Cook County officials projected a $550 million budget shortfall for the 2027 fiscal year, warning that expenses are continuing to outpace revenues while federal Medicaid cuts and persistent healthcare costs squeeze CountyCare and the county’s general fund.
By the time Cook County leaders walked through their financial forecast on Wednesday, the message was no longer abstract. For the next budget year. they are staring at a projected $550 million gap—an amount Cook County Board President Toni Preckwinkle called the largest deficit in her 15-year tenure.
Officials said the shortfall would hit even with a foundation they describe as stronger than in the last time the county faced a deficit of that scale. Roughly half of Cook County’s annual budget is a general fund and the other half is a healthcare fund. The general fund shortfall is forecast at about $336 million. while the healthcare fund’s projected shortfall is about $215 million. according to Cook County Bureau of Finance officials who presented Wednesday the county’s financial forecast through next year.
The numbers land against a comparatively brighter finish to the current year. Cook County is expected to end the current fiscal year with a net surplus of about $240 million, including a $283 million surplus in the general fund and a $43 million loss in the healthcare fund.
Cook County’s 2027 fiscal year begins Dec. 1.
“This is going to be a really tough budget year, but we begin it from a position of strength,” Preckwinkle said. She pointed to increased reserves and improved pension funding in recent years, and said the county has received increased bond ratings in the last four years.
Still, she argued that internal management can’t fully absorb outside shocks. Preckwinkle said court decisions, federal policy changes, and rising costs across the economy are driving pressure on the county’s finances.
Healthcare is where the stress is easiest to see.
Federal funding cuts to Medicaid are expected to lead to about a 16% decline in average monthly membership in Cook County’s Medicaid insurance plan. CountyCare. CountyCare officials said that translates to about a $945 million drop in CountyCare revenue for 2027 compared with what the county had expected before the federal Medicaid cuts.
At the same time, healthcare expenses remain high. Cook County officials cited agency and overtime costs as particular concerns, with vacancy rates still “remain higher than desired.” Pharmaceutical costs have also been rising, said Scott Spencer, acting Cook County Health chief financial officer.
Spencer said the county health department is reviewing government contracts and considering “non-labor reductions,” “overtime control,” and systemwide “cost discipline” to help close the healthcare budget hole.
General fund pressures are coming from different sources, but the end result is the same: money that must be found sooner than anyone would like.
Officials said the continued growth of employee payroll and healthcare benefit expenses is a major driver. They also pointed to what they describe as a “restricted use of transportation-related taxes.”
The transportation-tax issue is not theoretical. A Circuit Court judge ruled in January that Cook County misspent $243 million in transportation tax revenue in 2023. violating the state’s Safe Roads Amendment. which passed in 2016 and restricts local governments to spend transportation revenue only on transportation-related projects. like roads. bridges and transit. Budget officials said the restriction created a $258 million structural deficit in the county’s general fund.
Budget forecasters recommended that Cook County evaluate its budget priorities and consider a multi-year framework that “improves fiscal discipline and supports transparent decision making.”
As the county looks toward 2027. Budget Director Kanako Ishida Musselwhite said officials will start with cost-cutting measures to help fill the $550 million gap. She also said county officials are exploring opportunities to leverage the county’s existing assets to diversify and enhance its revenue base.
Preckwinkle stopped short of a pledge either way on taxes, but she made the county’s preference plain. She said the county’s “goal is always to balance the budget without asking more from our taxpayers.”
“We’re going to look at a variety of belt-tightening measures. We always begin with looking at our existing expenditures and trying to figure out how we can be more efficient. ” Preckwinkle said. “We’ve closed billions of dollars in gaps previously over the course of the last 15 years. and turn to revenue generation as the last resort. So, we’re going to be looking at cost savings and efficiency before we consider any new taxes.”.
For residents who will be asked to live with the tradeoffs, the county is scheduling a chance to weigh in. A virtual community feedback meeting about the county’s preliminary budget forecast is scheduled for 5:30 p.m. July 9.
Cook County budget shortfall Cook County Board Toni Preckwinkle CountyCare Medicaid cuts healthcare expenses transportation tax Safe Roads Amendment fiscal forecast Kanako Ishida Musselwhite
So basically they can’t find money for stuff? Wild.
I don’t get how they have a “stronger foundation” but still a 550 million gap… sounds like politics to me. Medicaid cuts and healthcare costs squeeze everyone, but why is this surprise? Like they’ve been paying more for years.
Wait, isn’t Cook County the one that always says they’re “transparent”? So if the gap is coming, why not adjust taxes earlier or cut budgets now. Also Dec 1 start date like that changes anything, they still gonna run out money. I swear it’s always healthcare somehow.
Half general fund and half healthcare fund… okay but Medicaid cuts don’t just “happen” out of nowhere, so who allowed it to get this bad? And they had a surplus this year (but healthcare fund was down), so I’m guessing they’ll just keep shuffling costs into next year. Preckwinkle saying largest deficit in 15 years is crazy, like maybe they should stop relying on bond ratings and actually fix spending. Court decisions and federal policy changes… sure, but the county still has to budget.