Cook County PHHS reports $3.3 million in unrestricted reserves, flags federal funding uncertainty for 2026 budget

Cook County Public Health and Human Services officials told the board on May 20 that the department closed 2024 with an unrestricted fund balance of $3,305,844 and used $518,635 of that balance during the year.

The fiscal summary matters because PHHS must hold a minimum reserve to operate until the first property tax distribution each year; the department cited a 42% reserve target set by the state auditor’s office. Plamen Dimitrov, fiscal supervisor, presented the report and said, “The revenue received was 3% more than the budget.” He added that overall expenditures were “14% more than the budget,” largely driven by increased personnel costs, software licensing and placement costs for adult and children’s mental-health care.

Dimitrov said federal and state reimbursements grew where personnel-related costs were higher (for example, billing tied to wages and related expenses), but some high-cost placements generated little or no reimbursement. He noted that certain mental-health placements can cost thousands per day and that those placements produced no state or federal reimbursement for the county. “One placement even for one person can, in a small county like us, lead to . . . significant cost per day,” he told commissioners.

The board heard department-level breakdowns: social services accounted for 56% of PHHS expenditures, public health 24% and economic assistance 20%. Revenue by source for PHHS in 2024 was reported as 42% federal and state grants and aid, 8% fees and recoveries, less than 3% nongovernmental grants and donations, and 48% county tax.

Dimitrov walked the board through program variances: out-of-home placement costs in children and family services ran at roughly 221% of budget because the number of children placed outside the home rose to 15 in 2024 (versus 8 in 2022 and 14 in 2023). Adult mental-health placement costs included $251,067 in expenditures; children’s mental-health placements were also recorded separately. He said some program revenue is tied to prior-period expense or client counts, which complicates year-to-year comparisons.

Commissioners and staff discussed timing of revenue recognition, how billing cycles and state reimbursement schedules affect reported results, and whether fund balance should be used to reduce levy requests in coming years. Dimitrov explained the department’s approach to monthly reporting and year-end adjustments, noting that staff move expenses and revenues into the proper fiscal year through January–March accounting processes.

Board members asked for additional trend reporting: one commissioner requested a multi-year breakdown by department showing the percent of revenue from levy, state and federal sources. Dimitrov said he would prepare four years of department-level revenue trends for the board to review ahead of the 2026 budget discussion.

Dimitrov and Director Allison (Cook County Public Health and Human Services) told the board the fiscal team recommends limiting or avoiding further use of fund balance in the 2026 budget because of federal and state funding uncertainty. Dimitrov said the board will receive a preliminary budget in July and a fuller presentation in the August/July budget cycle.

Ending: Board members praised the fiscal team’s work; the meeting packet also included a state letter commending the county for timely and accurate fiscal reporting. Commissioners signaled interest in a Committee of the Whole review of the 2026 budget and closer analysis of grant and levy trends by department.