All right, we're gonna get started.

Uh with the hour having reached one p.m.

I'd like to call to order the meeting of the Cook County Health and Hospital Hospitals Committee.

Roll call.

Thank you, sir.

Commissioner Aguilar.

Thank you, sir.

Commissioner Naya.

Commissioner Naya is absent for the moment.

Commissioner Britton.

Commissioner Daly.

Commissioner Dagnan.

Commissioner Gaynor is excused.

Commissioner McCaskill.

Thank you, ma'am.

Commissioner Miller.

Thank you, ma'am.

Commissioner Moore.

Absent for the moment.

Commissioner Marita.

Morita present.

Thank you.

Commissioner Marita is present, participating remotely.

Commissioner Kevin Morrison.

Thank you, sir.

Commissioner Sean Morrison.

Not in the room at the moment.

Commissioner Scott.

Did you connect?

Commissioner Scott?

Commissioner Scott is connected remotely and present.

Thank you, sir.

Commissioner Stamps.

Commissioner Stamps is excused for the moment.

Commissioner Trevor.

Thank you.

Commissioner Vasquez.

Thank you.

And Mr.

Chairman is present.

Present.

Let me revisit those that did not respond.

I have absent currently.

Commissioner Naya.

Excuse for Gaynor.

Commissioner Moore absent.

Commissioner Sean Morrison absent.

An excuse for stamps.

Howby ever, sir, you still have a quorum.

Thank you.

And may have a motion to allow remote participation for this committee meeting.

Move by the chairman, seconded by Commissioner Aguilar roll call.

Commissioner Aguilar, your vote.

Commissioner Naya.

Absent.

Commissioner Britton, your vote?

Commissioner Verton is not in the room.

Is he in a row?

I thought I heard his voice.

No.

Okay.

Commissioner Britton is absent.

Commissioner Daly.

Your vote is aye.

Thank you, sir.

Commissioner Degnan.

Is aye?

Thank you.

Commissioner Gaynor is absent.

Excused.

And the previous votes were aye.

Commissioner Ocasco, your vote?

Commissioner McCaskill is aye.

Commissioner Miller.

Present.

For this roll call vote, should it be aye or present, ma'am?

Commissioner Miller is present.

Thank you.

Commissioner Moore is absent.

Commissioner Marita.

Commissioner Marita, your vote, please for remote.

Commissioner Marita, are you still connected?

Yeah, Morita I.

Commissioner Marita is aye.

Thank you, ma'am.

Commissioner Kevin Morrison.

Is aye.

Thank you.

Previous votes are all aye, with the exception of Commissioner Miller present.

Commissioner Sean Morrison is absent.

Commissioner Scott.

Not committed yet.

Aye.

Oh, thank you, sir.

Commissioner Scott is connected.

Participating remotely.

Thank you.

Commissioner Stamps.

Commissioner Stamps is absent.

Commissioner Trevor.

Aye.

Commissioner Trevor is aye.

Commissioner Vasquez.

Aye.

Commissioner Vasquez is aye.

Mr.

Chairman is aye.

Thank you.

Chairman.

We have 10 ayes.

One present vote and six absent.

Thank you.

Please add Vice Chair Naya to the roll.

Thank you.

And can I also be added as an aye to the previous?

Roll call changes to 11 and 5 absent.

Thank you, ma'am.

Vice Chair Naya now moves approval of item 26-119.

The minutes from the meeting of the Health and Hospitals Committee held on March 10th, 2026.

Seconded by Commissioner Trevor.

All those in favor say aye.

All opposed.

The opinion of the chair.

The ayes have it.

Vice Chair Naya now moves to defer item 23-3815 requesting a meeting of the Cook County Health and Hospitals Committee to receive an update from the Cook County Health and Cook County Department of Public Health on their COVID 19 and other diseases of concern, immunization and mitigation plans in suburban Cook County.

Today we will hear relative to a number of topics, including RSV and measles.

And do you wish to speak to this item?

Thank you.

We will now have a presentation from Dr.

Kieran Joshi.

Chairman, before the presentation, I just want to remind you there were no registered speakers for this meeting.

Do we have any public speakers registered?

Thank you.

There are none.

Dr.

Josh.

Thanks so much, Mr.

Chair.

Good to be with you this afternoon, Commissioners.

I shall try to proceed expeditiously.

Um, as I know you've got a packed agenda this afternoon.

So first um, next slide, if I could just uh say uh the purpose of today's uh presentation is to provide you with an update about respiratory virus season, um some key issues that I want you to be aware of, uh work that we're doing to um uh address respiratory viruses.

Uh a quick update on a measles case that we had last month, and I'll end with an update on um what's happening at the federal level.

Next slide.

Um so always like to begin every presentation with this slide to distill what it is that we do at C C D PH.

So I'd like to remind you all that we protect health, prevent disease, we inform uh the public and engage communities, we analyze and share data for action, um, all with the underlying goal of advancing health equity.

Next slide.

Um so another uh why here is why is this important, why why am I sitting here before you today?

Um, and just by way of a reminder, uh, we're gonna talk a little bit about respiratory virus surveillance data.

Um, and this data is uh routinely monitored by uh CDC state and local health departments across the country.

The purpose being is that it's an early warning and outbreak detection system.

Uh the data we analyze is used by healthcare systems to uh plan for resources at the federal and global levels.

It's used for vaccine and therapeutic development.

Of course, we want to make sure we know who to protect.

So the data gives us a sense of who's most vulnerable, and we can thereby make recommendations about uh how to target our communications efforts.

Next slide.

Uh current state of uh respiratory viruses in suburban Cook County is minimal to low activity.

Um so at this stage we're essentially at the end of the season.

I do want to next slide make mention of uh a new recent uh COVID-19 variant uh called nicknamed cicada uh that has been covered by the media.

Um it's of concern because of the large number of mutations that it has.

This could theoretically make it easier to evade immunity.

Um we aren't clear yet if this could cause uh a wave later in the spring or in the summer, we'll be monitoring for that.

Um there's no evidence at this stage that um immunity will be impacted by this new variant, but again, something to watch.

Next slide.

Um, the uh respiratory virus we don't get to talk about that often is one called respiratory sensitial virus or RSV.

Very common.

Uh two out of two to three out of every hundred infants are hospitalized.

Um we did see a later peak than usual this season, and we're messaging accordingly about the need to get vaccinated.

A number of age groups can uh receive immunization or vaccination would highlight the need for anyone who's 50 to 74 at an increased risk or above 75 again to have a conversation with your primary care provider about that vaccination.

Next slide is um essentially the CCDPH response in brief.

Um you've got a lovely side slide uh photo here of one of our nurses uh in action administering a vaccination to one of our residents.

Um we held 22 events at uh the five suburban Cook County ACHN clinics, eight with community orgs, including shelters, long-term cares, um, and administered nearly 2,000 vaccines to over 1,200 residents this season.

That is an increase from last year.

Um we just looking forward, we we are hoping to shift our clinics next year out from the ACHN clinics and into the community, potentially looking at community colleges, large high schools, um, as in the setting of a large outbreak or a pen, or God forbid another pandemic, those are the sorts of scenarios that we would want to be ready for.

Um you can hear, you can see here um some of the paid media from uh a concomitant uh uh marketing campaign uh with over a million impressions, uh quite a bit quite a bit of a total engagement here.

Um so I think that's some exciting numbers.

Uh two slides forward uh for uh measles update.

Next slide, yeah, great.

Um so again, wanted to inform you that while we did share the press release about this case back in March, uh including to you all, that uh there was a case that was reported with 19 contacts uh that we investigated with uh two individuals in quarantine.

Um would just want everyone to be aware that when this kind of thing happens, it's very resource-intensive.

Uh given the number of potential contacts, uh, each of those contacts needs to have a very thorough detailed history taken uh to determine um where and when and how they may have been exposed.

Um so this is uh I guess my way of saying kudos to our community disease team for all that hard work.

Uh next slide just has some general guidance about measles.

I think at this stage, all of you have heard me talk about this before.

Um, even a brief exposure of uh you know, 15 minutes can result in measles transmission.

Everyone should get their two doses of MMR vaccine.

Uh those two doses provide over 97% effectiveness to prevent measles transmission.

