Cook County unveiled the preliminary forecast on Wednesday, June 18, for the 2026 fiscal year, showing a projected gap of $211.4 million across the County’s General and Health funds.  

Despite the fiscal pressures and economic instability created by federal actions, this represents a decrease from last year’s $218.2 million gap. The FY2026 gap is also significant drop from the peak of the pandemic and its $409.6 million gap.

The county has seen its bond rating upgraded three times, closed over $1 billion in preliminary gaps since the pandemic, continued to build up its reserves and developed hundreds of millions of dollars in equity fund and pandemic related programs all while putting forward balanced budgets with no increases to taxes on residents. 

Board President Toni Preckwinkle said the county will implement a plan to continue providing pandemic services once federal funds are no longer available by using an ARPA reserve which has been an important step toward sustaining vital programs established during the height of COVID-19. This includes medical debt relief, guaranteed basic income, justice initiatives, violence prevention efforts and environmental projects.

The preliminary forecast report presents a mid-year projection of year-end revenues and expenses for FY2025. The report also presents an initial forecast for FY2026 revenues and expenses for the General Fund and Health Enterprise Fund, the county’s two major operating funds.

For the FY2025 year-end, the county projects positive net results of $145.1 million in the General Fund because of continued national trends of longer hiring timeframes have increased payroll expense savings, while higher-than-anticipated sales tax revenue is being generated by the state closing a loophole on out-of-state sales.

In FY2026, the General Fund is expected to have a budget gap of $102.6 million. Revenues are expected to increase minimally by $78.6 million driven primarily by projected increases in Sales and Personal Property Replacement Tax revenues while expenses are forecasted to increase by $181.2 million due principally to scheduled increases in personnel costs, inflationary impacts and rising health care costs. 

Despite year-end revenues expected to be $61.8 million higher than budgeted, the county’s health system is projecting negative net results of $15 million for the FY2025 year-end, largely driven by the elimination of Illinois’ Health Benefits for Immigrant Adults (HBIA) program.

In FY2026, the Health Enterprise Fund is expected to have a budget gap of $108.8 million. Revenues are expected to decline by $63.5 million due to a significant decrease in Net Patient Service Revenue (NPSR), or reimbursement for medical services, due to a lower patient volume covered by Medicaid and Medicare. This is primarily due to the elimination of HBIA and fewer insured patients resulting from the resumption of Medicaid redetermination. The budget contemplates a $168.8M increase in per-member-per-month revenues for CountyCare members, and a commensurate increase in claims expenses.

Expenses overall are expected to be $45.3 million higher than FY2025 due to cost-of-living adjustments for all Cook County employees and normal salary progression.

Preckwinkle also highlighted the devastating impact proposed cuts to health care could have on the County, denouncing a federal budget proposal that would increase national debt while taking away health insurance for millions of Americans to subsidize tax breaks for the country’s highest earners.

“Ever-shifting federal guidance, threats of drastic funding cuts, impulsive decision-making with vast economic implications and the general unpredictability of this new presidential administration is creating stress for state and local budgets across the country,” Preckwinkle said. 

A virtual public hearing on the preliminary forecast will take place at 6 p.m. on July 16. Residents will have an opportunity to provide testimony and engage directly with the President’s office on their budget priorities. The President’s office will livestream the public hearing.

Beginning June 18, residents can visit the County’s website at www.cookcountyil.gov/Budget to view the preliminary forecast.

Residents will also be able to submit budget questions at www.cookcountyil.gov/service/submit-budget-questions.