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.

Thank you again uh for your kind words uh and unwavering support.

We have here with us today as well um Scott Spencer, who's sitting down next to me right now, uh our interim CFO, uh Dr.

Lauren Smith, Chief Medical Officer, Dr.

Arnold Turner, Chief Hospital Executive at Provenant, uh, Wynne Buren, Chief Human Resources Officer, Aaron Galiner, County Care Chief Administrative Officer, and Dr.

Kieran Joshi, uh, Cook County Department of Public Health, Chief Operating Officer, all here uh on the DIAS.

Uh and then we have several other staff members here in the boardroom uh as well as online virtually uh to help address any questions.

Our team's undertaken thoughtful, disciplined, and aggressive expense reduction efforts across the organization to ensure the fiscal sustainability of our health system and our mission to serve all.

As Chair Garza said, we've been very proactive in preparing for these uh these lean times.

This is our third year of consistent belt tightening, and between 2025 and 2026, we've eliminated more than 315 million dollars in expenses across the health system.

Excuse me.

Those savings have not come easily.

They've allowed us to absorb significant increases in charity care, labor costs, pharmaceutical expenses, medical supplies, and health plan member claims, while preserving the essential services our patients and communities depend on.

Through disciplined work and ongoing cost savings initiatives that we will continue to implement through the remainder of the year, we hope to make progress in closing our budget gap, which was at 42 million a week ago, or a few weeks ago, excuse me.

Fiscal year 2027 is expected to be one of the most financially challenging years our health system has faced in recent memory.

We anticipate continued growth in labor, pharmaceutical and supply costs while simultaneously caring for more uninsured patients and providing nearly 500 million dollars in charity care as Medicaid eligibility changes and coverage losses accelerate.

To put that in perspective, as Scott will show you in a few minutes, uh in 2023, our charity care costs were only 156 million dollars.

This year we expect to provide close to 400 million in charity care, and again next year we conservatively project that to climb to 500 million dollars.

The expenses we're cutting now are critical are critical to funding our mission to care for all patients, regardless of ability to pay.

The need is growing exponentially.

Those pressures are expected to return the health system to an operating deficit in 2027 with even greater financial strain protect projected in 2028 and 2029.

The reality is that we've exhausted most of the opportunities available to reduce costs without affecting our ability to deliver care.

There's very little left to cut.

Oh, sorry.

Oh, my apologies.

Um, our responsibility now is to prepare for that reality.

We are pro thank you.

Uh we are proud of the discipline that has brought us to this point, and we recognize that the challenges ahead cannot be solved through cost cutting alone.

We will continue strengthening operations, improving efficiency, pursuing revenue, and making strategic investments and the position Cook County Health to fulfill its mission for the long term.

Even as we prepare for these significant financial headwinds, we continue to make meaningful progress across the organization in this fiscal year.

We've released our new three-year strategic plan to guide Cook County Health through 2028.

We convened a broad coalition of community partners to help mitigate the impact of Medicaid changes, including the launch of Get Medicaid Facts, a multilingual public education and outreach campaign.

And I'll pause as an aside.

We have uh these pamphlets for you in multiple languages.

Um we'll be passing them around, and we would appreciate any support in helping us elevate that message.

Um, but we've also expanded opportunities for the next generation of health care professionals through scholarships and workforce partnerships, including a $5 million grant from the Pritzker Tralbert Foundation with City Colleges of Chicago.

We've advanced value-based care initiatives, we've strengthened our capital planning efforts, and we've continued building a more stable workforce while reducing our reliance on agency staffing.

These accomplishments reflect an organization that's confidently moving forward.

We're improving how we deliver care, strengthening our financial stewardship, and preparing for a health care environment that will demand even greater resilience.

Our mission has not changed.

Cook County Health exists to provide exceptional health care services to the residents of the county, especially those who have nowhere else to turn.

That mission becomes even more important during times of uncertainty.

We remain committed to making prudent financial decisions, investing in the health of our communities, and responsibly stewarding the public resources entrusted to us.

Thank you for your continued partnership and support.

And I look forward to discussing our financial results and answering your questions.

I'm going to hand it over to Scott now for a brief uh presentation on the current state.

Thank you, uh Dr.

McKitis.

Um Scott.

And I got identified yourself.

Okay.

Got you.

Okay.

Apologies.

Um my name is Scott Spencer, interim CFO for CCH.

Um we have uh a few uh slides uh to share with you today, you as you see on the screen.

Um we'll start going over the uh the federal policy and meta and Medicaid eligibility changes that uh uh I believe uh everyone is uh pretty familiar with as far as what we expect in uh January or uh what occurred in January was uh the federal ACA tax credits um that were reduced that uh resulted in uh approximately 92,000 individuals in Illinois uh being uh dropped from uh marketplace coverage.

Umward to October of 26 um uh as qualified immigrants is uh is redefined um or approximating that uh 10,000 individuals um in in Illinois will lose Medicaid.

Um and then of course uh January of 2027 um looking at the uh the impact of uh Medicaid uh work requirements uh and the uh change in the redetermination cycle.

Um so the impact to CCH of all of those uh coverage uh changes uh results in approximately 138 million um in less revenue to the health system or approximately 100 million um in additional uh charity cost.

Um we do not uh expect, of course, uh demand for services uh to decrease.

Um we expect um to see more uninsured patients and uh as I mentioned charity costs uh growing um but as uh the stresses um exist uh will make it uh um more difficult from an uh from an access point of view um and also uh uh will could threaten uh other other programs.

On the next slide.

So this uh showing our payer mix um over the last uh few years um want to highlight that in 2023 our uh Medicaid payer mix was uh at a high of 61.4 percent um and we are now at uh 49 percent um the other item to to highlight would be would be the uncompensated care in uh 2023 at 13.1 uh which is now at uh 25 percent uh the 24.8 um the increased charity care which is the slide on the right again um you can see at uh at a low of in and uh 2022 of 134 million and then 156 million in 2023 and then as redetermination resumed um after uh after it was paused during uh the pandemic period um our charity uh care increased to 237 million um and then 310 million in uh 2025 uh july 1st of 2025 uh HPIA uh health benefits uh for immigrant adults um discontinued um and so now in 2026 uh we are estimating uh 380 million um in charity care which reflects a um a full year of uh that uh the HBIA activity um being eliminated on our next slide we are uh we're proud of uh various cost savings initiatives that system leaders have implemented over the past several years as Dr.

We do, however, still have a $42 million gap in 2026.

We have targeted some initiatives to reduce this gap while also preparing for the significant Medicaid reductions in 2027.

Looking beyond 2027 projections indicate that the financial challenging challenges uh facing CCH will become even more severe in uh 28 and 2029.

So with that, I will hand it back to uh Dr.

McGuire.

Thank you, Scott, for the updates.

I think Chairman Daly, we are ready for questions.

Followed by Commissioner Ny.