Um and then the next couple of slides here, I think you're just gonna see some additional visuals that our comms team um developed, as well as some earned media medium mentions and interviews uh resulting from that measles case.

Next slide, federal update, and this is my last slide.

Um so some of you um are are were probably following what was happening at the federal level with vaccine recommendations.

Um so essentially what's been happening is that the Secretary of Health essentially ended the appointments of all 17 uh members of the uh committee that makes vaccination recommendations and appointed his own sort of folks, uh many of which did not have a background in um uh uh vaccine science.

Um and so that was then challenged uh and a stay was recommended by a federal judge that then reversed all the recommendations that this newly compromised panel had put forward.

So a lot of swirl, a lot of confusion here.

Um I think at the provider level, there's an understanding, unfortunately, that we need to look away from CDC and to our professional societies, namely the American Academy of Pediatrics, Family Medicine, Internal Medicine, and Obstetrics and Gynecology for science-based vaccination recommendations that are not guided by by ideology.

All right, that's it for me.

Thank you for your time.

Happy to take any questions, Commissioners.

Dr.

Joshi, thank you.

Do any commissioners okay?

We're gonna start with you, Commissioner Trevor.

Thank you, Chair.

I just have one question.

Uh for the revised um for for the recommendations based on the professional societies, do they carry the same weight with insurance companies?

Um, or um, whatever uh whoever tends to follow those those guidelines and basically making sure that uh people still have access to insurance coverage.

The the short answer is that the uh National Association of Insurance Companies, I forget exactly what it's called, but has come out and put out a position statement indicating that um they would ensure that their whatever they were reimbursed for would be like the science-based recommendation.

So I think in effect uh they are advocating for uh reimbursement of the same recommendations that the American Academy of Pediatrics and so forth would put forward.

Thank you.

Any other questions, comments?

Hearing none, seeing none.

Uh Doctor, thank you again.

Uh there's a motion on the floor to defer item 23-3815.

Roll call.

Uh-huh.

Chairman, because this is deferral, it stays in committee.

Voice vote is fine.

Voice vote.

All those in favor say aye.

Aye.

All those opposed.

The opinion of the chair?

The ayes have it.

Dr.

Thanks.

Thank you.

Always a pleasure.

Come on up.

That we've uh we've ended the meeting.

You what do you want me to do with uh Aguilar?

We haven't taken adjournment.

Okay, sorry, then fine.

Then we'll add you.

We're on the roll call already.

You're on the roll call.

Do you want to be added for other votes?

Commissioner Aguilar.

Okay.

He will be added.

Okay.

All right.

All right.

Okay.

All right.

All right.

So, Vice Chair and I now moves to defer item 0202, a resolution requiring a hearing of the Health and Hospitals Committee for a report from the senior staff of the Cook County Health and Hospital System.

We're going to hear today about the work of the Medicaid Impact Work Group.

Uh, there's a second by Commissioner Vasquez.

And now we'll have a presentation.

And are you going to kick us off, Dr.

McKay?

Please do.

Thank you.

Well, good afternoon, Commissioners, and thank you, Chair Lowry, for the opportunity to come share uh what I think is some uh very exciting work, uh, despite some of the headwinds that we are concerned about uh around Medicaid and the recent policy changes that have both started to be implemented and uh will continue to impact us into 2027.

I have here with me several CCH team members, um, and I'm gonna hand it off to Kathy Chan right now to give us kind of a foundation.

Great.

Thank you, Dr.

McKaidis, and good afternoon, Commissioners.

Kathy Chan, Director of Policy at Cook County Health.

So the presentation that we're gonna share with you today.

Next slide, please.

Um, first, we're just gonna provide a very brief overview of Medicaid and the eligibility changes that are prompting this work that Cook County Health is convening.

Uh Dr.

McKitis will then walk us through some of the projected impact of these changes on Cook County Health, and then we will talk about uh what we're doing to try to mitigate the harms from these changes uh in the form of the Medicaid Impact Work Group, which Dr.

Makitis will go into more detail about.

Uh next slide, please.

Next slide.

So just as a foundation, because we are talking about the Medicaid program, we thought it would be useful just to share a very high-level overview of what the Medicaid program is.

I know uh many people in this room are familiar with Medicaid, but just to be clear, it's a jointly administered and financed program by the federal and state government.

Eligibility for populations is primarily based on income and immigration status.

In Illinois, we have close to 3.2 million residents with comprehensive Medicaid coverage.

That's about one in every four residents here in our state of Illinois.

And prior to 2014, which was the year that the Affordable Care Act really became uh fully implemented in many states, including in Illinois, Medicaid mostly covered children, persons with disabilities, parents, pregnant people, and older adults.

It really excluded a population that has now been known as the Affordable Care Act expanded Medicaid adults.

Um these are low-income non-disabled adults, 19 to 64 years who don't have dependents living with them.

And the reason that we are kind of focused on this population is because this is the population that is most at risk of losing their Medicaid coverage with the changes that are coming from HR one.

These are individuals that are at 138% of the federal poverty level or less, which is equivalent to about $1,800 a month for a single person or just over $2,400 a month for a two-person household.

Illinois adopted Medicaid expansion uh early on, and as many of you know, county care was actually even an earlier adoption that was able to get started here in Cook County uh before the statewide expansion took place.

Um in Illinois, we have over 700,000 Affordable Care Act adults enrolled statewide, with half of them living here in Cook County.

Next slide, please.

So, what are the changes that are happening as a result of HR1?

So the primary eligibility changes that we as a health system are most concerned about when it comes to the what is changing for people in order to get and keep Medicaid really fall into kind of three areas.

The first one is um HR1 narrows the definition of quote unquote qualified immigrants.

Um these are legal immigrants who are in the United States, uh, and their coverage is going to end October 1st of 2026.

These are individuals that uh fall into uh a category that many have referred to as humanitarian immigrants, so refugees, asyles, survivors of domestic violence, um, and these are individuals who will no longer have access to Medicaid starting in October of this year.

Additionally, starting in January of next year, there's two major changes that are happening that will impact these affordable care act adults.

Um those individuals will have to redetermine their coverage or renew their coverage twice a year instead of once a year.

Additionally, the same population will also have to demonstrate that they are meeting what is called work requirements or community engagement requirements.

This is a brand new requirement that is new to the Medicaid program that will require that these individuals show that they are working, engaged in educational activities or job training programs or volunteering for at least 80 hours a month.

What's important to note is that most adults with Medicaid who can work already do work.

And study after study really shows that work requirement requirements do very little to nothing to increase employment.

Um federal guidance around this new requirement is expected sometime in June.

That is right around the corner.

And as noted, these are eligibility changes that take effect January of 2027.

So every state that is required that is required to implement these requirements, including Illinois has a very short timeline to understand what that federal guidance will be when it comes out and then implement it as well as communicate it to beneficiaries and stakeholders and providers, especially for those that are trying to assist patients and enrollees in helping to keep their benefits.

Next slide, please.

So we're just going to go into a little bit more detail in these next few slides about what some of these specific changes are.

So I had mentioned earlier that starting in October, the change that is being prompted by HR1 that will result in a set of immigrants losing coverage is that it it it uh shortens this definition of qualified immigrants.

Um again, refugees and asylum seekers, victims of domestic violence and trafficking are no longer going to be eligible for Medicaid.

That coverage will go away in October.

The state estimates that about 10,000 people statewide are going to be impacted by this loss of coverage.

There are immigrants that will still qualify for Medicaid that are noted on this list, including children under 19 years of age, pregnant individuals, green card holders who live in the US for at least five years, Cuban and Haitian immigrants, and individuals who are uh migrants through the Compact of Free Association or COFA migrants.

Additionally, as mentioned, starting January, uh the Affordable Care Act adults who got new coverage through the Medicaid program, and of which there are about 700,000 that reside in the state.

Uh those individuals will start to have to renew their coverage twice a year instead of once, and then comply with those work requirements.

Next slide, please.

So why is asking people to renew coverage twice a year going to result in more people potentially losing coverage?

We know that following the COVID public health emergency when Medicaid began to require individuals to go back to the redetermination process, the annual process that was paused while we are in that public health emergency.

That individuals fell off the program.

Um not because they weren't eligible, but more so they ran into a paperwork issue, they didn't receive the mail, they didn't understand what they were supposed to do, they sent their information back, but it wasn't processed on time.

