Cook County Finance Committee Hears Cook County Health Mid-Year Budget Update – July 21, 2026
Cook County Finance Committee Hears Cook County Health Mid-Year Budget Update – July 21, 2026
On July 21, 2026, the Cook County Finance Committee received a mid-year budget update from Cook County Health (CCH). CCH Board Chair Raul Garza, CEO Dr. Eric McKaitis, and interim CFO Scott Spencer presented the health system's financial outlook, highlighting $315 million in cost reductions over two years, a $42 million budget gap in FY2026, and projected charity care rising to $500 million in FY2027 due to federal policy changes (HR1, Medicaid work requirements, ACA tax credit expiration). Commissioners expressed strong support for CCH's mission, asked detailed questions about workforce, agency staffing, revenue cycle, and the impact of federal cuts, and received commitments on specific initiatives.
Presentation & Discussion
- Raul Garza (CCH Board Chair) praised CCH leadership for fiscal discipline and proactive preparation for federal cuts, noting improved financial outlook but significant challenges ahead from Medicaid changes and rising costs.
- Dr. Eric McKaitis (CCH CEO) reported $315 million in expense reductions (belt-tightening, operational improvements, agency reduction) that prevented service cuts or layoffs so far. He noted FY2027 will be the most financially challenging in recent memory, with charity care projected to reach $500 million (up from $156 million in 2023). CCH has launched a Medicaid education campaign (Get Medicaid Facts) and partnered with City Colleges via a $5 million Pritzker Traubert Foundation grant for workforce pipelines.
- Scott Spencer (Interim CFO) showed payer mix shifts: Medicaid fell from 61.4% (2023) to 49% (2026), while uncompensated care rose from 13.1% to 24.8%. Federal policy changes (ACA tax credits, HBIA discontinuation, work requirements) are expected to reduce CCH revenue by $138 million and add $100 million in charity care in FY2027. CCH is targeting a $42 million gap in FY2026 with additional savings, but FY2028-29 projections show even greater strain.
Commissioner Questions & Comments
- Commissioner Bill Lowry (Vice Chair, CCH Board) thanked CCH leadership, noted the uninsured rate rose from 14% to 24% due to federal actions, and praised CCH's commitment to charity care and self-sustainability. He asked about potential service cuts or layoffs; Dr. McKaitis confirmed none to date but acknowledged future need may require such steps.
- Commissioner Ny asked about specific savings initiatives (Earn project, agency reduction), behavioral health positions at JTDC, reproductive health equity grant, revenue cycle improvements, and ARPA fund spending. CCH committed to unfreeze two psychiatric social worker positions and include the $2 million reproductive health equity grant in the FY2027 budget. New revenue cycle system expected to yield about $100 million in additional revenue. ARPA funds: $36 million remaining, on pace to spend by end of September.
- Commissioner Steams focused on workforce strategy, praising the shift from agency to permanent staff. CCH reported agency usage dropped from above 15% to under 9%, with 250+ conversions and 262 deactivations. Time-to-hire improved from 120 to ~60 days for accelerated positions. Pipeline programs include CPS internships, City Colleges partnership, and plans for LPN/RN expansion.
- Commissioner Given raised concerns about safety net hospital closures (e.g., West Suburban, Mount Sinai) and urged a proactive strategy to preserve access. CCH noted state leadership is primary, but they support safety nets through prospective payments and quality advancements. CCH also discussed efforts to hire displaced workers from closed hospitals, but outreach has been limited; Commissioner Given requested better coordination via job fairs.
- Commissioner Sky asked about the impact of HR1 on Cook County, noting 400,000 Illinois Medicaid recipients could lose coverage (45% in Cook County). CCH estimates FY2027 charity care at $500 million, but Commissioner Sky warned this may be an underestimate. CCH acknowledged uncertainties but said they are preparing for a potential 30% self-pay rate. Commissioner Sky also referenced a New York Times article about federal Medicaid funding cutoffs for California and Minnesota; CCH said such a move would be "ruinous."
- Commissioner Trevor pressed for a specific dollar figure of HR1’s total financial impact on CCH; Scott Spencer noted charity care is the primary driver but declined to provide a precise estimate due to unknowns. Commissioner Trevor asked about the accuracy of projections and the economic ripple effects.
- Commissioner [name not provided] (seniority, last to ask) thanked CCH for partnership with CPS and inquired about Haitian/Cuban categories in the eligibility slide. CCH will confirm whether those groups include TPS holders, noting possible additional losses if TPS is revoked.
Key Outcomes
- No formal votes were taken; the meeting was informational.
- Commitments made by CCH leadership: Unfreeze two psychiatric social worker positions for JTDC; include the $2 million reproductive health equity grant in FY2027 budget; continue and expand workforce pipeline programs (CPS internships, City Colleges, and grade school outreach).