Thank you, Chairman, and let me first say to Chair Garza, uh, thank you for your commitment and your leadership in the context of the context of the Cook County Health Board of Directors, it has been an absolute pleasure to uh serve under your leadership on that board.

Thank you, Commissioner.

And I also want to say to Dr.

McKaydis and the Scott, thank you for the presentation.

I want to acknowledge the entire uh CCH team.

I have the great privilege of working with all of you, uh, if not on a daily basis, certainly several times per week, and you are each very, very stellar, very, very responsive, and I appreciate it, and I want to shout you out in this forum.

Thank you, um, it's largely because of your partnership that I'm able to serve as chair of health and hospitals and as vice chair of the Cook County Health Board of Directors.

So I want to acknowledge you.

Thank you.

You know, much like the communities of Cook County, uh, CCH has been greatly impacted during the past year by the actions of the Federal Government.

There's just no way around that.

But despite those cuts, I think it is important for us to really shine a light on two things.

We have seen the Cook County Health patient population lose insurance or go from 14 percent uninsured to 24 percent uninsured in just a matter of months.

And, you know, quite simply, these actions from D.C., they are affecting families, individuals, and lives.

But despite that, I am very proud that largely because of our commitment to charity care, a commitment which is unparalleled by any health system in this state, we don't turn anyone away.

So whether you have insurance or whether you are uninsured, we recognize that health care is a right shared by us all, not a privilege reserved for the few.

So that is part of the Cook County Health Mission, and I just want to say thank you for living that out during these difficult times.

But it's also important that we we embrace that in addition to taking care of emergency situations uh as we respond to the behavioral and traditional health care needs of Cook County residents, we also continue to be proactive in leaders relative to health care.

You know, whether it's our behavioral health care strategic plan and our investment relative to making sure that we help produce and support behavioral therapists, uh, whether it's our commitment to the various types of cancer screenings, whether it's our commitment to good food options and food as medicine.

We just continue to be leaders, leaders which often are recognized by entities outside of the county, and I'm not sure we brag enough about it, but I'm gonna brag about it.

We continue to get just vast accreditations, uh recognitions, and I'm very proud of what we are doing at Stroger and Provident and the Bronzeville Health Clinic and all of our clinics and SERMAC and on and on.

You know, I applaud the fact that our collection rate, I think, is 96 or 97 percent.

That is amazing.

And you talk about you know how we try to fill gaps.

Well, one way to fill a gap or to fight against a gap is to make sure the resources we're owed, we go get.

And I think we are doing a great job of that.

You know, aside from uh some unfunded mandates and just a percentage of our charity care pot, uh the health fund and Cook County Health feeding into that fund.

We're we're pretty much self-sustaining.

And uh I think that needs to be stated even during these difficult times, especially during these difficult times.

I applaud how we have uh taken really very seriously the need to reduce our reliance on agency workers and instead invest in full-time employment as we support not only individuals but the working families of Cook County.

We gave you as a board a goal of a 20 percent reduction, and we're over 40 percent uh reduction in that same time period.

That is great, great work.

So as I continue to uh serve in the ways that I've outlined and working closely with each of you, uh I just want to say thank you.

I want to say thank you to the entire team for always being available.

Uh it might be a briefing, it it might be an update, it might be a possible new initiative, but more than likely it's asking you to be present with us in our various districts.

So whether it's a back to school outing, it's a job fair, it's a health fair, it's a town hall meeting.

Uh, whenever I reach out to CCH, uh C C D PH, County Care, or any component, any department under the uh umbrella of Cook County Health, um, the team is ready to be there with us.

And uh I speak on behalf of the third district and beyond in saying thank you to that.

So with all that good news stated, I have to ask you, Dr.

McKay, is we do have a gap.

And as we go forward, uh I think it'd be helpful for us to know.

Have you had to cut any services, the provision of services uh that we've historically provided or uh look seriously at layoffs?

Uh just what have we had to do to date uh relative to combating uh the gap and the reality of what we're now face given the loss of resources from the federal government and what might be coming down the road.

Right.

Well, thank you first um, Commissioner, for those very kind words.

Um the the short answer is no, we we have not um to date had to consider any layoffs um or service reductions.

That said we, as I mentioned, um we have taken 315 million dollars out of our costs.

Um that has been through belt tightening, it's been through operational improvements.

We continue to look at kind of the upside you mentioned revenue cycle.

There's still more work to do there.

Um we have new leadership um over that work um and and a lot of potential there as well.

So we continue to look at those upsides.

Um the the cutting piece as I mentioned in um in my comments, we we have kind of reached the end of that line where we can cut without affecting services.

Um so looking into 27 and beyond 28 and 29 where those continued pressures can continue to mount and and we continue to see those gaps.

Um while we haven't had to consider that, that may be um a need in the future.

Thank you.

Nothing for further, Chairman.

Thank you, Chair.

Um so I I too echo um you know the chair's um uh accolades of uh Cook County Health.

I always say I always when I talk about uh CCH, I always start by saying it's been a mission for nearly 200 years to serve everyone that comes to us regardless of their migration status, um their ability to pay, whether they're insured or uninsured.

Um and I think that that's an important thing to uplift because that is to the core of like a county health was created um to uh sustain healthy communities in a county um and to ensure that no one gets left behind in regards to attention, medical attention, life-saving medical attention.

So I I brag about that in the sense that you know um not every county does it.

Um not everybody and every county can do it to the level that we've been able to do it.

Are we perfect?

No.

But there's always willingness um from uh the Cook County Health team to improving services and ensuring that folks always have um the necessary medical attention.

So um whether you know we we look at the expansion that we've seen in the professional building or in our clinics, I want to thank you all for staying true to the mission to staying true to the reason why Cook County Health was created back in 1835, I believe.

Um so uh Dr.

McKitis, I know that you and your team have been working very diligently and implementing um saving uh initiatives within uh Cook County uh health, particularly because when the Trump administration um uh came about, we knew that there was going to be threats.

Um and we knew that we were anticipating for fundamental changes to Medicaid, the Medicaid program.

Can you just describe some of those uh savings associated um and some of those initiatives that you've been able to implement?

I know um Chair Garza mentioned them briefly in his in his statement, but I I do want us to kind of talk about those.

And if you can just kind of walk us through what you all have um already done.

Absolutely, yeah, and then Scott maybe can help fill in some of the numbers for me as well.

Um but yeah, I mean it's been kind of a broad look across all the opportunities, both from a cutting as well as a revenue um opportunity, and thank you, um, Commissioner, for your kind words as well.

Um so um just looking back 25 um 26 and then into 27, we've done the bell tightening, right?

10% reduction in 25 again in 26 and then another five percent looking forward.

Um and you know, we've done a lot of internal operational improvements, improving access.

Uh, there's more work to do there.

Um, working on how we as the broader organization, the health plan, the health provider side, how we coordinate and collaborate better so that we are recapturing um our members so that they're also our patients.