So those are really considered administrative uh uh challenges that resulted in individuals not being able to keep their coverage, not necessarily because those individuals were not eligible.

We also know that it takes a lot of effort to try to keep individuals continued uh in to continue their coverage.

We are proud that the county care health plan that the health system operates has one of the highest retention rates among all of the Medicaid managed care plans.

This is really due to the fact of all of the effort that they put in, the enrollment events, the regular communication, the text messaging, working with providers.

So it takes a lot of effort to keep people enrolled and retained in coverage.

Next slide, please.

And then when it comes to work requirements, we just want to share this case study from Arkansas, which uh did try out work requirements in 2018.

They were able to uh have this in place for about four months until this uh uh this change was halted by a federal judge.

Um, what was the result of this uh pilot?

Well, about 18,000 people in Arkansas actually lost their Medicaid coverage.

But in the end, it turns out that 97% of them actually should have kept that coverage.

They lost it because of that paperwork requirement, and also just because of those administrative barriers.

Again, not because they were not able to meet the work requirement, but because the information just could not be sent to the right place or registered in time.

And so there is a huge concern for us because this is a brand new requirement to beneficiaries, and also there is pending guidance that has yet to be issued or received by the states that the timeline to implement this, communicate it, and ensure that everything is working the way it's supposed to be working, is going to be very challenging.

Next slide, please.

And I'm gonna turn it over to Dr.

Mikitus, who's gonna walk us through some of the projected impact on the health system.

Thank you, Kathy.

Uh next perfect.

Okay.

Um so just looking, you know, this was Kathy's alluded to a lot of this, both at the macro and the local level.

So this is kind of county impact uh in the framing.

Um, you know, first obviously we'll start with residents losing um their coverage.

Um we've already now seen several facilities close uh within the county, given these additional pressures coming over the next year or two.

We're likely to see a few more, leading to, of course, service decline, right?

So access and service um contraction.

Um that will inevitably lead to a sicker community uh and an impact on workforce, um, which then also reduced access to care and more visits to the ED is going to lead to you know worse outcomes and ultimately decreased tax revenue.

Um the um commonwealth fund uh is estimating about a loss of uh 200 and I think 14 million um dollars to uh the tax base out of Illinois because we'll have a sicker population that won't be able to work, 2.5 billion being removed from the GDP just in Illinois.

Um and ultimately medical care and insurance costs will increase as well.

Um next slide.

So this is a trend, you know, we're gonna focus on CCH and you know the county impact as well.

So there's two graphs here.

The one at left shows our trends in terms of payer mix.

That gold uh line across the top is our Medicaid percentage, and that line that's inverted, the one that's kind of V-shaped, it's a lighter blue color at the bottom.

Um, that is our uninsured um uh percentage.

So you can see the trends here.

You know, we hit a high during the pause in uh redetermination of 61.4 percent and obviously a low of uninsured of about 13 percent.

That trend is reversed now as redetermination has started.

Um and uh I can say in early 26 we've seen a continuation of that trend.

We are now below 50 percent Medicaid um as of February uh and have crept into the 25% range for uninsured.

Um and as you can imagine, um some of the additional impacts that the Kathy was talking about.

We'll we'll expect that trend to continue into 2027.

Next slide.

Oh, sorry, one one more thing.

The right side.

Um the bar graph there shows.

I'm sorry if you could go back and thank you.

Um the bar graph at right um shows our uh charity care trends.

So you can see obviously when we had uh a high percentage of Medicaid, our charity care was at its lowest at about 134 million in 2022.

That has since continued to increase.

Uh, and this year we have budgeted 380 million um for charity care.

Next slide.

Uh this is a breakdown of hospitals and health systems uh it in Cook County, uh about 60 uh hospitals represented here, and year over year, the percent of charity care um that each of these institutions uh takes on.

Um in 21, 22, and 23, um the the slices of the pie were individual hospitals that became systematized in 2024, so it's actually health systems represented, um, which is why you see fewer pie slices there.

Um it's probably not a huge guess uh to figure out which one Co County Health is.

Um we're the Navy Blue uh wedge and in 2024 we're responsible for over 40 percent of the charity care delivered in Cook County.

Next slide and this slide I think should be familiar to everyone, but we've changed some of the information here to update uh as as things have shifted.

Um so I think everyone's aware in January um there was an enhanced um tax credit for uh people under ACA that had ended.

Um so people saw their out-of-pocket costs increase.

Uh and related to that, I think that's driven some of that shift that we've seen in early 26 uh in increase in uninsured.

Um, but as those um people come for redetermination, we're anticipating that we'll see about 35% of that population forego care or lower um their coverage because of that increased cost uh to them.

Um as Kathy mentioned in October, uh, we will see certain immigrant populations, refugees, asylum seekers, uh, victims of trafficking and domestic violence no longer not just not eligible for Medicaid, but unable to purchase even on the exchange, they will not be able to be insured, and that'll be about 10,000 people in Illinois.

Um and then coming in 27, we heard um these details from Kathy, but Medicaid work requirements were anticipating 10% of individuals covered will lose their coverage, and Medicaid redetermination doubling in cadence moving from annually to twice a year, um, between five and twelve percent additionally that we'll lose.

Uh we had um the dish cuts on this slide originally.

Uh that has been pushed out now to October of 2027.

So we'll come back on uh as a concern uh into next year.

Um but all in those four boxes across, we're anticipating uh 400,000 Illinoisans to potentially lose coverage, uh, and to the health system a potential of 280 million dollars negative impact to the bottom line.

Um the dish cuts would be an additional 200 million a year, but again, we've kind of taken that off because it's not as immediate as the other um pieces.

Uh as you can imagine, you know, as as I mentioned, we've seen health systems close.

Um this potentially creates the start of a pretty unfortunate cascade where you have more uninsured having to go to the hospitals, potentially not engaging in chronic disease management, showing up with advanced disease to the emergency room, more costly.

Um, and when uninsured a cost of the health system, it drives the cost locally instead of being covered under a uh a plan, um which then further destabilizes uh initially the health care safety net, but it's gonna eventually drive um broader access issues um across um the healthcare infrastructure.

Um next slide.

One more.

Thank you.

So I know that sounds pretty bleak, um, but uh, you know, we've taken the position that we aren't entirely powerless in this situation.

Chronic disease management showing up with advanced disease to the emergency room more costly and when uninsured a cost of the health system it drives the cost locally instead of being covered under a uh a plan um which then further destabilizes uh initially the healthcare safety net but it's gonna eventually drive um broader access issues um across um the healthcare infrastructure um next slide one more thank you so I know that sounds pretty bleak um but uh you know we've taken the position that we aren't entirely powerless in this situation um and we convened uh in September uh the Medicaid Impact Work Group and in all we've now had over 60 organizations um sign on to be a part of this conversation and it's more than just healthcare we have had um healthcare providers offices health systems um FQHCs um participate um but also uh health plans we've had public health departments um HFS DHS uh have been incredible partners in this and we've also gone outside of healthcare um we have business leadership academic leadership uh community organizations philanthropic organizations all coming to the table to talk about how we might um do things a little differently how how we can engage our communities how we might change systems to ensure that people um retain their coverage um a few of the initial opportunities identified is to create and disseminate a communication packet um and training resources um and we have Alex Normington here who's gonna talk about that in just a couple of slides she's gonna share we just launched this on Friday um and Alex will give us a rundown of what that looks like um a few other things identify the best practices from the unwinding that started when redetermination uh the pause ended um so identifying best practices and spreading it um across uh multiple health plans uh Kathy mentioned that you know we're in the 12% neighborhood um at any given time on redetermination and you know we're losing about 12% of the people uh who come up for redetermination the state average is closer to 25 to 28 percent so a lot more uh people being lost so it's spreading those best practices and trying to get everybody to you know 12% if that's you know the best we can get to um leveraging technology platforms a lot of discussion around medical records and patient portals and AI and opportunities there to earlier flag people and make sure that they are aware and and engaged in renewing their coverage when possible uh and then prioritizing uh exempting people from the process of redetermination there's there's a uh you know an ex parte status where people don't have to go through the renewal process um medical frailty is one that's being explored right now um so if they're deemed frail they come off that renewal process and just remain on the Medicaid role so really a partnership with the state um and a lot of the providers in the conversation about how we can be more effective in identifying people who truly are medically frail and giving them that credit so they don't have to continue renewing and then the the second piece the second iteration of the impact work group is going to be to think about how we engage with those who end up losing their coverage and can't get re enrolled into Medicaid they're just not eligible how are we going to provide care in in a in a coordinated way to the people who no longer have health insurance so I think I covered the rest oh one piece this is also being mirrored at the national level through the president's leadership at NACO we're having similar discussions with county leadership across the country we've had I think four other counties engage in this conversation so trying to spread those best practices more broadly than just at Cook County.