- Next steps: CCH will finalize its FY2027 budget internally within a month, then present to its board before submission to the Cook County Board in October. Commissioners requested continued collaboration on job fairs and safety net preservation planning.
- Data points highlighted: $315 million in cost savings (FY2025-26); $42 million FY2026 gap; charity care from $156M (2023) to $400M (FY2026) to $500M (FY2027 projected); agency staffing reduced from >15% to <9%; 250+ agency-to-permanent conversions; 780 net hires in FY2026; revenue cycle improvements expected to yield ~$100 million.
Meeting Transcript
The Finance Committee, the Cook County Board will reconvene. We have the Cook County Health Budget. Perfect. You have the presentation. Thank you. Thank you, Chairman Daly. We're good. Okay. Thank you, Chairman Daly. I think we're going to start with some comments from CCH Board Chair Raul Garza. Uh, thank you, Dr. McKaitis. And uh good afternoon, Cook County Board of Commissioners. Um again, my name is Raul Garza, and I have the privilege of serving as the chair of the Cook County Health Board of Directors. Uh, I appreciate the opportunity to be here today to share an update on the health system's financial outlook and strategic initiatives for the uh mid year point. Um I'll characterize this into three categories, um, which I'll cover in a minute. The mid-year budget uh update reflects both the progress Cook County Health has made and the significant challenges that unfortunately lie ahead. Uh the board, the health board recognizes the tremendous work of our leadership team and the staff in strengthening the organization's financial position. Um all this while continue to advance our mission and ensure our long-term sustainability, including meetings it meeting its directive to reduce non-personnel costs in 2025, 2026, and fiscal year of 2027. So I'll start with the first category uh which I'll characterize as improvements. The improved financial outlook is encouraging uh to say the least, and it's a reminder that sound governance, fiscal management, and long-term planning matters, especially in times of uncertainty. And I don't think anyone would doubt that we're in those times as a result of what we see happening nationally and what we're forced to have to respond to. It also is a direct reflection of the commitment and fiscal responsibility through thoughtful oversight and certainly disciplined decision making. Uh this has been demonstrated by our our executive leaders, which you'll hear from in several minutes, and each and every committee of the board, including but not limited to uh the board's finance committee led by committee chair Rob Ryder, the managed care committee led by Cook County Commissioner and Vice Chair of the Board, Bill Lowry. Um in a few minutes you'll hear about uh some savings that Dr. McKaitis and his team have been able to realize uh in the amount of over 300 million, and I'll allow him to get into those details. The second category I'll touch on is our challenges. Uh at the same time, we are not naive about the challenges that lie ahead with the impending implementation of HR 1. We know that rising costs, which happened in healthcare anyway. I mean, health care represents about 18% of GDP, and uh unfortunately that will have continue to have a negative impact across the nation, but certainly locally here in this state and in this county. Uh the federal funding cuts, the growing demand for safety net services will require thoughtful decisions and continued fiscal discipline. In an environment of rapid change and increasing expectations, continuous improvement and operational efficiency are essential to sustaining our mission and maximizing the impact of every dollar within Cook County. Uh fortunately, there's been proactive work, and that's the third category I'll cover. It is because this team that you'll listen to in a few minutes, their proactive work uh has put us in a stronger position to weather the upcoming storm. Still, we also know that we have more work to do to improve key processes such as hiring, such as procurement, and revenue cycle to operate as efficiently as possible. By challenging ourselves to streamline processes and pursue innovative solutions. We feel very confident that we can better serve our communities today while building a stronger, more resilient Cook County Health for the future. I also want to take a moment as I wind up my comments to acknowledge uh the outsize role of of the Cook County Health System is this and the role that it's playing uh as it navigates the national health care ecosystem at a time when many public health systems across the country are struggling, and I think those have been well documented. Uh we heard those stories every day. Cook County Health has demonstrated that it is possible to pair rigorous financial discipline with innovative strategies aimed at addressing the challenges many of our patients face when accessing care. And we'll see that impact in less than five and a half months when 400,000 individuals are eliminated from Medicaid benefits. This is something that both the Board of Directors of the Health System and I have for sure that the Board of Commissioners take great pride in. I want to thank uh President Tony Preckwinkle, the Cook County Board of Commissioners, our community partners, and especially our team members for your continued support of the Cook County Health System and its mission. Now I'd like to turn it over to Cook County Health CEO, Dr. Eric McKaitis. Thank you. Thank you so much, Chair Garza. Chairman, did you want to take no thank you very much, uh Chair Garza, and good afternoon, Commissioners. And thank you, uh, Chairman Daly. Um I'm joined today, uh, as you heard already uh by Board Chair Raoul Garza.
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