Um so we've done you know, the Earn project this year.

Um, you know, there was an uh identified 137 million dollars of potential recouped um, you know, where essentially our pro our our our um members become our our patients um and of that we've realized about 54% of it um this year so far, so about 74 million dollars there.

Um agency reduction, I think Scott, you've got some numbers there in terms of uh savings as well.

Um hiring has been um taking off very nicely uh with the the great work that the win and team have been doing.

Um, you know, we have uh at several steps have to freeze um swaths of positions.

Um that's again to you know ensure that we're able to close the budget, but you know, again, it's not it hasn't been layoffs, right?

It's been open positions that we haven't hired yet.

Um Scott, do you want to talk a little bit about uh agency?

Yes.

Before we move on, can you um do you have the numbers of how many vacant positions have been um eliminated versus how many can continue to stay open?

Because I know there's some vacancies that are crucial that we definitely are looking to potentially hire because we don't want to impact services.

So I'm not sure if if that's something that you you have right in front of you or whether you can get the information chair daily we can absolutely get it before we're done today.

Absolutely.

Do you want to talk about that?

So yeah, just to to add to that uh specific to agency.

Um looking back to uh fiscal 24, uh where we spent about 190 million, um, and then in 25 uh about 150 million, and so we're on track in fiscal uh 26 to spend uh just over 100 million.

Uh so the a lot of you know effort uh there additional progress in that direction.

And I'm sorry, this is regarding agency agency hiring.

We've made a lot of progress, you know.

We pulled in a bunch of people that we are allowed to pull under um our personnel uh silos.

So what are the barriers to moving the system away from additional agency hiring um to kind of get to those the 20% you don't want to do?

I'll say we've done a lot of work around our working with our employment plan to kind of smooth that glide path into bringing um you know additional employees in.

Um we've done a lot of work with our union partners to have uh memorandums of understanding about how we can kind of smooth that out and do the conversion.

So we've had a lot of work with agency, for example, nursing that just this year is reduced by 50 percent our agency use.

Um lot more work to do to your point.

Um but you know, when you want to talk a little bit more about Wayne Durham Chief Human Resource Resource Officer, thanks for the uh question.

Um so from a barrier standpoint, I think we're making really good progress.

Um most if not all of our our uh areas are under that 20% that we discussed.

And in fact, I think as an organization, we're under nine percent right now agency usage.

Where where do we start out?

Um we were above 15 percent, and when you look at that number, we started.

Agency like possibly across the across the board.

Um, but you look at around 1500 agency employees, and now we're down to under 700.

So we've cut that number or a little over 700, but we're close to in half on what we've done in the last probably year, year and a half.

Um I think that we can continue to push that number.

We have been meeting with uh various unions to make sure that we can put plans in place to help us convert.

So the conversions are what really helps us.

So we've converted over 250 agency employees uh to CCH already.

And then we've done a number of emplo we've taken a number of agency and demobilized them.

So one of the things we're working really hard to do is ensure that as we bring in new employees, we're actually demo demobilizing other employees, right?

So we don't want agency staying on for extreme periods of time.

Where's the sweet spot with that where you still have the flexibility to allow staffing to come in, you know, for people who call off for emergencies for holidays?

So you have the flexibility.

I think at a system level, and I'd have to work with and we've been working with operations on this, but it's somewhere between five and eight percent.

So our real goal is to get down below that number in the next year, somewhere between five and eight percent.

Okay, sounds great.

Um okay, so on a different tact, we've discussed the possibility of bolstering our internal capital workforce.

We've talked about this, I've talked to you about it, Dr.

Makida as I talked to Craig Williams, who I know is the COO who's no longer here, and Scott about it.

Um and the real idea is for our internal uh building trades to work on smaller projects within the health system, which then could save contract dollars that we'd be using externally and boast our more rail for our in internal workforce.

We know we have a lot of bigger capital projects that we send those dollars out to vendors like JL, and there's always gonna be enough work for them.

But to kind of hit that sweet spot of like the 1.5 million dollar projects that we keep inside, that we save that money.

How is that capitalized workforce going with Kineco and the budget?

Yeah, so I think you know, as you mentioned, there's still meetings going on.

Um, and I think from our side, it sounds like a really good idea.

Um I know Adam Weber's online, and he's been much closer to it in terms of current state.

So, Adam, if you're on, if you want to talk to that a little bit.

Um, but I would say, you know, we support our workforce.

We want to definitely, you know, where we can.

Uh, yeah, it looks like there's still a savings there.

So and then what do we know when the budget will be finalized?

The FY27 budget will be finalized approximately.

I guess that's more of a can echo.

Well, president is October, right?

Usually the normal time is mid, like October 15th or something like that.

When she presents a budget.

But internally, isn't aren't we?

Don't we hit we try to hit like end of July, beginning of August, so there's time to negotiate through October.

So I can say for CCH, we'll be taking it to our board first within the next month.

And it'll work its way through the process.

So I guess my hope for this is that it is this capitalized workforce is kind of solidified by that time.

Adam, are you online?

Can you speak to kind of current state?

I think is Adam having mic issues.

There he is.

Oh no, everyone's having mic issues.

Fuck.

Oh, he's off mute.

The mics aren't working for some reason.

Adam.

Yep.

Oh.

There you go.

Did you hear the question?

Great.

I did.

Yeah, yeah, we can hear you clearly online.

Uh so it it is going well.

I think we are we are working with our internal budget team, um, looking at what projects would make sense for them, and then as well as the labor team on finding that right mix of the staff to be able to go and do those labor, uh, that capital labor work in house is still a great idea.

It's still something that we are committed to continuing to work through internally to figure those things out.

Okay.

Sounds great.

I think you know, it being a nut uh a net positive to your budget is really important, but equally important is making sure that we have the right people in the right places.

Okay, so to move over to behavioral health at the GTDC.

There were two seek psychiatric social worker positions that were frozen.

I know CERMIC was working on request to hire.

Um, but those the movement on those is incredibly important as we kind of look holistically at the juvenile temporary detention center, knowing that only a certain portion of those kids are getting mental and behavioral health regularly.

When we have heard over time that every single kid in the JTDC needs and deserves mental and behavioral regular mental and behavioral health.

Um, so I know that you have a huge, huge system and a lot of employees, but those two psychiatric social worker positions in particular, I think are critical to pull in this year.

So I would love your commitment that those are gonna be unfrozen and those will be hired because we really need to make that's just what makes sense for the JTDC.

Um we will definitely do what we can with yeah, okay.

Okay, that and so we have two that accepted offers, how about that?

Oh, perfect.

Excellent.

Excellent.

Okay, thank you.

All right, so this is more of I don't know if it's really a question, it's just more of a statement.

And we had this conversation uh several years ago about reproductive health equity grants, and that the state and the city had put significant month money into it for to support and protect women's health care in Illinois.

So knowing that women move throughout Illinois and women's reproductive health is critical.