Next slide so there is a photo just showing how crowded the room was it was a very nice kickoff meeting in September.

We have met a second time since and next slide we've also spun out three work groups uh communicate and educate which is focusing on uh making sure that not just the community and the Medicaid recipients are engaged and informed and and understand what these changes mean but also that the the people at the table in the broader communities um have resources at hand so they can help communicate out um to uh people on Medicaid roles and and exactly what will be expected so trying to really amplify that message uh coalition building is developing partnerships to make sure that we're working together uh in providing care and um and mitigating impact and then innovate and create uh this is uh initially been a close partnership with the state thinking about how we can use the systems to you know the frailty example is is a very good one how we're working together to ensure that um that that we're able to um leverage data and and optimize processes so that we can um minimize the impact um so with that I think our next slide I'm gonna hand it off to Alex Normington we launched uh getmedicafacts.com uh on Friday last week I believe so it's only been a few days um but Alex is gonna show us some of the great work that she and her team have done hey thank you hi commissioners I'm Alex Normington I'm chief communications and marketing officer for Cook County Health and I have the privilege of leading the communicate and educate work group for the Medicaid impact group so as we shared with you on Friday we are thrilled that we established a micro site to help educate both Medicaid enrollees and the organizations that serve them about the changes that are coming up when we had our uh first kickoff meeting and then our subsequent subcommittee meeting we identified that public education is a primary need there's a lot of confusion about what's changing and when so this microsite is a direct response to that need.

Cook County Health is taking the lead in developing the materials for this micro site it includes information about what's changing when it's changing and then how people what steps people can take now to protect their coverage.

It includes information about what's changing, when it's changing, and then how people, what steps people can take now to protect their coverage.

Next slide, please.

So on uh the micro site, there's information for enrollees, but also a communications toolkit for health systems, payers, uh, community groups, and elected officials uh to help amplify this information.

And we really appreciate your help in sharing this information among your networks and constituents.

While we have uh sets of all of these assets branded to Cook County Health, to Cook County Department of Public Health, and to County Care, the assets that we posted on the micro site are unbranded, and we wanted to make sure that there was no competitive edge or anything that would uh be a barrier for other organizations to share this information.

Um, maybe someone gets their information from CCH or County Care, and that's great, but maybe they go to another hospital and have another health plan.

We wanted to make sure that our partners could use these and brand them to their own organization with no hesitation so we can get out clear, consistent information across all of the channels that are available to us.

Next site uh slide, please.

The materials on the micro site have been translated into uh six languages um English, Spanish, Arabic, Mandarin, Polish, and Ukrainian.

We know that language access is really important, especially right now in this time of significant ambiguity.

So we wanted to make sure there was something available for community groups who specifically serve a non-English speaking populations.

And next slide, please.

Uh, this is uh an image of the one-page handout that's available uh on the toolkit.

Um, and this just really indicates what's changing and what people can do to make sure that they're staying informed and staying connected so they can keep their coverage as these changes start rolling out.

Our goal is that this is a resource not only for our partners locally, but we do plan on sharing this through our uh partners at NACO and America's Essential Hospitals in hopes that there's something that they can lift from this site and use in their own uh jurisdictions and and regions.

And with that, I'll turn it back to Kathy or Dr.

Merchitus to close us out.

Okay.

Okay, this is our last slide.

Again, I think the big ask in this discussion is um all of your support uh in and helping us spread the word about getmedicaid facts.com.

Um, if you haven't yet, click around.

I think it's a very nice site.

It offers a lot of information.

Um, and we've been very fortunate to um have a lot of public interest um so far in news media, print media um asking about it and helping us elevate it.

So if we could have that help from all of you, it would be greatly, greatly appreciated.

Um, for awareness, we have a virtual meeting uh scheduled for the full impact work group uh this summer, and we're planning the next in-person and fall.

Of course, the work groups continue to meet in between um the larger meetings.

Um, should there be any um any interest um from staff um from your staff to participate, we'd welcome it.

There's uh a link there uh in the deck, uh the second one, and then any follow-up questions, we'd welcome.

We'll obviously have a discussion here, but any follow-up questions after the fact, uh, email Kathy Chan, please.

So I think with that.

Thank you.

This was a wonderful presentation.

Thank you, Dr.

Mikitus and Kathy and Alex.

We appreciate you.

Before we open it up for uh comments or questions by uh the commissioners, uh, I want to add Commissioner Moore to the role.

And Commissioner, would you like to be added uh to the previous votes in the affirmative?

All right, we will do so.

I'm gonna add Commissioner Stamps and would you to the role, and would you like to be added to previous votes in the affirmative?

Thank you.

All right.

I'm gonna kick off, and I'm a broken record, but you know, I don't care.

I think this is uh the right record.

We need help with charity care, you know.

And I think what's going on with the federal government in the way it's now landing here in Cook County just really underscores that.

Legislatively, our friends in Springfield, are we having conversations?

Do we have a strategy?

Please comment.

So, in terms of state, and I'll pass it to you, Kathy, since you're very close to that group.

Um, yes, there I would say with the impact work group, um, especially with the state agencies, they have been incredibly supportive and appreciative too of the fact that this has been an effort to really pull a larger group together to have more meaningful conversations in terms of individual electeds.

I don't know if you want to comment.

Yeah, I think uh excuse me.

Kathy Chan again, uh director of policy at Cook County Health.

Um, I think what we are I think that's a great question.

Um, and one of the areas that we are really focused on right now is obviously preventing people from losing Medicaid in the first place, right?

We have to we know that there is an opportunity to keep this, keep your coverage now.

I think the toolkit is really amplifying that message to ensure that people keep that coverage.

We want to have kind of safety nuts in place as well if people are at risk of losing that coverage or losing that coverage and still eligible to help them get back in.

Um, I think those are things that are happening.

I'd be happy to talk to the legislative team to see as well to see what's going on in Springfield.

I know that the Medicaid piece is really front of mind because that is provides comprehensive coverage.

It has, we've done a great job in Illinois, uh, especially through the redetermination period and being one of the top states, even though we do lose people every month, but being one of the top states in ensuring that people are retaining their coverage.

Yeah, let's be sure to do that in addition to the very important work we're doing with Medicaid and related issues.

Let's also track what's going on with charity care.

If I could add, um, you know, I think one of the nice things we saw from state legislature was a lot of engagement with kind of the output, what Alex just shared with us.

Um, and I think elevating that not just to constituents but also to business leadership to religious leadership, right?

There's um and and that's an ask of of this body as well.

Um, you know, the some of the resources on the website um are the toolkits that Alex talked about, and that's that's more geared towards businesses and community leaders, right, to allow them to brand those resources and push them out from their vantage point to their constituency, their membership, so that it is, you know, if it's a small independent doctor's office in an underserved community, that doctor's name is on the top of that form and they're giving it to their Medicaid recipients, right?

That's part of the, you know, if it's a uh religious organization, that religious leader is branding it to that church or that organization, right?

So the ask would be here to engage with your leadership within your districts to ask them to do that as well.

Thank you.

Vice chair.

Thank you, Chairman.

Um, so a follow-up on that question.

Um so today is ISECO's lobby day.

Um so they're in Springfield, we're in committee.

Um, so typically we like to coordinate with them so that we're down there as a body, being the largest county in the in the state.

Um, I think given the fact that um the majority of our budget here goes to health care.

It is um I want to just stress the importance of you know, kind of tapping some of the commissioners on the board and helping with some of the conversations in Springfield, particularly because we know that um it's important um because it impacts their constituents as well.

There's not one representative or state senator that could say that they're not that their constituents are not going to be impacted by HR one.

So it's extremely important for us to kind of highlight that.

