Taxpayer Subsidy to CCHHS Down by 77% Since 2009; Still Projected to Run a $221M Deficit in 2017 Due in Large Part to Uncompensated Care

Cook County Board of Commissioners Finance Committee - Departmental Budget Hearings 
October 18, 2016

Cook County Health and Hospital System - presented by Dr. Jay Shannon, CEO

Proposed Budget: 
FY17 - $1.849 Billion dollars  
FY16 - $1.714 Billion dollars  
Net gain of $135,000,000
Proposed FTEs:
FY17 - 6,865  
FY16 - 6,736 
Net gain of 129 FTEs

Key Information Presented by Department:

• Projected revenues CountyCare (expanded Medicaid paid federally under ACA) $802,274,000 total (only $221 M retained by CCHHS; remaining paid to other network providers)   Traditional Medicaid, Medicare & Private Insurance ($371,119,290)  DSH ($165,700,000); BIPA ($132,337,500) and “Other” ($11,000,000)---virtually all of revenues come from Federal and State entitlement program payments 
• Subsidy contributed by Cook County taxes, budgeted in 2017 to decreased to $110 M, plus statutory pension & legacy debt service of $184.3 M (total $295.6 M)
• Proposed 2017 budget shows a – ($214 M) deficit; much due to $503 M uncompensated care.
• New Direct Access program for the uninsured, covering 40,000 lives will cost the system in the short term but with projected savings in the mid-to long term (due to preventative care and less emergency room care).   Funding was not directly addressed.

Questions/Comments from Commissioners:

• Commissioners Daley, Boykin, Garcia, Moore, and Sims asked numerous questions about staff cuts of clerical and Licensed Practical Nurses

Dr. Shannon explained that 320 FTEs were eliminated and 450 new positions created due to a new staffing model.  Clerical/ administrative assistants who lacked modern IT/computer skills and were not able to acquire them, required to manage new Medicaid contracts could not be used by the System.  LPNs were replaced with RNS who could cross-cover different service areas independently, allowing more efficient staffing.
New hires are skilled in safety, quality assurance, care managers and Medicaid managed care administration.

• Com. Garcia asked why there appeared to be no progress in increasing the % of FTEs (staff & leadership) that were bilingual.

Dr. Shannon replied that the union contract criteria for hires were based on seniority and not competency in a 2nd language.  New contracts would “require” bilingual competency

• Com. Suffredin, Morrison, Steele, Butler, Gainer asked various questions for clarification of the 2017 Budget.  Most of the information is available in the budget and strategic plan documents. 

​Observer - Susan Kern