And Scott and I had a conversation about this last week that the reproductive health equity grant, it's only two million dollars, but it still is so critically important to women who are really under attack.

And we're not just under attack for our health equity, we're not just under attack on you know our health care.

But when you live every day as a woman and you see the attacks that come up on our voting rights and our ability to make a living and our ability to walk around without being sexually harassed, it's not just one thing.

It's the way that these all combine together to make us feel less than.

And so when you live and you work, and every single day there's something that comes up that kind of knocks you off kilter.

Having this reproductive health equity grant, knowing that women are taken care of in the healthcare space and are allowed to have terminations of pregnancy if they so choose.

This isn't just about women in Chicago, women in Cook County.

This is about the mission, critical reason to be for us to be here to say we support 51% of this population.

Every single person in this room was born of a mother.

We may not all be married, we may not all have women currently in our lives, but we all had women start our lives, and that is so important that that's why this $2 million is critical to make sure that those women feel cared for, not just them, but their families, all of us and everybody together is united to say we care about you, and this is our this is our um this is our commitment to show you that we care and and that health care is important.

So I I can't stress strong enough that is my expectation to see that inclusion of that reper um the reproductive health equity grant included in the fiscal 27 budget.

Okay.

Um so two more questions I have.

Um on page six, your first uh goal around revenue cycle systems and implementing a new one, excuse me, with more tools to improve revenue recovery.

Um I'm I'm curious about how this will affect physicians and if they'll have an easier time coding in all of their procedures, and then if you have an estimate on what you expect to gain in revenue once this project's complete.

Yeah.

Yeah.

Um the uh the conversion to uh from two um billing systems to one um we expect to um improve uh reporting um for us and um the just uh um bring an overall improvement and and workflows.

Um apologies, I just want to make sure that I heard your uh question correctly.

Can you repeat what what you're okay?

So the revenue cycle revenue revenue cycle system has long been something that you guys have coordinated with this board on.

I know Andrea Gibson had brought in a full team on this and done an evaluation and really saw a lot of significant improvements.

And so um on page six of your goals for fiscal year 27 and 26 was to include more tools to improve revenue cycle recovery.

So I guess my question is uh do you have an estimate on what you expect to gain in revenue once that project is complete?

How much money will you and revenue will you gain because that system is more efficient?

Yeah.

Um and if you don't know, that's a perfectly acceptable answer because it's a little bit of a unique nuanced question.

So yeah, we we know that um there's lots of opportunity, and we are uh particularly looking um to fiscal 27.

We know we're um have a variety of and uh improvements that we're expecting to uh to see.

Like within the physicians themselves who are coding like their ICD 10 codes when they code them, right?

If it's the broken arm, they have lacerations, a bone break, it's 10 different things that the physicians are working on.

If they're not coding every single thing and not getting paid for every single thing, then that reduces your overall overall revenue.

So with these revenue cycle improvements.

Yeah, so there's a piece of that, right?

Certainly.

Um that that also plays into how we're measured for quality outcomes as well.

Because as you get all that credit, right?

It's your you get the credit for how sick the population is when they appear healthier and something happens that was expected.

Yes.

That becomes a big problem, right?

Um, so yeah, so that's CDI, um, so clinical documentation integrity.

That's a piece of it.

There's also efforts around proper statusing of our patients when they're in the hospital, so observation or inpatient.

Um, so really focusing our physician advisor team on ensuring that utilization management.

Is that trans?

Does that translate to dollars?

It absolutely does.

Oh, yeah.

Um what I'm getting at is there's yeah, so I don't have the breakdown, but I'm giving you all the pieces.

Um, the total amount is on the order of about 100 million that we're looking at going forward of a pickup.

Okay.

So my last question is about ARPA dollars.

Uh FY26 uh CCH was awarded 110.5 million in ARPA funding.

In May of 2026, we got a report saying 80 million was spent, and there's a remaining balance of almost 30 million.

Will you be able to spend that by the end of the year?

So, from my perspective, we're on a glide path to send it to to spend it.

I believe the last numbers I saw were about 26 million now.

Andrea, are you able to speak to that?

Um, sure.

Um hi, this is Andrea Gibson.

Can you hear me?

Yes, hi, Andrea.

Hi.

Um, yeah, we actually have about 36 million as of yesterday to spend.

Um, and most of the expenditures, the activities will be taking place by the end of September.

That's the end date for the subrecipient work.

And then we'll use the remaining three months to pay invoices, but we are on pace to spend the entire amount.

Excellent.

Thank you, Andrea.

Great work as always.

The last thing I will mention is more of a uh thank you and great job.

Um you noted in uh on page seven of your materials that CCH established an initiative to increase access to surgery by improving your processes at Star War and Provident.

You OR surgical volumes were favorable to budget by six point three percent and sixteen percent respectively.

So I just want to say great job.

You know, thank you for all of the materials, but you know, it shows that when you put the efforts into things and then kind of gradually in micro stuffs move move forward the way that you know you had planned that you guys do a great job.

So thank you for all the work.

Thank you for that.

And yes, we have more work to do there, but yes, great progress being made.

So thank you.

Thank you, uh Chair.

Um thank you for this great information.

I have some questions mostly around the page, and I don't know what page number it is because it's cut off here.

The federal funding cuts and impacts for uh impact on CCH.

First of all, I just want to clarify clarification on the last box on the right.

Uh impact to CCH, are those year-to-date numbers or uh uh anticipated full year numbers for uh 2026?

So 138 is that 138 uh in patient care revenue decrease in 100 million in charity care costs.

Yeah, that's a full year.

Um and then to clarify, we're expecting um uh 500 million in charity care in FY 2027.

Is that an increase over this year or total percentage?

Yeah, so this year um we had budgeted 380 and are anticipating potentially in the neighborhood of 400 um for charity care.

So this will be over and above an additional hundred million that will shift into charity care with these changes.

So you're anticipating an additional 100 million for next year.

Um how uh in terms of of not revenue but percentage of cases here, you're you're talking about about 24 percent uninsured.

Um 24.8 percent uninsured in 2026.

What is that percentage that that number is based on?

So do you know for next year?

So yeah, we we're budgeting about uh 30 percent uh 30 percent uh self-pay, so roughly um a 20 percent uh increase.

And so uh for Medicaid, we're budgeting um 43 percent, which is about uh a 15 percent decrease in Medicaid.

Um the same page it says that we anticipate about 400,000 people in Illinois will lose Medicaid.

What proportion of current Medicaid recipients is that?

So um I I think approximately um of the 400,000, about 45 percent reside in in Cook County.

So when we're looking at um what we're budgeting for fiscal 27, um we looked at uh a couple of things, um including our um historical uh payer mix um as well as uh preliminary estimates from the state as to what that impact to CCH would be.

Right.

And it did you go through this the similar process with the ACA changes this year?

And did these numbers overshoot your expectations or were they within what you were expecting?