And oftentimes there's a lot of interest in a lot of things.

So for us to be the squeaky wheel that continues to remind people that they may lose coverage uh and and to really elevate this conversation at the state level.

We know that we have great um, you know, uh Congress people um uh from Illinois that advocate at the federal level, but figuring out what we could do here locally is is very crucial.

So I just want to, you know, kind of highlight that because I think it's important for us to coordinate, you know, if there is going to be a lobby day for commissioners to attend this year for us to kind of plan for that and for this to be front and center of our conversations.

Um of us, you know, go on on our own or maybe have other business and then end up talking to some of our legislators down there.

So if there's any toolkits that you can provide commissioners as well, even if we're not doing it collectively, if there's certain areas that we need to be focusing on, if that can be communicated to commissioners so that we can also kind of um uplift that with our um counterparts at the state level.

Um so that that's one end.

Um I I wanted us um if if you can kind of follow up on that conversation, Kathy, and and seeing if there's any um advancements that we've had with a state with the reimbursement rate.

I know that that's been something that we've talked to them before, so I'm not sure if if there are negotiations happening or if that's kind of like not gonna happen this year.

Um, but just wanted to know about that, and then also wanted to know if there's any coordination in regards to the state on um messaging.

So it looks like we do have our toolkit.

A lot of this information is gonna be very valuable, but is there any coordination with um with the state?

Um, I think one of the beauties that kind of came out of like, for example, the census or uh some of those wider initiatives that we've had the the past few years is that you saw great coordination and the message was the same with all levels of government.

So this is a time in which we need to kind of all get together and make sure that we're all saying the same things and that we're uplifting the same things around you know, redetermination or any work requirements.

So just wondering if that that's happening as well.

So we can certainly get a kind of communications toolkit um for all of you if if there's a willingness.

Uh we would very much appreciate that support um at the state level and any other level that you might be willing to help with.

Um what was the second?

Yeah, I know I'm gonna go to Alex for the third question.

Um, what was there was a second one?

And commissioner, I hear you loud and clear about the uh the coordination with um any opportunity with Springfield, and I'll add that to the list to talk with the ledge team about.

Thank you.

And then I'm sorry, Commissioner, there was a second question there.

Oh, it was it was rates we've made.

We've made um progress on rates.

Okay.

Um I think it's a question of implementation at this point.

My understanding is that that will be dated back to April 1st once there's agreement and we're moving forward.

Okay, so we'll be reviewing.

Okay, perfect.

Yeah, and then Alex, do you want to talk to the third one?

Sure, Alex Normington again.

Uh HFS has been a really tremendous partner through all of this.

They participated in all of our work group meetings as well as the subgroup meetings.

Um and we've been in lockstep with them on messaging.

They've had the opportunity to preview and provide feedback on all the language.

And so our perspective is that um we're supporting the state as they're trying to adjust their systems to prepare for work uh requirements, in particular without any federal guidance, they've got a lot on their plate.

So our goal is to step in in this interim period until uh that guidance is shared and then out to enrollees in September, that we're helping people understand what they can be doing now, and then once the state has their final guidance and they know what that's gonna look like on their end, the state's going to take the lead in putting together mass communications and we'll be elevating that.

So I'm really happy to say that um we've been working together very very closely.

Okay, perfect.

And they're part of that Medicaid working group.

They are okay, perfect.

Um the other question I had was in regards to so a few things from the slides.

Um so under the Cook County Health uh Payer Mix, um, there is a slight increase in commercial um, which I feel like it's a good thing, right?

Uming that there's an increase, do you know what has happened to cause that?

And is there anything that in which we can kind of help continue that trend?

You know, I yeah, we're not entirely sure.

I don't think uh why I I would like to think it's improved um image, better access.

Um I know we've done a lot to encourage county employees to come to CCH.

Um so I would suspect that all of those things are playing a role, but one specific tactic I don't have.

Um and if I could tie back to just part of Alex's answer outside of the communications piece in terms of coordinating with HFS.

Okay.

Um there's been a lot of work with the innovate group as well, um, where they are partnering really to look at systems and data transfer and how we're coordinating.

So so again, I kind of mentioned it when I was speaking during the presentation, but um HFS has been very engaged with the group and and grateful that we have kind of a multitude of of providers in the conversation so they can understand all the different systems and how we can better kind of tie all of that data together to make sure that people are, like I said, kind of you know, if they're gonna get off the the renewal um, you know, process of having the continually renew that that it'll move them to um you know kind of an auto renewal where they don't have to do the paperwork.

Yeah, that's perfect.

Okay, my last question is kind of a two-part.

Um under the federal funding cut and impact on C CH that slide, um, I believe it was mentioned that 10 about 10,000 individuals will lose coverage statewide within the uh quote unquote um uh the uh immigrant community that is eligible.

So these are the asylum seekers, the victims of trafficking, domestic violence, et cetera.

Do we know how many in Cook County out of those 10,000?

We don't.

We have asked the state for this information, so we'll be happy to follow up once we hear back from them.

Okay.

Um please, uh that would be helpful.

Um and then the second part to that is um part of the working group, there was a section where it said strengthen and coordinate health care for uninsured.

What does that mean?

So as we have increasing uninsured numbers, it is how we best coordinate around right, how how do we as a broader healthcare community as well as um community partners coordinate better to ensure that people who maybe aren't gonna be as willing to engage in um their care are able to do so?

So, as an example, um, you know, this kind of came up initially as an idea around um ice when the ice activity was very high.

And um in talking with Greater Chicago Food Depository, there was discussion about how we co-locate access points to health care in their pantries because if somebody has to choose, I'm gonna go pick up my food and or or go get health care, obviously they're gonna pick food first, right?

So, how do we make it easier to engage in health care is kind of part of the discussion, but it's it's you know, how are we innovating and how are we collaborating so that we're providing specific ac access points?

Or is it um coordinating communications and I mean because I heard that part.

Yes.

So I'm just trying to figure out is it all encompassed or is it just like getting health care access?

Care delivery is care delivery, okay.

And that's that's a second iteration right now.

It's uh we're 100% focused on mitigating the impact, right?

So once once we've kind of got all that in place, the second iteration of the impact work group will be exactly that.

Okay, and then the 60 plus partners, these are I I saw that it's providers as well.

So it so does that mean that we're also kind of even expanding beyond our walls of county health and seeing if there's other people that are also gonna be helping out with on issues.

We had academic institutions, we had other community hospitals, we had FQHCs in the conversation, specific to providers, but then we also had businesses and community organizations, and yeah, a lot of lot of lot of participation cross sector.

impact right so that once once we've kind of got all that in place the second iteration of the impact work group will be exactly that okay and then the 60 plus partners these are I I saw that it's providers as well so it so does that mean that we're also kind of even expanding beyond our walls of Kakani Health and seeing if there's other people that are also going to be helping out with on insurance we had academic institutions we had other community hospitals we had FQHCs in the conversation specific to providers but then we also had businesses and community organizations and yeah a lot of lot of lot of participation cross sector wonderful thank you thank you chair thank you commissioner Trevor Burrus Thank you Chair uh I have a couple of questions uh first of all on the sheet with uh the um Cook County Health Charity care uh first of all the number uh for uh 280 dollars 20 or 280 um million sorry uh for 2025 is listed as an estimate is that correct um yeah I think this slide was probably made as we were rounding out the end of the year's financials I think we ended up a little closer to 300 than than the 280 so it actually came out above the the 280 estimate okay so it in other words it hasn't been updated yet similarly for 2026 I know that we're kind of running um higher than our original estimates for charity care uh is that 380 number going to hold or um is 2026 going to come in higher and if so do you have some idea of what that might be?

Not an idea of where we'll end up the hope is through this work we'll minimize people losing insurance.

However, you know as you mentioned the run rate is higher than we currently budgeted so there is a chance that 25 26 will look like 25 that will we may overrun on charity care unfortunately.

And do we have any estimate given um what we know what we might run into in 2027.

