Cook County Board of Commissioners Unanimously Approves $10.12 Billion Balanced Budget

COOK COUNTY, IL — Today, the Cook County Board of Commissioners unanimously approved a balanced $10.12 billion FY2026 budget. This thoughtful and balanced budget includes billions of dollars in public health, public safety and economic development funding and continues successful pandemic recovery efforts without layoffs, tax increases or cuts to essential services. The budget passed 17-0, following a month of departmental hearings, briefings and the annual amendment process.

“This budget is Cook County’s response to sweeping cuts and ongoing chaos at the federal level,” said President Preckwinkle. “We’re stepping up and filling the gap for our residents by focusing on critical safety net programs, health, community safety, and economic development. This is an over $10 billion balanced budget that doesn’t increase taxes or cut services. We are keeping taxpayer dollars in taxpayer pockets, and it means the work we have done over the last 15 years is paying off. We’ve been prudent and pragmatic, addressed structural deficits, secured pension stability and bond rating upgrades.” 

Approved Amendments to President’s Recommended Budget 

As part of the final budget process, the Cook County Board of Commissioners also approved a package of amendments totaling $102.7 million: 

• $82.8 million in technical amendments including: 
  • $57.3 millions in Special Purpose Funds, mainly to reflect updated ARPA initiative carry-over 
  • $21.2 million in Restricted Funds to account for updated grant award estimates
  • $5.8 million in capital funds to account for updated carryover estimates 
  • -$1.5 million in the Health Enterprise Fund (HEF) to correct a small over-estimate related to capital project revenues
• $19.9 million to continue the County’s work for the unhoused ($4.1 million), court-supported rental assistance ($5.8 million) and food access ($10.0 million) funded by the additional TIF surplus declared by the City of Chicago. In the event the collection of TIF revenues is not as expected, the County will scale down these investments. 
• FTEs are expected to increase over the executive budget recommendation by 205. 

Budgeting Best Practices  

Preckwinkle added that Cook County has received four bond rating upgrades in the last four years, backed state legislation to fully fund County pensions, built up its reserve funds and developed hundreds of millions of dollars in public safety and health programs, as well as innovative pandemic relief efforts. These accomplishments come while closing more than $1 billion in preliminary budget gaps since 2020. 

“We’ve proven that when government is disciplined, determined and collaborative, we can deliver real results for our communities,” Preckwinkle said. “This has not been easy. The board has made difficult choices and taken hard votes to get here. But, the people of Cook County deserve to have a government they can depend on – where services are reliable and programs enhance the quality of life.” 

The County successfully closed a $211.4 million projected budget gap through a combination of higher-than-expected revenue collections such as sales taxes. The County also decreased expenditures at the hospital by increasing turnover rates to align with actual hiring timeframes and further implementation of a strategic hiring plan. Hiring will also remain relatively flat in the approved budget with a 0.9% increase from the FY2025 adopted budget. Over the past 10 years, the County’s employee count has only increased by 601 or 2.6%. The County’s budget department worked closely with bureaus, departments and separately elected officials to identify areas for saving and structural solutions to avoid the need for raising any new taxes, fines or fees. 

Public Health & Public Safety Highlights 

Healthcare and Public Safety account for 74.2% of the County’s total operating budget. The County Health Fund’s FY2026 budget of $5.14 billion is $2.8 million lower than the FY2025 adopted budget. Cook County Health (CCH) continues to face financial pressures as uninsured rates reach pre-pandemic levels and is proactively preparing for continued fiscal challenges in subsequent years due to sweeping federal funding cuts.  

The FY2026 budget reflects CCH’s ongoing discipline and innovation to sustain essential services by implementing both cost-saving and revenue generating initiatives. Cost efficiency efforts include reducing reliance on contractual staffing in favor of full-time County employees and tightening non-personnel expenses. Agency staffing has been reduced by more than 450 positions, and the health system’s number of net hires has increased more than 80% compared to the year prior, strengthening both financial sustainability and workforce stability. 

CCH serves 300,000 patients annually at its hospitals and community health centers. In the coming year, CCH will advance behavioral health and neuroscience care across the system. Stroger Hospital will also expand oncology, cardiovascular services and increase surgical volume, while Provident Hospital will grow gastrointestinal and women’s health programs. CCH is also embracing technology and value-based care models to enhance patient outcomes and ensure long-term stability. 

CountyCare, which was recently ranked as the highest quality Medicaid managed care plan in Illinois by the National Committee on Quality Assurance, has nearly 400,000 members. In FY26, the health plan will be focused on supporting members in retaining coverage and increasing members’ utilization of CCH’s health care services.  

The FY26 budget includes a $4 million increase in the Cook County Department of Public Health’s budget, and approximately 40 positions to fortify its regional public health services and infrastructure.  

A total of $1.51 billion, or 56.1%, of the total approved General Fund expenditures is for the public safety system. The budget includes $28.6 million dollar (18%) budget increase for the State’s Attorney’s office, $69.5 million (10%) for the Sheriff’s Office and $47.7 million (15%) increase for the Office of the Chief Judge. 

Cook County has invested over $110 million in Community Violence Intervention and other prevention strategies. Cook County Health has invested $44 million in behavioral health services through the Stronger Together initiative. And this summer, Cook County awarded an additional $25 million to support intervention and wraparound services for survivors of gun violence. This fiscal year, the County will invest $20 million in violence prevention. 

Preckwinkle said that much progress has been made in the public safety space recently, noting that over the last four years, almost all types of crime are down.  According to the Medical Examiner’s Office, violent crime, including gun homicides in Cook County have gone down by 55%. 

Long-Term Stability Through Reserves 

With ever-shifting federal guidance, harmful and costly cuts to Medicaid, threats of further slashing of grant funds and a federal administration focused on creating discord and disruption in the region, Preckwinkle noted that her finance team has done a remarkable job building up reserves over the last couple of years. These reserves are a way to prepare for emergencies that include health crises, future litigation, pension stabilization and federal grant cuts. The FY26 budget includes over $320 million to shore up strategic reserves. These reserves ensure that the County can address unexpected future fiscal challenges. The FY26 budget includes $65 million for a grant risk mitigation fund to protect against reckless federal actions that threaten congressionally appropriated funds. 

“We live in a time of great uncertainty and division, but we’ll continue to be a government that is steady and reliable,” said Preckwinkle. “We are stepping up as the Trump administration creates division, weakens the healthcare system in this country, and targets our region with aggressive, inhumane and unlawful actions that jeopardize the safety and stability of our communities. This budget will protect people and invest in a shared future that is fairer, healthier and more resilient for all.” 

Continued Relief Efforts  

Cook County directly received over $1 billion from the federal government through the American Rescue Plan Act (ARPA) in 2021 and has coordinated an extensive process to develop a responsible, comprehensive and equitable spending plan. This means that an overwhelming majority of this once-in-a-lifetime funding will go to programs for residents, not operational costs. 

This includes a program to abolish up to $1 billion of medical debt. Last month, 105,000 letters were mailed out to Cook County residents to notify them that Cook County Government – in partnership with Undue Medical Debt – has forgiven $122 million dollars of their medical debt. That brings the total to $787 million dollars in medical debt forgiven for over 600,000 Cook County residents since the Medical Debt Relief Initiative first began. Hundreds of millions of dollars in additional funding have also been dedicated to health care and health access initiatives, justice initiatives, violence prevention programs, infrastructure improvements and environmental projects. 

Budget Materials Available Online 

All  FY2026 budget information is now posted to the Cook County website, allowing the public to review documents and engage with the President’s Office directly.