Yeah, so so the ACA um the what's the ACA and uh the the full year of HBIA um is what's impacting our fiscal 25 um charity care.

Um so the the increase of approximately um uh 70 to 75 million over prior year.

Um so we know that um that is a primary driver of charity care to the health system.

Um have you run any sort of estimates uh I guess uh I want to say what the standard deviation of your estimate is on this number.

Is it is it uh basically are you talking about a curve like this or a curve like this?

Because I worry that we're uh I mean you mentioned that this is a conservative estimate, and I just just looking at these numbers of I'm just using dividing by two because it's the quickest way to do it in my head that about half of these numbers actually live in Cook County, and that's an overhead.

That's about right.

But um uh an increase of about 45,000, probably plus a few uh uh individuals who lost ACA coverage put us as far in the hole as we are now.

If you divide 400,000 by two, that's 200,000 people without more people without insurance.

I worry that uh we could be severely underestimating the number of uninsured people that we're we're going to be treating next year.

Yeah, it's it's possible.

I think again, you know, we're looking at potentially getting close to pre-ACA numbers, right?

Getting back into the 40s percentages, right, for uninsured.

Um just to answer back to your um total number, 3.4 million Medicaid members in Illinois, right?

So that 400,000 is coming out of that about 11 percent.

Um half of which, to your point, um, are in Cook County.

Um I think there's a few variables that we just can't account for.

What is gonna influx to us from other health systems as people lose coverage?

What's what processes and procedures will we have in place?

So just to give kind of the county care perspective, um, you know, we lose only about 11 percent through the current redetermination process, right?

But when we look at that 11 percent, about three quarters of those people coming off are losing their coverage because of administrative reasons, right?

Which is the feature, not the bug with these things that are coming in January, right?

Um and and you're at that's just redetermination.

Now you're adding work requirements on top of that as well.

Um so to accelerate that and know that other health plans are not performing at the level of the county care is for the state averages in the low mid-20s to for any any uh you know drops uh during during redetermination currently, right?

So you double that cadence and then add an additional um process on top of that.

Um it's hard to predict exactly how much you know we are gonna lose in terms of coverage.

We did put the Medicaid impact work group in place.

We've had a lot of traction there.

Um again, uplifting that through your help, greatly appreciated.

Um trying to ensure, you know, there was um a recent article published that 55% of the people on Medicaid have no idea that these changes are coming even now, right?

So elevating this, banging that drum repeatedly um is gonna be crucial over the next six months.

Um because it is, it's uh you know, we don't know w how how deeply this is gonna cut and how many people are really gonna lose coverage.

Changing the said subject somewhat.

What given the estimates that you currently have.

I mean, these are budget estimates, and we're cutting at the same time that the charity care is expanding.

Um and when I talk to people outside this room about this, uh constituents, lawmakers, state, federal lawmaker makers would really help to have a dollar figure, even you know, up to this point.

This is what our estimate of the HR one has been to Cook County Health's finances.

And uh and not just the you know, the increase in charity care, the re reduction of you know, grants or whatever, uh all the other components.

Um to be able to say this is costing us X dollars this year, either through direct you know increased costs or cuts.

And this is what we anticipate in 2027.

It would be a very useful number to have, and I'm wondering if you've done any kind of estimate of that sort.

Um I think the cost um outside of what we're estimating um in terms of you know the uh the additional charity care.

Um I mean that that's what that's all we're looking at.

Um I think that um as as um Dr.

McCutter has mentioned, you know, the efforts um the the efforts to to get out a uh um to get out ahead of that and um educate patients um uh um every little bit of that um helps.

Um but our our biggest, our primary driver is um is that increase in charity care.

I'm sorry.

And I think we can certainly try to I think put more of a frame around it.

Um I think again it's we're kind of it's a shot in the dark to some extent, just because we don't know how deeply these losses are gonna cut.

Um and you know, to to point out what the trend we're seeing currently isn't even HR one yet, right?

I mean the the policy change with the ACA tax said that wasn't HR one.

The HR one starts October 1st with the redefinition of of qualified immigrant and then January with all of it.

So I mean this cascade hasn't really even started yet.

So I mean, yeah, but I completely agree.

I think getting more of a estimate or even a range, right, to say it could be this much to that much.

And also thrown thrown in on top of that.

This is a broader question for offices under the president and everybody else, is there are also economic impacts to this that go way beyond your budget.

Uh you know, we're we're uh there's you know loss of loss of productivity, there's loss of life.

This is going to result in decreased life expectancies for particularly for um, you know, uh communities that are currently under served and it's gonna get worse.

Uh all of that is gonna have an impact on the finances of Cook County, the state of Illinois, and of course the country.

And I don't know whether it's even possible.

I'm sure there's an economist out there somewhere who's trying to figure this out.

Uh it'd be nice to get a hold of that paper when it's published.

Yeah.

I can I can tell you the estimates we've seen in terms of GDP impact for Illinois is about 2.5 billion once this is fully impacted.

And that is a combination of kind of the health health care ecosystem collapsing, fewer jobs, right?

Um less opportunity, less access, sicker population, and ability to work because of that population being sicker.

Um so that that's kind of the general number just for Illinois.

Um but I agree.

I think again, kind of to the intent of these changes, it's to get the dollars off the federal books and push the costs down.

Unfortunately, it's at a multiple, right?

It's not it's not just funding for vendative care now.

It's you know, you look at colonoscopy as $2,000,000 to get a colonoscopy done.

Treating stage four colon cancer is $130,000 a year.

So it's you know, it's uh multiple factors of right, I mean, of increased cost.

So in one last question, and this is kind of a I don't know if you've taken a look at the online version of today's New York Times.

Uh but they reported today that the federal government, the Trump administration um has cut off Medicaid funding for California and Minnesota.

Oh wow.

And um supposedly from Medicaid fraud.

Uh Right.

So the so the question that I have is what impact if if the federal government were to do something like this still, I assume that California and Minnesota are probably our lawyers are in court as we speak, probably uh trying to uh uh stop this.

But if something like that were to happen here, how uh what would be the immediate impacts on the Cook County health system?

Well, I think Aaron, what do you think?

Um I mean, I you know, general Medicaid funding is I think 5050, right?

Federal, um, federal state, and then ACA is 90 10.

Um so as you can imagine, that would be the vast majority of the funding would just dry up and the state would be left to essentially figure out how to fund the care.

Um so that I mean that is just a wild card that I don't think anyone is really thinking about in terms of what happens from a funding standpoint.

I mean, that would be ruinous.

Thank you.

I think that was all my questions.

Thank you.

Commissioner Steams.

Grant, you have no questions right here.

I'm sorry, guys.

I'm showing it's okay.

Um first of all, um thank you.

Thank you for being here.

Thank you for the briefing.

And thank you for all the really impressive questions that my colleagues ask.

Um I do have questions, but I also have a uh anyway, this is it.

