Board of Commissioners of Cook County
Health & Hospitals Committee
Thursday, September 26, 2019

11:30 AM

Cook County Building, Board Room
118 North Clark Street, Chicago, Illinois

REVISED NOTICE AND AGENDA

There will be a meeting of the Committee or Subcommittee of the Board of Commissioners of Cook
County at the date, time and location listed above to consider the following:
PUBLIC TESTIMONY

Authorization as a public speaker shall only be granted to those individuals who have submitted in writing,
their name, address, subject matter, and organization (if any) to the Secretary 24 hours in advance of the
meeting. Duly authorized public speakers shall be called upon to deliver testimony at a time specified in
the meeting agenda. Authorized public speakers who are not present during the specified time for public
testimony will forfeit their allotted time to speak at the meeting. Public testimony must be germane to a
specific item(s) on the meeting agenda, and the testimony must not exceed three minutes; the Secretary
will keep track of the time and advise when the time for public testimony has expired. Persons authorized
to provide public testimony shall not use vulgar, abusive, or otherwise inappropriate language when
addressing the Board; failure to act appropriately; failure to speak to an item that is germane to the
meeting, or failure to adhere to the time requirements may result in expulsion from the meeting and/or
disqualify the person from providing future testimony.
19-5740
COMMITTEE MINUTES

Approval of the minutes from the meeting of 09/25/2019
19-4310
Sponsored by:
DONNA MILLER, JOHN P. DALEY, BRIDGET DEGNEN, SCOTT R. BRITTON,
DENNIS DEER, KEVIN B. MORRISON, SEAN M. MORRISON, PETER N. SILVESTRI, LARRY
SUFFREDIN, JEFFREY R. TOBOLSKI and ALMA E. ANAYA, Cook County Board of
Commissioners
PROPOSED RESOLUTION
REQUESTING A HEARING OF THE HEALTH AND HOSPITALS COMMITTEE OF THE
COOK COUNTY BOARD OF COMMISSIONERS TO DISCUSS THE PRACTICES OF

Page 1 of 3

 Health & Hospitals Committee

NOTICE AND AGENDA

COOK
COUNTY
HEALTH
(CCH)
RELATED
TO
COUNTYCARE
DISCUSSED IN THE INDEPENDENT INSPECTOR GENERAL REPORT (IIG 18-0100)

September 26, 2019
FINANCES

AS

WHEREAS, in 2012, the State of Illinois obtained a federal Section 1115 demonstration waiver to get an
early start on Medicaid expansion as a result of provisions in the Affordable Care Act, which allowed
adults living in Cook County and making less than roughly $15,860 (or 133% below the federal poverty
level) to get Medicaid; and
WHEREAS, the initiative was named “CountyCare” and was designed to help the state and CCH build
capacity and experience to support implementation of the official Medicaid expansion in January 2014, as
more than 618,000 uninsured adults were estimated to be eligible for the ACA’s Medicaid expansion in
Illinois, with over 341,000 of them residing in Cook County; and
WHEREAS, as part of this initiative CountyCare had to handle management of its waiver from the
Centers for Medicare and Medicaid Services, and needed a third party to evaluate the effectiveness of
the waiver showing that it enrolled enough patients; that those patients were geographically acceptable
enough to encourage providers to participate in the plan; and showing that CountyCare could deliver and
generate enough medically necessary claims processed through the state Medicaid agency; and
WHEREAS, the program is considered crucial to the financial survival of the health system, and to the
county itself, which subsidizes the system with tax dollars; Before CountyCare, the system historically had
been spending $500 million to $600 million a year for uncompensated care; and
WHEREAS, in 2014, CountyCare transformed its health plan to also accept traditional Medicaid
populations and as a result is now one of the largest Medicaid managed health plans in the State;
CountyCare currently has a healthcare network of approximately 4,500 primary care providers, 15,000
specialists, 50 hospitals, and 335,000 Members; and
WHEREAS, on June 21st, 2019, the Office of the Independent Inspector General (OIIG) released a
report on CountyCare Healthcare Expenses (IIG 18-0100), which was prompted after receiving
information during the course of their review of CCH bad debt expense and claim denials; and
WHEREAS, the OIIG report identified key managerial decisions and financial policies associated with
large volumes of unpaid healthcare expenses related to the CountyCare program including outstanding
liabilities of $701 million for the 2018 fiscal year-end compared to the small amounts the State tends to
owe CountyCare at the end of the year and according to the report can only pay 2% of the outstanding
liabilities; and
WHEREAS, according to the report, CountyCare does not generate enough revenue to pay all the
outstanding healthcare expenses at the end of the fiscal year and has a practice of using subsequent
period budgetary funds to pay prior period bills, such that CountyCare's unpaid healthcare expenses are
steadily growing and could become too large to pay without an extraordinary contribution from another
funding source in the future; and

Page 2 of 3

 Health & Hospitals Committee

NOTICE AND AGENDA

September 26, 2019

WHEREAS, the report further states that CCH routinely changes revenue and expense figures between
CCH's operating units (e.g., Stroger, CountyCare, etc.) to reach desired financial goals for CountyCare
and Stroger Hospital in CCH's monthly and annual financial reports, and as a result, these practices make
it difficult for the CCH Board and Cook County Board of Commissioners to have a sound baseline to
evaluate the performance of the individual operating units that make-up CCH; and
WHEREAS, CCH has stated that they are absolutely confident in the integrity of the CountyCare
program and will respond in a comprehensive manner in time; and
WHEREAS, with the FY2020 budget process already started, the time is now to address this report and
provide answers to the Board and the Public;
NOW, THEREFORE, BE IT RESOLVED, that the Cook County Board of Commissioners does
hereby request that a meeting of the Health and Hospitals Committee be convened to discuss the
CountyCare program and financial and reporting practices of Cook County Health as it relates said
program; and
BE IT FURTHER RESOLVED, that the OIIG appear before the Committee and be prepared to
explain its review of CountyCare, CCH, and the five report recommendations; and
BE IT FURTHER RESOLVED, that the Chief Financial Officer and any other pertinent
representatives of Cook County Health, as well as the Independent Hospital Board appear before the
Committee and be prepared to update the Committee on the contents of the OIIG report and the
relationship between CountyCare and CCH, and be prepared to answer questions on the same.
Legislative History :

6/27/19 - Board of Commissioners - refer to the Health & Hospitals Committee

Legislative History :

7/25/19 - Health & Hospitals Committee - recommend for deferral

Secretary
Chairman:
Deer
Vice-Chairman: Arroyo
Members:
Committee of the Whole

Page 3 of 3