Budget includes $40 million in additional County funding to help prevent service reductions and layoffs as federal Medicaid funding cuts increase demand for safety net care.

Cook County Health today introduced its proposed Fiscal Year 2027 budget, outlining the significant financial challenges facing the health system as a result of sweeping federal Medicaid funding cuts while reaffirming its commitment to serving all residents, regardless of their ability to pay or immigration status.

To help preserve access to care, the proposed FY2027 budget includes an additional $40 million in County support to help offset the impact of federal funding cuts, bringing total County support to $208 million. Without this additional funding, Cook County Health will be forced to cut services and lay off employees, limiting access to care for patients in need.

“Medicaid has not faced cuts of this magnitude since its creation more than 60 years ago. As more individuals lose health coverage, Cook County Health will become an even more essential lifeline for Cook County residents,” said Cook County Health Board Chair Raul Garza. “We appreciate Cook County Board President Toni Preckwinkle’s recognition of the extraordinary challenges these federal cuts create and her commitment to helping Cook County Health preserve access to care for the people who depend on us.”

Federal Medicaid eligibility changes are projected to leave approximately 400,000 Illinois residents without Medicaid coverage. Additionally, the expiration of enhanced federal marketplace tax credits resulted in an estimated 92,000 Illinoisans losing marketplace insurance in FY2026.

These federal funding cuts will result in markedly less revenue coming into the health system. Cook County Health’s proposed $4.7 billion FY2027 budget is $439 million less than the FY2026 budget.

Cook County Health projects its uncompensated payer mix will increase to 30% in FY2027, more than doubling from a low of 13% in 2023. Charity care costs are projected to increase by $100 million, reaching an estimated $485 million in FY2027, far exceeding the $257 million in charity care the health system provided in 2013 before statewide implementation of the Affordable Care Act. See additional data in FY2027 budget presentation.

“Cook County Health has spent the last several years preparing for 2027. We have worked diligently to improve efficiency, strengthen operations, optimize revenue, reduce costs, and position Cook County Health to weather these challenges. Those efforts have made a meaningful difference, but they cannot fully offset the magnitude of the federal funding reductions now before us,” said Cook County Health CEO Dr. Erik Mikaitis. “Continued support from the County is critical to help us preserve essential services and continue delivering on our mission to provide accessible, exceptional care for all.”

Since 2024, Cook County Health has eliminated approximately $314 million in expenses through operational improvements, including significant reductions in agency staffing, purchased services, supplies, maintenance, and other costs.

After exhausting internal savings opportunities, Cook County Health has reached the point where additional funding is essential to sustain services.

Without the proposed increase in County funding, Cook County Health will be forced to evaluate significant workforce and service reductions during FY2027, including the possible closure of facilities, reductions in clinical services, elimination of wrap-around programs, workforce reductions, and other measures that would limit access to care for thousands of Cook County residents.

Click here to view the full presentation on the preliminary FY2027 budget.

Public hearings on the proposed FY2027 preliminary budget will be held on Monday, August 10 at 6:00 P.M., and on Thursday, August 13 at 10:00 A.M.

The Cook County Health Finance Committee is expected to consider the preliminary Fy2027 budget at its regular meeting on Friday, August 20. Final consideration is expected at the regular meeting of the Cook County Health Board of Directors on August 28. The health system budget will then be introduced to the Cook County Board of Commissioners in September for inclusion in Cook County’s FY2027 budget.