So one of my priority or priorities, ensuring that we are investing in people rather than perpetually paying a premium for temporary labor.

So can you walk us through your workforce strategy for transitioning from costly agency staffing to a stable, more permanent workforce?

And I know that we've already made some inroads in that, so it's really to elaborate on what you've already shared.

Specifically, what investments in recruitment, retention, compensation, and career pathways are expected to reduce agency expenditures over time, and what benchmarks should this board expect to see over the next several budget cycles.

I got a thing for staffing.

I don't know where that came from.

Um but a, as a as a unionist, I'm always just very curious and and advocating that we move toward um permanent staff and less dependency on temporary work, also referred to as agency.

So that's the first of a couple of questions, if you don't mind.

Sure.

So um I think we we haven't talked about the hiring progress.

We've we've talked about agency reduction um as a start.

We're down now in kind of the mid 8% range from as when shared probably double that um a year and a half or so ago.

Um so a lot of progress being made.

Um we continue to work with our union partners to find ways to smooth kind of that transition, especially in conversions.

Um but from a hiring perspective, we've done a lot of work.

With Wynn and his team have done a lot of work um with our employment plan to really try to make it easier to hire.

So our time to hire has decreased.

We have with our um actively recruited positions, we're down around 60 some days, I think.

Is that our accelerated hiring process allows us to hire within around 60, 65 days?

And that's that's that's on from like 120, 140.

Yes.

So last year we were on 120 days uh time to fill or to hire.

We're in the 90s to we're in the 80s and 90s right now, somewhere in the high 80s to high 90s.

But if we use the accelerated hiring process, which is a little bit different than our normal hiring process for certain positions, especially those that are uh probably uh uh more volume from from a hiring standpoint, we're able to get those positions into about the 60s.

So that's extremely helpful for us.

Helpful.

What do you mean when you say more volume?

Um if they're higher volume positions, we're able to we we move them into the accelerated hiring process.

Okay.

And then just in terms of hiring kind of trajectory overall as an organization, um, we filled approximately uh 780 positions this year so far.

Um and we well that's up from what last year.

So last year we ended net 464 positive.

Now, if we look back year over year, it was I think 250 ish the year before and 125 before that, and then we were break-even the year before that.

So it's been a steady increase in terms of net hiring.

So we are growing as an organization.

Um then around that, and I'll I'll hand it back to you in just a sec, but around that, you mentioned pathways.

Um, you know, we've we've presented the um the Pritzka Traubert uh partner uh foundation award that we got with the partnership for city colleges.

Um we are still anticipating opening the first uh cohort of medical assistance uh at Providence as uh training program that would then act as a glide path um into potential employment at CCH.

That is being done to really kind of get to know the students, let them get to know us, and hopefully create that that interest and that stickiness with our system so that they want to stay uh and be a part of our team.

Um the plan there over the coming years beyond um 27, once that um program is up and running is to start expanding into nursing as well.

So LPNs and RM programs.

Um and once you're an RN, for example, in our uh organization, it's full tuition reimbursement through the terminal degree through a doctor of nursing practice.

Um and that that's through our CBA, so again our partnership with the union.

Um, but it's just an example of one of the pathway programs.

Um so we've built kind of the front end of that pathway.

Now we're building the front end of that pathway so that non-clinical people have a path into a clinical career.

Even in front of that, we're partnering with um right now, primarily um Chicago Public Schools.

Um we've had their internship program.

We've had several people come uh the last two years um to do rotations to really understand and kind of get exposed um to the healthcare um environment.

Um and in front of that, we're having conversations about getting out to the grade schools to to have the various um you know professions come and speak to the students to talk about you know, here's what a therapist does, here's what um physicians and nurses but but the point there is is that it's more than just physicians and nurses, right?

There's therapy, there's sterile processing, there's all the different things that you could do in the healthcare fields, um, and to really highlight that so that they can understand like set your trajectory towards something that might pique your interest, right?

Um, and then as much as we can to kind of build the front end of that pathway to give them a way into that work.

Thank you.

Can you just um you went through it rather quickly?

Can you describe what the relationship is with CPS that you mentioned?

Yeah, so so there's an internship program, CPS funded.

Um it's really really neat.

Um so we've taken the seniors um into uh our rotations.

So so we we offer up rotation spots for their students and then they'll place the students into those rotations for us.

And they actually think it's a six-week program after the school year ends, so early summer, uh, and they actually pay them for the six weeks to come uh and do the rotations with us.

Um so we've set that up now.

We've done two years um this June and then the June before we had a cohort.

Um we're looking to continue to grow that.

Um, and then again, it's the grade school piece in front of that where we're that's really really good news.

And so if you have that in writing somewhere, I would like to really amplify that relationship between CPES and county.

I would like to as you know, uh quite definitely is something I've been pushing since I'd sat down.

Yeah, um, that we have to build what we want, what we need now and into the future, and that begins with really investing in our schools and our school communities to build that.

Absolutely.

Commissioner, would it be okay if I pitched in Nick a little bit?

He's been the heart and soul of of this work recently.

Of course.

Nick, Commissioner, Commissioner Given.

Uh Chief External Affairs Officer for Cook County Health.

I I appreciate Can you hear me?

I appreciate I appreciate you.

Yes, we've been having multiple conversations uh throughout the entire summer with CPS.

We've been talking about uh K through 12, making sure they have exposure to all that we're doing uh within the health system.

As Dr.

McKitis mentioned, we have interns currently all throughout uh our clinics and Stroger and at Provident uh as we currently speak who are CPS interns, and we're looking to expand that.

We will have our doctors, nurses, and those uh who do not have uh an MD behind their name, right?

Uh to make sure they have uh the exposure and experience to see what is happening um and what the possibilities are uh within the health system.

In addition to that, we're just having conversations in general with CPS to see what is possible so we can bridge the from the awareness to actually a career pathway in from multiple fronts.

Uh they're very interested in continuing the conversations with us, and the and those conversations will continue into uh the summer and fall.

So uh Commissioner, I we we we've talked about this in the past, and I'm looking forward to continuing to uh partner with you on this and to keep you uh up to date on what that partnership looks like looks like uh in the months ahead.

We're very excited, and they are too.

Thank you, because you know I have a deep and abiding commitment to young people and to merge um my past life with my new life.

Um, I'm forever a teacher, just advocating for young people to get in position um and to make sure that we understand our role in ensuring that those young people are prepared.

There is absolutely no reason with all of the talent and desire that we have in the city that we cannot be making a more intentional and robust investment in our young people.

Um that is that is just critical.

I think that was the note that we left in the charge, the call to action that we left NACO with is that really all of this is about what we're doing to prepare the next generation.

Um so that's one part of it.

So thank you for that.

When you were talking about reducing um the agency, was that through um offering them positions as as as permanent staff and them taking it or where did how did that work actually?

Yeah, so it's a little bit of both.

