Cook County officials project a budget shortfall of approximately $550 million for the upcoming fiscal year. The figures were released during a presentation by Cook County Bureau of Finance officials on Wednesday.
Board President Toni Preckwinkle stated that this projected deficit would be the largest in her 15-year tenure as county board president. Officials noted, however, that while the absolute dollar amount is significant, it represents a smaller portion of the overall budget compared to previous instances when deficits were similarly large.
According to Cook County Bureau of Finance officials who presented the forecast on Wednesday, about half of the county's annual budget consists of a general fund and the other half consists of a healthcare fund. The general fund's shortfall is forecast at approximately $336 million, while the healthcare fund's projected shortfall is about $215 million.
Cook County is expected to end the current fiscal year with a net surplus of about $240 million. Specifically, the general fund projects a $283 million surplus and the healthcare fund projects a $43 million loss for that period.
The county's 2027 fiscal year begins Dec. 1.
"This is going to be a really tough budget year," Preckwinkle said, noting that the county begins from a position of strength due to strengthened reserves and pension funding in recent years. She added that the county has received increased bond ratings over the last four years.
Preckwinkle stated that even strong internal fiscal management cannot shield the county from external events, including court decisions, federal policy changes, and rising costs across the economy.
Federal funding cuts to Medicaid are expected to result in about a 16% decline in average monthly membership for CountyCare, Cook County's Medicaid insurance plan. Officials stated that these projected federal Medicaid cuts equal about a $945 million drop in CountyCare revenue for 2027 compared to what the county had expected prior to the implementation of the cuts.
At the same time, healthcare expenses remain high according to officials presenting the forecast.