Years of Fiscal Discipline Allow Cook County to Absorb $550 Million Gap Without New Taxes

FY2027 budget protects essential services while making tough choices to strengthen Cook County’s finances for challenges ahead

COOK COUNTY, IL — Cook County Board President Toni Preckwinkle on Thursday unveiled a proposed $9.69 billion Executive Budget Recommendation for Fiscal Year 2027 without layoffs, tax increases or cuts to essential services. This balanced budget includes billions of dollars in public health and public safety funding while closing a $550 million budget gap at no additional cost to taxpayers.

"This $9.69 billion budget is balanced without raising taxes on residents," Preckwinkle said. "That's no accident. For 15 years, we've made the disciplined choices that put Cook County on solid ground: strategic investments, stronger reserves, stabilized pensions and multiple credit rating upgrades. That foundation is what allowed us to weather extraordinary external pressures this year, including a court ruling that froze hundreds of millions of dollars in transportation revenue and deep cuts in federal health care funding from the Trump administration."

Cook County has received six bond rating upgrades in the last five years, significantly increased pension funding from 56% to 66%, built up its reserve funds and developed hundreds of millions of dollars in public safety, health and economic development programs.

This year, the County has been experiencing significant external pressures that required careful planning and difficult decisions. The preliminary budget forecast released in June projected a budget gap of $550.7 million across the County’s General and Health Funds in FY2027.

Absent a court-ordered restriction on the use of $258 million in tax revenue and an expected $138 million fallout from federal changes in the One Big Beautiful Bill Act (OBBBA) impacting the hospital system, the FY2027 gap would have been a significantly smaller $154.6 million.  

"We've done budgeting the right way: following best practices, spending responsibly, paying down legacy obligations and planning ahead," Preckwinkle said. "But no county is immune to outside forces, such as court rulings or cruel policies by the Trump administration. This budget closes next year's gap and, through tough choices and strategic investments, protects the progress we've made and the County's long-term financial health.”

The County was able to close the $550 million projected budget gap through a combination of using reserves ($18 million), smart investing ($88 million), asking departments and separately elected officials to do more with less ($35 million in spending cuts) and taking a stricter approach to vacancies ($46 million), while addressing the fiscal pressure of rising employee healthcare costs since June (-$5 million). That strategy has resulted in a balanced budget without raising taxes.

To support core operations this year, the County is utilizing higher-than-expected revenues of $93 million and funding that had been committed to ARPA Sustainability programs in FY28 and beyond. Programmatic funding will continue as previously planned next year but will decrease in each following year. In total, $52.6 million will be used for ARPA programs in next year’s budget; $61.2 million will support General Fund operations. 

Additionally, a multi-year effort to reduce Cook County Health expenses closed $174 million of a $214 million hospital system gap through a combination of revenue optimization and cost reductions with the County closing the remaining $40 million deficit with an additional tax allocation.

Hiring will also remain almost entirely flat in the proposed budget from the FY2026 adopted budget. Since President Preckwinkle took office, the County’s employee count has decreased by 8%. The County’s budget department worked closely with bureaus, departments and separately elected officials to identify areas for saving to avoid the need for raising new taxes.  

Public Health & Public Safety Highlights

Healthcare and Public Safety account for 72.7% of the County’s total operating budget. 

Cook County Health (CCH) continues to face financial pressures as uninsured rates reach pre-pandemic levels. CCH is proactively preparing for continued fiscal challenges in subsequent years due to sweeping federal funding cuts. 

To help preserve access to care, the CCH FY2027 budget included 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, CCH would be forced to cut services and lay off employees, limiting access to care for patients in need.

Federal Medicaid eligibility changes are projected to leave approximately 330,000 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 mean markedly less revenue will come into the health system. CCH’s proposed $4.7 billion FY2027 budget is $439 million less than the FY2026 budget.

CCH 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.

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

“Cook County Health has been preparing for the challenges ahead and taking meaningful steps to strengthen our operations, improve efficiency, maximize revenue and manage costs,” said Cook County Health CEO Dr. Erik Mikaitis. “That work has put us in a stronger position, but the massive scale of the federal funding reductions exceeds what we can do from an efficiency perspective alone. We are grateful for the additional support from Cook County government, which will be essential to protecting access to critical health programs, and ensuring the health system can continue to fulfill its mission of providing high-quality, accessible care and services to the people who rely on us.”

Cook County Health delivers a high return on investment. Less than 5% of its budget comes from the county tax allocation and the health system delivers more than 40% of the charity health care to patients in the region. In 2013, the county tax allocation comprised 26% of the health system’s budget.

A total of $1.67 billion, or 60.6%, of the total General Fund expenditure is proposed for the public safety system, an increase of $150 million, or 10%, compared to the adopted FY2026 budget.

Preckwinkle noted that dramatic progress has been made in the public safety space recently. Since the height of the gun violence crisis in 2021, gun homicides in Cook County have fallen by 50%.

“This is proof that our coordinated, sustained investment in communities is working,” Preckwinkle said. “Across the state, county and city, more than $350 million was directed toward community-based violence intervention and prevention efforts, including $110 million from Cook County alone. These funds supported youth development programs, outreach workers and survivor services.”

Budget Materials Available Online

All FY2027 budget information is now posted to the Cook County website, allowing the public to review documents and engage with the President’s Office directly. An interactive budget website is available, providing historic financial data and detailed budget information.

Starting today, residents can also now submit budget questions here.

View the Budget at a Glance document here.

Read President Preckwinkle's full budget address here.

Watch President Preckwinkle's full budget address here.