Not yet I think we're still seeing impacts of redetermination starting um and or having restarted about two years ago but then we're gonna have all these additional the ACA piece um you know we it wasn't quite as violent of a swing as I had worried it would be so hopefully that will kind of keep us you know a little better um in terms of the run rate um and then you know the 26th October uh part with the the 10,000 um immigrant population losing I mean that's gonna obviously contribute as well um to the uninsured um so it's really I think there's so many moving pieces right now it's just it's not entirely clear and speaking of the ACA and redetermination I think one of the more insidious parts of this whole thing is that uh for those uh people who um don't uh basically don't satisfy the work requirements whatever um and fall off of Medicaid they don't have a chance to uh enroll in a in an ACA plan.

Right.

Um also one of the things that I think is really striking is the difference between 137 percent of popular of uh poverty level and 139 percent of poverty level level in that if you qualify for an ACA plan as opposed to Medicaid although the the um redetermination requirements are more than they used to be they're not as um from what I understand as strict as with Medicaid it's still one year as opposed to six months correctly Commissioner are you asking about the marketplace or yeah the ACA marketplace plans versus yes so there's the open enrollment period that typically starts uh at the beginning of November this year because it was a state based marketplace they ran they were able to go through June or sorry January the end of January so most people have to pick a plan at that point in time there are exceptions referred to as special enrollment periods where if there is a life changing event you can pick a plan at that time but if you don't pick a plan during the open enrollment window you really are very limited in what your options are in entering the marketplace.

That's true but they only go through that if if you are in fact on an ACA plan as opposed to the Medicaid part of the ACA you're um you're you essentially only need to go through that process and that paper once a year.

That's correct yes thank you.

And there is no work requirement for the subsidies correct that is correct.

So the work requirement is just Medicaid yep.

That's a pretty striking difference also just for those people who are on the Medicaid portion of this and when they go through their six month redetermination thing if they become unqualified because they're projected to earn too much money are they then eligible for an ACA planes they would be and hopefully the running of the state based marketplace now that the state has full control of the marketplace would help ease some of that transition.

So and the the big question is how big of a subsidy would those individuals be able to get you know in terms of if their increase in uh in what they're earning puts them out of the uh realm of possibility for Medicaid but now bumps them into marketplace you know how much of a subsidy are they getting is that is that subsidy enough for them to afford a plan that meets all their needs there's lots of lots of open-ended questions there.

Yeah exactly a lot of moving parts but yeah I just I just wanted to highlight that that I mean this is this these changes are so complex and they're gonna affect people in so many ways.

Um and weirdly enough, I think there's a uh it it's those that are just a little bit better off are gonna have a very different experience.

Um which which I mean a lot of things are unfair in life, but that that's one of them.

It's just uh it it seems it seems to me that the that um part of what we should be be putting resources into is is trying to in fact get people um perhaps on onto some ACA plans who are close enough to the margins uh to be able to make it because it we're we're much less likely to lose them because of the redetermination process if they're an ACA plan versus um the Medicaid portion of it.

So anyway, it's more of a comment than a question, but thank you.

Thank you.

Commissioner Scott.

Thank you, Mr.

Chair.

Um so to piggyback off of uh Commissioner Trevor, um in terms of the redetermination after so it's two times they have to to go in and be returned after the first time, and we lose um X amount of folks, right?

Is there a plan in place to reach out to those folks who have fallen off of the roles and get them back enrolled and what is that?

Yeah, so that's part of kind of what we're working to develop with the impact work group right now.

Um you know, right now it's more of an inform and don't let that happen, right?

That's more what kind of what we're building.

Um but I think behind that it's definitely gonna be how do you recover when you're still eligible if you can get back on, what does that look like?

So go ahead.

Commissioner, I would just add that um, you know, redetermination is happening right now, right?

Once a year.

So I think it's a matter of doing some of what's working now, but doing it way more frequently because we will have to, because a certain portion of the Medicaid population will be having to do this twice a year now instead of just once a year.

So again, thinking about those best practices, but also knowing that those best practices are very resource intensive.

Um County Care has kept up all of those events that happen on at least a weekly basis uh for redetermination that they still see many, many people come to on a regular basis.

Um that's that's one piece, but I also think like what are new strategies that can be deployed as well.

Yeah, and and what what is that that window um for redetermination?

So like just what is that window?

So I'm I mean, I know things are changing.

I'm just wondering, you know, once you're off and I'm sure that there's some kind of window.

Just trying to think outside of the box of how we make sure that one people are educated.

I mean, that that's really important, but there are going to be some people you talked about the paperwork is just arduous, or they did not get their mail, or they, you know, some of those things.

What what are those windows?

What are the runways to make sure that people are um so there are requirements that the state has to adhere to in uh timelines that they send out notices to beneficiaries, and then there's a period of time when beneficiaries have to submit the paperwork, and then there's a reinstatement period.

So in talking with our partners at the state, what they said was for ACA adults, they are gonna be in a constant state of redetermination, is the best way to think about it, and to reinforce those messages about make sure your information is up to date, make sure we have your correct information, uh both uh mailing address, email, phone number, um, and pay attention to official communications.

There's also other ways that in addition to USPS mail that uh individuals can sign up for um kind of like an electronic portal with the state.

That can be challenging for people who don't have ready access to internet, are not tech savvy, may not, you know, they they may just not be comfortable using those types of things.

So we know that they're the digital divide is real.

Yeah, I'm I'm just really concerned about um folks that are a little up in age, right?

Who just you know I I have an aunt right now who, you know, I got I gotta go over there and help her kind of walk through a a lot of these things and you know, I'm sure that there are folks who just don't have the ability or the wherewithal the knowledge to do so and so those are the folks that I'm I'm really yeah yeah, and sc and scams is um the chairman just just alluded to.

Yep.

Yeah.

Commissioner, I think um if I could add just kind of one of the innovative ideas that's coming out of the broader discussion with the impact work group, we actually had academic leadership in the room.

And one of the gentlemen there came up and basically said, Well, you know, we did a get out the vote effort a couple of years ago with a civic-minded student body.

What if we could train them to help do all this, right?

So more boots on the ground, more people, right?

It's not just county care having these events.

You've got people out trying to help people re-enroll.

I was gonna say um, you know, I have um you know, several senior buildings within the my my district um into making making sure that you know those coordinators that are in those buildings, those build-in managers, those folks who work directly with our senior population have this information and are trained to help those individuals who just aren't technically savvy so that when they come down to their offices, they can you know continue to make sure that they're they're on and then uh again I I think that is a great idea about having um you know folks that are civically engaged being able to help a population, whether they're seniors or not who just don't have the ability and to keep reminding them over and over again, specifically if they're in a uh a redetermination like every every other week, i we need to make sure that we have people staying on top of them and and and helping them remember that um this is important, it's critical to make sure that they you know keep their thing.

Yeah, I think um so so yeah, you know, with Medicaid um going to 64, right?

I think hopefully some of that is mitigated.

But I think with any of those types of where you have some type of building leadership or whatever, I would encourage, you know, send them over to get Medicaid um facts.com and have them look at the toolkit and maybe that helps they can print that off, brand it to their facility, give it to the family members of the people who are in the building and get everybody kind of educated.

And D well to Commissioner uh Anaya's point, you know, whatever you have to send to our offices so that we can go out when we're engaging with our senior population when we're engaging with community just in in the norm that we can um make sure we do that.

And then as as we have events, you know, I know that you guys will send folks out to kind of talk and engage with them as well.

So I look forward to to working with you to make sure that that happens.

Thank you.

Ms.

Chairman Daly.

Thank you, Mr.

Chairman, and l let me thank you for this great presentation.

It really wakes people up, hopefully wakes people up to see the effect that this is going to have on our county and our on individuals who rely on our health care.

I just want to follow up on Commissioner Anaya's point.

So much is happening in Springfield.

So we have a co the Cook County delegation, and we uh we have a supermajority in Springfield.

So hopefully we could use our resources down there to say this is the effect that it's going to have on.

Last session, I know the the uh migrants uh senior migrants, I believe, that hit we the health hospital system was hit with 112 million dollars.

I mean, the more communication we could have with our delegation, the better off we are.

And I know we're doing a great job and uh Kathy, thank you always for the update.

In reference to the outreach, which is this is tremendous portal, during COVID, we went out to communities that were not ever served before.

And we learned from COVID that people are not coming to us.

So my question would be how are we and how what what did we learn from co COVID?

Are we going out into communities?

Or is it all digital?

And the basic revents.

It I think I think it's uh it's a mix.