Um I'll give it over to Wynn, and I think you've got some numbers, but but really the initial attempt was to convert the agency employees into CCH employees, but there wasn't really there weren't really teeth behind it, right?

So if they said no, they would just continue as agency.

Now win and team have put a kind of demobilization process in place.

If they say no, they get deactivated as agency.

So now there's a little bit of consequence if they don't accept the role, but when do you want to do that?

Dr.

Marquettis is uh 100% correct.

And we and we've really been working through some processes to ensure that we don't have agencies sitting around for months and months at a time when they have the opportunity to join us.

If they don't, we will demobilize them.

So just for some stats, obviously, we've we've we've hired uh converted over 200 uh and fifty agency employees into um CCH staff, and we've also demobilized over 262 agency staff as well.

So that is our commitment to ensure that we are bringing people on board, not giving people a place to just sit.

Okay, thank you.

Sort of like both and all right.

So given the pace of hospital closures across suburban Cook and and even uh within the city of uh in the city, Chicago, should the county begin developing a long-term strategy or safety net preservation strategy, uh working with municipalities or health systems, philanthropy in the state to identify communities at greatest risk before another hospital closes, as you know.

Um I represent the area where um West Suburban uh just closed, and of course I have my eye on um Loreto and um and um uh Commissioner Sky has his eye on on uh Mount Sinai and the West Side electives are just looking at all of that because we know that when those hospitals close, there's an impact that happens to county, right?

And so they're going that's gonna feed into some of those numbers that uh Commissioner Trevor is kind of saying this think you all are being a little too modest about in terms of what we may see in the coming in the coming uh months and years, right?

So, how can we better prepare ourselves to be more proactive and less reactive when we see what is happening to uh safety net hospitals across the country and specifically in Cook County?

Yeah, I think um you know there have been a lot of conversations with the state.

Um at the end of the day, it's really their kind of coordination and leadership that we need to follow in terms of you know, we as a health system can't go to local health systems and tell them how to operate.

Um the state is stepping in um in that regard at this point.

We have been part of some of those conversations.

Um I'm interested in what the state is is proposing.

I'm also interested in, you know, what I'm saying is is the time for us to kind of create like a a task force, a uh something that's looking at hospitals and various communities, safety net hospitals in various communities that are going to be vulnerable that are vulnerable, right?

Because I think we have enough uh information right now to kind of see the the potential setup and the and so how can again how can we just be more proactive and less reactive because we know ultimately us being able to support them is gonna help us because whoever is when those hospitals close, they're gonna head straight to county, absolutely or they're gonna hear straight to Provident, and that's gonna increase the burden that we're already carrying because we believe that health care is a human right.

Right.

So based on our mission, we're gonna have a heavier lift.

So I'm just I'm just you know, kind of throwing it out there that how can we look at this early?

Yeah, I think two things.

So one of the early things, right, is protecting Medicaid as much as possible, getting our safety nets engaged so that they are engaging their employees or their employees, their their patients around ensuring they're informed, ensuring they don't lose their Medicaid coverage unnecessarily.

Um the other pieces through our health plan, we've already been supporting, we continue to support um essentially the entire well the county safety net ecosystem um through prospective payments, it helps um the hospitals with cash flow.

Uh, and then uh we have on occasion done quality advancements um when we know that someone is struggling, there have been you know payroll issues and those types of things, so we do uh what we can to make sure that they can bridge the gap.

That's obviously not a fix um to the question, but uh it is something that we have been doing for quite some time.

Um again, I think our role has been in partnership with the state under their leadership, right?

But that we have kind of taken um a bit of a more proactive discussion around the education and awareness piece around Medicaid.

And I think right now our main focus has been how do we protect Medicaid given all of these things that are about to happen.

Okay.

Thank you.

Before I go to commission, just to follow up, and you might have answered the commissioner.

The these institutions are closed.

They're closed.

Are we have we reached out to the staff?

Yeah.

See if we could bring any over.

So we have.

Um we in fact uh worked with our employment plan team to create an emergency hiring process that it basically allows any affected employees from outside organizations to go into the accelerated hiring process, which is what Wynne was uh talking about earlier.

Unfortunately, during the outreach, we haven't really gotten responses or any type of contact to allow us to connect with those employees who have lost their employees.

Well, yeah, we need to beef that up because um West Suburban um employed over 700 employees, and whereas um doctors and nurses may be able to go on to other hospitals.

We need those people who may not be doctors and nurses, but they may be orderlies, they may be the people in the kitchen, they may be, you know, many and many of those people who are not in um the medical field are also residents of my district, right?

So they not only work at the hospital, they live in the community.

And so it's coming because you said they are West Suburban.

There no, West Suburban is not coming back.

I like you know, they're promising okay.

July is almost over, they say it in July.

Um July is we're at the more than halfway point for July.

Um, and there has not been any good report that I've heard uh recently, it's likely that it will not.

Um so anyway, uh I don't I don't know about this expedited hiring, but I do know quite a few um agencies within um the first district that may be fielding some of those people who are looking for work, and so if there is an opportunity for these um people to apply, I would I would welcome that information to share out of post and using my using my network, of course, and then to share that throughout my district.

Yeah, so so we have reached out.

I we I we would love to partner if if there's um a willingness, a job fair, something um to to try to get that out there if you know.

Yeah, I'm gonna tell you about me in job fairs.

Let me just be real clear.

I'm just you know, because I'm a woman of a certain age, and um so I just say things people who are going to job fairs are do it.

We're gonna attend to the obvious here.

They're looking for a job.

If our intention is not that, then we need to call, we need to do something else about how we're describing these opportunities because you all are in your offices making great things happen, and we thank you.

But I'm sitting in my office, or my staff is sitting in their office, and we're getting calls after calls of our neighbors, our constituents looking for work, seeing the um the flyers and the advertisements and believing, you know, that at the other end of that is a real possibility.

So we need to be sowing seeds of real possibility here when we're talking about these job fairs.

If it's about exposure, then we need to be deliberate and clear about that.

But if it's about real hiring, because what I'm seeing is you know what I'm hearing, and probably many of my other uh commissioners are folks saying, hey, I I saw this flyer and I went down, I got, but nobody talked to me, or this thing didn't happen, or that thing didn't happen.

And it's it's hurtful and it's hurtful for for a couple of reasons.

A, because it's I'm seeing the hurt in that woman's eyes as needing a job that has to put food on the table for her family.

And then also I'm I work for Cook County.

I represent Cook County.

Uh the entities that I put my that I'm attached to are important to me.

I protect them.

I advocate, I stand up for them.

And so it's hurtful when I feel like my hands are tied, or there's not more that I can offer that's going to bring real solace to the people that have elected me to serve them.

And so that's that's all I'm saying.

I'm not saying that it's you know not to have it.

What I am saying is that we have to be clear and honest and transparent about what is available or what is the purpose when we are doing these, and and and everybody in this room knows it's not just about you, it's not just about it's about every entity that has these job bears.

