for 2025.  CCH then took action and has reduced the gap to a little over $8 M.
• There has been a decline in use of workers from agencies at CCH.  At the beginning of FY2025 there were 1,380 positions filled with agency workers.  That has been reduced by about 1/3 to 968.  With new initiatives, hope to reduce by another 1/3, which the COO explained is likely the lowest can reasonably go.  One of the big successes is converting agency employees to CCH employees,

Almost all the Commissioners had questions related to understanding a contract with Guidehouse, which contract is currently the subject of a labor grievance and an upcoming arbitration hearing. After a number of questions and different responses, this observer’s understanding is

• The contract is to provide consulting services and actual workers for billing and collecting from entities providing coverage for patients who have received CCH services.  There are about 287 workers under the contract, with 140 of them doing entry level work in coding and related services.  Of these, 72 are the subject of the grievance by the union which says that they should be union jobs.  
• The complications for replacing the 140 with CCH employees include the specialized knowledge/training needed for proper coding to be able to collect on bills and that the 72 coders are located outside the U.S., which means that they cannot easily train their replacements.  
• CCH management said that even if all the workers provided by Guidehouse were to be replaced, there would still need to be some of the management consulting services under this or a new contract with another entity because of the expertise required that keeps changing. In fact, the current contract is coming to its end and an RFP is out for bid.
• CCH management also said that they are in the process of going through all their contracts to see if there are other positions that could be otherwise covered by the union contracts.  At this point, they are not sure that Guidehouse is the only instance,

Other information provided in response to Commissioner questions:

• There are 10 to 15% of appointments that are no-shows all across the system, but this is nothing new.  There has been an 80% reduction in new arrivals (immigrants), which resulted in a reduction of 37,000 appointments with the closing of Belmont-Cragin for that service, but overall the total appointments across the system is only a reduction of 6,000.  So thus far, there does not appear to be a chilling effect on people coming for service.  Mandatory staff training has been done for all employees to know what to do if ICE agents come onto CCH facilities. (Comm. Anaya and Degnen questions)
• CCH works hard to make sure there is sufficient staffing across all facilities.  Absences and unfilled positions are often staffed by agencies, but the process for filling staffing needs has been changed to include the Bureau of Human Resources to ensure that departments do not automatically call for agency workers without appropriate review.
• There are 19 interpreters on staff that are deployed across the system as needed, but in addition, a number of staff people are bi-lingual and there are separate job classifications for that.  In addition, there are translation services provided through hand-held devices.   (Comm .Anaya question.)
• Comm. Degnen asked if there was a tech solution to help with Medicaid redeterminations.  The COO explained that redeterminations are done on the State level in accordance with Federal requirements.  CCH can assist people in complying, but not change the way they need to apply.
• Comm. Stamps asked how CCH was ensuring that equitable care is provided across Cook County and no “health deserts” exist?  The response was that care is not being cut anywhere; the concern is that there will be a large increase in uncompensated care as a result of Federal and State actions.  The costs for that care would have to be covered by Cook County and its taxpayers.

County Clerk- Monica Gordon
Clerk Gordon’s presentation:

• Ran a successful 2025 Consolidated Election in April: results posted within 2 hours of polls closed, with all precincts opening on time.
• Implementing a new election management system.
• Installed the first “Smart Drop Box” for mail-in ballots at the headquarters at 69 W. Washington that will allow voters to track the processing of their ballots. Will expand to other locations.
• Implementing a new Clerk Recording System that was totally built in house, saving approximately $7 M.  Includes a mail-tracking system.
• Implemented a new queue system for Vital Records with ability to make appointments and also get texts that your place “in line” is approaching.  Has also reallocated resources to help. As a result, the long lines waiting to access Vital Records should be gone.
• The process for implementing the new Integrated Property Tax System being developed by Tyler Technologies has been challenging.  Significant problems, especially with the tax redemption services, has caused the Clerk to create a manual system until the new system is operational. 

Commissioner questions and responses:

• Comm. Lowry and Stamps:  how do you get more people voting, especially young people?  One new pilot program will have early voting sites at 14 high schools run by student election judges for a few days prior to election. Clerk is adding 2 new early voting sites in Bridgeville and Countryside.  Clerk also wants to do more education of what government does at local levels so people understand why their votes matter to their daily lives.
• Comm. Anaya:  Why the additional overtime this year?  Due to transition to Real I.D. which resulted in a huge demand for birth certificates.  Clerk had employees doing other jobs help with that, with those employees then working at night or on weekends to do their normal work.  Do not expect that in 2026.
• Comm. Stamps and McCaskill:  Clerk clarified that those incarcerated after being convicted are not eligible to vote.  Upon release, the State is supposed to be providing a packet of information that includes that they can now register to vote in Illinois. Those in Cook County jail awaiting trial are able to vote and the Clerk works with the Sheriff to both register detainees to vote and provide early voting.

​Observer:  Priscilla Mims