Um certainly county care is out there.

I I want to say they do 25 plus um events a month um around redetermination and and helping people get uh stay get and stay enrolled uh in Medicaid.

I think um the other piece through this is while while it's a digital access point, it's really I think the secret sauces in getting the community partners engaged to work actually helping to amplify that message.

And Alex, I don't know if you want to add anything around the communication strategy.

Yeah, well, and the third work group is coalition building, and it's being led by Nick Shields.

Um and that's exactly right, pulling together community partners and organizations that have boots on the ground because we know that they're going to be the most trusted messengers in their community.

So it's really important that we engage them.

So there's a whole other group working exclusively on a community outreach.

So if there's any community groups we have or uh groups that we might suggest we could send them up over to and hopefully they are able to participate.

Yes.

Okay.

And just what I know it was mentioned earlier with the hospitals closing.

The two hospitals.

And this is totally off tap on this.

Have we been able to reach out to any of those individuals to come to uh the Cook County Health System, whether it be the doctors, nurses, because these hospital uh hospitals are closed and they're yeah, so we had reached out and um we we the the the position currently is that they expect to reopen the hospitals.

So there there wasn't um really a willingness to allow us to contact their any of the patients, what about the patients who need services?

Yeah, the patients were spread um kind of across through the help of IDPH were spread across existing um open hospitals.

I know insight was one of them.

Was were we part of the insight?

We were we we received a handful.

Um there were about 65, 67 um patients who ended up being transferred.

Um we received a handful of five ish um from them.

Yeah.

Thank you very much.

Thank you.

Thank you.

Commissioner Miller.

Thank you, Chair.

Thank you for the presentation.

I just wanted to find out um when you mentioned the partners, the community partners, especially the academic institutions, like which ones are we currently engaged with, and I I look at that as kind of multifaceted too, because many of them have satellite offices and in differ different areas outside of the main academic hospital.

Yeah, we've had thank you for that question, Commissioner.

So um at the September convening, we had Northwestern University at the table.

We are in conversation with University of Chicago, um, Crown School, who's participated in our most recent events.

We've had both UIC and UI Health.

UI Health is obviously their provider side, but UIC and various people from uh UIC at the table as well.

Um and then I know through the coalition building work group that was mentioned earlier that Nick Shields is running.

Um obviously through the relationship that he has helped build with city colleges, that's another area that we are looking to think about as uh uh partner um to share information, but also like uh a way to, you know, are there other ways that we can uh work with city colleges as well?

Oh yes, and uh Rush uh both you know kind of as a academic medical center as a and as well as as a provider.

Thank you.

I just um so you know those are good start but you know my my focus is always what's happening in the suburban piece, and a lot of those don't touch suburban Cook County in big numbers at all.

So it who do you have on an academic level that's focused on the suburban?

We uh off the top of my head, I'm not sure that we have anybody specifically.

We'd certainly welcome their participation.

Um so if there's anybody that you'd recommend we get in touch with, or you're welcome to share my information with them.

We'd love to invite them to the table.

This is a really big tent approach that we want to take.

Um and so uh however people want to plug in, we're glad to have them there.

Okay, thanks.

We'll talk.

Suburban.

Thank you.

Commissioner Stamps.

Thank you so much, Chair.

Um I'm gonna uh ask these questions backwards because I wanted a little clarification.

As you know, West Suburban is in my district, which is one of the hospitals that closed.

I was um addressing community very, very concerned community residents this morning.

It was done in a very unceremonious way.

Um literally March 27th, they said, okay, the emergency room is closing at four.

And and and no notice to the patients, their families, uh employees.

It was it's really been a mess.

And so um constituents have been reaching out and just wondering what kind of support they can actually get from county um relative to the hospital.

And I was just curious, are we engaging any of those conversations or are we talking with I don't even know who we're talking with, you know, the the hospital was privately owned.

This um Prasad has not been responsive, but the needs of the community still remain.

Uh there were two uh safety net hospitals, neither of which do obstetrics.

Um that some of the red some of the patients were transferred to.

So I'm just curious as to what you were saying about supporting uh those community members who um are in this situation with this hospital, mind you, the same privately owned company, resilience healthcare corporation owned Westlake Weiss and West Suburban, and all three of those hospitals have closed um in the last five years, West and West Suburban and Weiss within months apart from each other.

I hardly uh I'm very suspicious, given the amount of debt was suburban and the state of some of the conditions of the actual hospital, that it would open.

And when Minaj uh Prasad, the majority owner was invited to the community to speak about the possibility of reopening, he was he was a no-show.

So I'm I'm pretty concerned, um, particularly with women and obstetrics, although they closed obstetrics obstetrics in January 2025, and I kind of sounded the alarm on that back then.

So I'm just curious about that.

So if you want to just address that, and I have two other questions unrelated to the closing hospitals.

So yeah, I mean, again, you know, they're they're welcome to engage.

Um, Alex, I don't know if we've done a campaign for patients in terms of coming to us.

Um, we haven't done a campaign specifically for patients.

Um, we have been trying to recruit some of the providers who we believe have left to try to increase access in that way.

Thank you.

I think a campaign to um extend care to the pay to the community is warranted.

Um, you know, again, I get tired of this report, but you know, I think it's been said time and time again that Chicago, i.e., Cook County, also Cook County, has really just one map, and it's really the map of the have and the have nots, and in and it seems like um in every category that is important where we're talking about the quality of life, black folks are at the bottom and forever trying to get what uh is promised and what they deserve.

And so um, I know that's not whole, that's certainly not our complete responsibility, but it is painful uh when you have people calling your office and they're just trying to get care, or you have people calling your office and they're just trying to save their homes, like commissioners are on the front line hearing and receiving all of these calls where people's lives are being torn asunder, and we have to have a better response, then that's not in my control.

Like we I I it's just so hurtful for me to be on the other end of those calls and people are are are going through, and I know that times are only gonna get harder.

So I think it's really important that as a county we we continue to meet as much as we possibly can to to put up whatever defense as we know things are just going to get worse.

One of the things that we're not even talking about yet, not a whole lot.

We know that SNAP benefits for many are going to be cut on May 1st.

Uh, we're not talking about yet how if you know the state of Illinois doesn't help to pay a bill, that September, the entire state could be in jeopardy of losing SNAP benefits, which is gonna impact millions and millions of people, and I don't want us to be reactive if we hold if we have that information, I would like for us to be proactive, even if it means educating our people.

Um, thank you to uh Commissioner Britton.

I think I heard this earlier, where the Forest Preserve will be allowing um folks that receive SNAP benefits to do their volunteer hours at the Forest Preserve.

I want to know what more can we do?

Can they have volunteers in commissioners' office or at other spaces that we own or have connection to because people are going to actually have to prove that they are as poor as they are in order to eat, and so I want us to be thinking about what else can we do to help these families that will be in that state?

The other um question I have is how do we get intel on the issues that are being addressed at the state level and how it might impact if we are not attending lobby days.

I remember last year I went, you know, I do a lot of lobby days, and uh uh you know, when I'm down there, I'm covering a lot of different kind of territory depending on what's going on, addressing some issues.

But I really do think at um with everything that's going on and our stake in the game that this was not a lobby day to miss.

Uh this was really a time to be front and center and and the faces of the legislators who are making so many important decisions at the state level that's going to impact us at the county level, and we really did as a body needed to make FaceTime for that.

So I'm curious as to why that didn't happen because I know we didn't have a lobby day last year either.

It was my understanding that we go every other year or something to that effect.

But if there is an opportunity for us to coalesce, um we need I think we need to do that before this session is over.

So that was really just a statement, partly a question, because the question part was how do we get the information about what's going on if we are not making FaceTime for our legislators?

And then finally, as a part of this whole campaign and education, I saw that there were three breakout groups, one being communicate and educate, and so you know, there is a time in the history of my ancestors where a lot of what we had to do was about sustaining ourselves because we couldn't go to hospitals for all of the reasons that we know in this room, right?

And so you know, there is a time in the history of my ancestors where a lot of what we had to do was about sustaining ourselves because we couldn't go to hospitals for all of the reasons that we know in this room, right?

So my question is as a part of our overall campaign, how are we pushing individual wellness?

Something like remember when we talked about and really was active with may you rest in peace, food is medicine.