That when I ask how many people got hired, it's a handful, or it's and then when I say, Well, what are our vacancies?

It's in the hundreds.

I you know, I'm not a math teacher, so I won't do that part.

But I did teach language arts for a very long time.

So I'm just saying, how are we communicating in a way that makes us remain favorable and make us you know, is and that we're as good as our promise.

Right?

Because I just had this conversation and I had it last month or the month before last with Dart's office, and it's the same thing.

People are coming looking for work.

We're saying that we have available work, but when I ask how many people are getting hired, getting interviewed, it's it's single digits or scarcely double digits, but we got triple digit vacancies.

So I need it to make sense, and I need it to be intentional and purposeful and and real for for these um from my neighbors who are pouring out really looking for work.

Yeah, no, that's yeah, that's fair.

I think when some more to come, and I'd love to connect with you about ways in which we can work together uh on that front.

That is one of the top priorities right now is making sure everyone is aware uh from an HR1 perspective and from uh city colleges and community colleges standpoint throughout this summer.

We have been focusing very much when it comes to all of our community colleges.

So uh would love to connect with you on that front.

That's been our top priority when it comes to uh making sure that students are involved uh with our health system as well.

Would love to connect with you on that too.

We've had some preliminary conversations.

We of course, throughout the board, can do even more, and so ways in which we can collaborate, let's do it.

Absolutely.

I appreciate that, Ned.

Thank you.

And then lastly, with regard to Blue Island.

So in Blue Island, you know, we're kind of busting at the seams.

Um we have a parking shortage, we have a lot going on there.

Um if we could just kind of reimagine, and you don't have to address it now, but just kind of put it on your radar that at some point Blue Island needs to be expanded.

I don't know how, especially with all of the cuts, but I do know that some of our South Suburban hospitals have changed um ownership, and it is going to impact if it hasn't already.

If you've not seen an uptick, you can expect to see one.

We already preparing for Nick was at a meeting with me.

Um, so we see that the change is actually occurring as we speak.

Um, but I don't know that um Blue Island is gonna be able to handle what's to come.

So just kind of keep that on your radar.

No, I appreciate that flag.

We have a lot of services there in a very small space, and parking is a challenge.

We have brought on ballet services there, which has been helpful, but it's you know, to your point, it's still we're we're very we're very tight there.

So yeah.

Thank you, Chair.

Um, first I just want to say how grateful I am because I have had several conversations with multiple staff across CCH, and everybody has been so um informative and answers very quickly.

Um, and I also want to echo uh what some of my colleagues have already said, um encouraging a reduction in agency hiring.

Um not only do we know it's cost effective, but it's also I believe morally the right thing to do to make sure that whoever we employ has a pathway out of poverty, and we know that unions have historically been a pathway out of poverty.

Um wanted to uh very briefly also say that um the partnership that you all have with CPS is fantastic.

Um I know we have high school seniors that have participated in it, uh specifically from SHERS in my district, and it's lovely to see kids going to school in my district, working at the Belmont Craig and Health Center through the externship, learning, and I I love it, and it's it's fantastic.

So, first I just wanted to thank you so much for for that partnership and to tell you how how great it's been.

And I don't know if you want to jump in on that.

I I appreciate you so much mentioning that commissioner.

I was at their graduation about a month, month and a half ago.

The powerful stories that they told, the fact that I think they've been going through the program for a number of years now, right?

And um the impact that it's had on their lives and the pathway for them to have a job coming out of high school.

Um it's it's it's uh it was just so heartwarming in the moment, right?

So uh we are very excited about that program, and we've been talking um internally about ways in which we can expand that beyond Shures and some of our uh other CPS locations.

Uh Commissioner McCasco to your point, trying to figure out ways in which we can expand that to suburban cook, right?

Uh what that means.

It looks like we just need more time as well as building out what we current what currently exists with CPS, but these are all a part of our conversations that will take place over the next 18 months.

Absolutely.

Thank you, Commissioners, for that.

Yeah, um and then going back to HR1, um, and I apologize if this has already been addressed, but um in the presentation, there's um, and it's really helpful, uh, but there's two groups, right?

There's the folks that will no longer qualify for Medicaid, and then there's the groups of non-citizens that will still qualify, and under that group we have Cuban and Haitian immigrants listed.

Is that a reference to TPS or what is that in reference to?

Not sure actually.

Do we know how if it's helpful to know um it is one slide?

Two, three, four, five, six.

The seventh slide in the deck.

And the reason why I'm asking is because TPS has been under intense scrutiny and threats of you know uh removal of the status, specifically for our Haitian community.

Okay.

Sorry, Commissioner, just give us one second.

Um, yeah, so specific to Cuban and Haitian, I'm not sure we'll have to get back to you.

Um is that are are you referred?

Is it being included in the excluded population?

Or is that so it's actually listed under these groups of non-citizens will still qualify for Medicaid.

Okay.

Which would be great.

Um I would love for that to continue.

But I, as I was telling my colleague here, Haitians in particular have been um under attack um and removal of TPS would certainly put them in the other category, which is they would no longer qualify.

So I'm just curious um because if if this is a mistake, then we unfortunately are in for even worse.

There'll be more losses.

Right.

Yeah, so let us confirm that.

Um I think for now they're still defined as eligible.

Um right now it has been it's essentially uh domestic violence and then the qualified um um asylum seekers that they've redefined.

And we actually learned that um the majority of the asylum seekers are actually uh from Ukraine that are gonna be affected affected uh in terms of lost coverage.

Um but those are the two main areas.

Uh we'll confirm the the the Haitian and Cuban piece though for you.

Okay, and I would just say, you know, um, in addition to Cuban and Haitian, if this is in reference to TPS, there are various other you know ethnic groups that qualify for that.

Um I know Haitians in particular are a very large group that have been able to qualify for that lately.

Um but understanding what that is in reference to would be really helpful so that we know the the actual impact that could be coming down the road.

Um and then because I'm always the last to ask due to seniority.

I want to thank all of my colleagues for asking so many great questions.

Um really that's it from me.

Thank you.

Thank you, Commissioner.

And you're be sick going to six six up next next time.

Yeah, so all of you Eric, let me thank you and your entire team for the executive work you do on a daily basis.

It's on the pro the quality of care that we provide is and I commend you.

Domestic violence was brought up, and as you know, there was a reputation.

Individuals who come in to that are any of our facilities who are victims of domestic violence.

Do we work with groups to help place them and leave the facility?

Absolutely, yeah.

We've we've our care coordination team um works to identify resources and get people plugged in with whatever their needs may be.

And I know you're facing a difficult circuit with uh everything.

Not only from the Fed, from the state.

Um and uh so we look forward to seeing you in October.

Thank you very much, Chairman.

Maybe we have better news, but yeah, you know we can we can still hope.

Yes.

Uh thank you, Commissioners, and thank you to the C C H team.