How are we really amplifying wellness as a part of the overall structure of how we keep ourselves safe, how we keep ourselves healthy in the face of these cuts where we know that our uh many of our people's um health insurance is going to be compromised?

Is individual uh uh individual wellness health plan being promoted as a part of this larger picture of us um or as people's um health care being compromised.

I know one of the blessings of being on this board is that we continue to go do really good things to people that really need it.

We had food as medicine, we had um, or we have what uh uh Chair Lowry put forth with you know getting the screenings, right?

So I want to know how much deeper can we go and how much broader can we expand ourselves to really be engaging as a holistic campaign about wellness.

And to the point, what are the things, the natural things we could be eating and growing?

How are we partnering with the food?

I mean the forest preserve to say, hey, this might be an opportunity to do some bigger gardens or some, you know, be real innovative about how people are getting food, what foods people are eating, and uh what natural plants have medicinal properties that can be folded into an overall wellness plan as we're talking about you know uh really improving and sustaining our health.

So that could potentially be chair, a part of the conversation in the second iteration around how we're delivering care, uh especially as we talk about how we approach the newly uninsured and uninsurable.

Um I will say, as a health system, uh we are leaning into that as you know, a lot of the programs you mentioned.

That's you know, CCH is has really engaged in taking the lead on.

Um I think as a suggestion, as I said, kind of in that second iteration to the other health systems, we can certainly have that conversation.

I it would be hard to kind of dictate to say, you know, to another health system you should be doing these things.

We can certainly talk about it, um, but to compel someone else to another health system to do that um might might be a bit of a challenge.

Um again, it's a it's a conversation we can certainly have, but uh no, I wasn't saying to impose our way of life on others.

I was just simply saying how can we expand what we're doing to fold it into an overall more comprehensive campaign around health and wellness, and because I'm always of the mind, what can we do for ourselves until our help comes, right?

So we're always kind of looking for, and this kind of came out of my own experience with the flood.

I won't go into that, but I was not only just the commissioner at the time, I was a victim where my my house flooded and all this.

And and as people were just trying to figure out the madness and this situation, my mind said, Well, what can we do for ourselves and each other until our help come?

And that at the time that helped with FEMA and the declaration and all of that.

And so all I'm saying simply is what can we be pushing forward or expanding if we're doing it anyway.

How can we make what we're doing more broader for the people that we're serving whose whose health insurance is going to become?

Yeah, so I think yeah, so right now I think the focus is on maintaining coverage, so many moving pieces, additional attacks coming in 2027.

I think that second iteration, like I said, right, that that that'll be kind of how do we innovate care delivery, and I think that can certainly be a part of that discussion.

You know, just great points, Commissioner, and and one thing I'm gonna suggest, and I see that we have the chair of legislation and intergovernmental uh relations here.

Um last name starts with the B and N's with an N, and in between it's a written.

Um I think we should talk about through your committee, getting an update at some point relative to what our lobbyists are doing in Springfield and in DC, given these difficult days, that will lead to a path forward, which will include us.

Okay.

Commissioner McCaskill.

Thank you, Chair.

Um I just wanted to echo what Commissioner Miller was saying that much of the research, not just in this particular um department, but in all departments leave out the South Suburban areas.

However, a lot of the heightened concerns or crises, whether it be STIs or HIV or trauma, what have you, is always in those particular areas.

So we need to be purposeful with our intent to redirect how we're actually placing these committees in these workshops.

They're excellent academically, but they're act they're excellent on paper if they're not actually impacting directly the people that are impacted.

So that was one question.

The next one, the next one comment.

My next question would be how did you go about inviting the people that were there?

Because you didn't mention South Suburban College, Prairie State College.

You identified absolutely none of the health care programs in the South Suburban area from Lynwood to Orland Park.

So how did you invite who's responsible for that piece and how do we make sure that we get a list of who's been invited so we'll know who how to assist you?

So I think as the phrase Kathy used was uh big tent, right?

I mean we kind of just pushed it out open to anybody who wanted to join.

But how?

Um electronically, I mean we did multiple public speaking engagement city club.

I mean, there were QR codes created.

We did a Crane's breakfast uh, but do you have like a uh maybe I'm missing something?

Do you have a comprehensive list of every health care facility in the county?

Do you opt okay?

So when you do a blast, is it that you're blasting it out to our area and they're simply not responding?

Is that what you are implying?

I mean, I think it was a mix, Alex.

I think Yeah, we uh we also shared it through our community newsletter distribution, which includes uh CBOs and partners.

I think there's about 30,000 individuals who receive that list.

Um, and it was really more of an opt-in, but uh your point is certainly well taken that we can do more directed outreach to say, hey, we really want to make sure that your organization is represented, who can you send to this?

Or if possible, I'm not sure that every commissioner would want to be a part, but when you send those types of blasts out, please include me on those because I would like to see because when people, when organizations say I didn't know about it, I wasn't aware, I want to be able to say it went out on this date, and this is what it included.

Yeah, no, we don't we'd appreciate that, yeah.

That would be greatly appreciated.

I would like to be included.

I will I will share, I think we were answering uh what academic um health care institutions were included from the Southland.

So we did have the Ingalls through UFC as a part of it, but also not necessarily academic.

Um Aunt Martha's is a part, an active part of the group, and they're represented in the Southland as well.

Um we're happy to invite the colleges that that you that you mentioned as well.

Yeah, what about like Roseland?

Rose.

Do we have participation?

Roseland Medical District was part of our uh our initial convening.

Um again, you know, if anybody wants to join moving forward, we are happy to engage them.

There's plenty of work to go around.

So we'd love to have additional suggestions.

Yeah.

So uh again, uh thank you, Commissioner Moore, because I'm wondering about Rose Lynn Hospitals specifically as the medical district is separate.

So I'm trying to make sure that the people that are targeting the actual resident, not just the higher level policymakers, but the actual people are actually in a part of the process.

We can make sure that we uh double check that Roseland Hospital is also on the list.

Yes.

And then again, please include me on the blast.

That'll be very helpful.

And then also with regard to um, we spoke a lot about uh Medicaid and ACA.

I'm just wondering, have you begun to do any forecasting as to if people miss those because the enrollment period it closes up, your uh Medicaid happens to die during that period.

Are we prepared with county care or any other process for how we're going to uh provide services to the many people that may are we preparing for that?

Are we preparing our staff?

Are we well staffed?

Do we have open FTEs that need to be filled in anticipation of?

So we've been making a lot of progress on hiring.

I know we've talked about that recently.

Um, you know, reductions in agency hiring um on the other side of it.

We are we ended last year at just shy of 500 net new hires, so we are growing.

We're on track.

We're actually outpacing that for this year already.

So if that trend continues, we should end closer to 600 net hires.

Um again, we're early in the year.

Hopefully that trend continues.

Um then um in terms of the uninsured, I think the bigger lift internally, I mean it's what we do, right?

It's it's we take care of anybody who needs us.

Um I think the bigger exercise is going to be that second iteration of the impact work group.

Once we mitigate the insurance, kind of the procedural questions on keeping people insured, it's gonna be how do we then come around the people who are now not insured, uninsurable, um, and ensure that they still have access to to health care.

And then I will um reach out to you directly.

I'm thinking maybe some virtual workshops or something for my clergy.

That seems to be the fastest pace in my area.

Thank you.

Yeah I'd appreciate it.

All right thank you.

So there's a motion on the floor to defer item number two three-0202.

All those in favor say aye.

All opposed?

In the opinion of the chair the ayes have it.

Uh before we adjourn this meeting and go to the special two o'clock meeting just want to note uh we received information last month concerning the Providence scholarship fund.

Well just want to reiterate that the application period for this year's cohort closes on April nineteenth so that's looming.

Also in follow up to your written notice last week Craig Williams will be leaving CCH effective May 15th to serve as president and CEO of Spear Memorial Hospital in Plymouth Mass near his hometown.

And we want to thank him for his good work including his leadership relative to the agency reduction effort.

We're going to see if we can get Craig here in person um on Thursday May 14th since he'll technically still be a CCH employee so all of us can greet him in person.

So with that I'm now going to take a motion to adjourn by Commissioner Scott, seconded by the Vice Chair all those in favor say aye.

All opposed we're adjourned thank you guys thank you.