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Cook County health fund outlook worsens: CountyCare cites utilization surge and federal policy risk
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Summary
County health fund presenters reported a FY25 surplus but warned of a projected $100 million deficit in 2026 driven by higher utilization and membership changes; CountyCare said utilization surged in late 2025 among ACA and immigrant populations, increasing near-term claims costs.
County health fund staff told the Independent Revenue Forecasting Commission they are projecting a substantial swing in the health fund between 2025 and 2026 driven by utilization and pending federal and state policy changes.
"For 2025 we are currently projecting there to be a surplus of about a $166,000,000," Ray, the health fund presenter, said. He added that the county is currently estimating a roughly $100 million deficit for 2026 and emphasized that out-year pressures remain from expected federal policy changes and changes to state eligibility rules.
CountyCare's chief administrative officer, Aaron Galiner, provided color on utilization patterns. "We saw a big surge in utilization in the last 6 months of 2025, particularly in our ACA and immigrant populations," Galiner said. He told commissioners the surge was concentrated in mid-level claims (roughly $1,000 to $10,000) rather than routine primary-care visits, and that some of the behavior appeared driven by members seeking care ahead of anticipated coverage changes.
Staff walked through assumptions behind membership and per-member-per-month (PMPM) revenue scenarios, noting that higher‑rate populations such as MLTSS will be removed from the CountyCare membership beginning in 2027 and that OBRA/OVA provisions and other federal changes could eliminate coverage for some immigrant seniors in mid‑2027. Those membership shifts, combined with assumed state rate increases and provider-payment changes, produced a range of scenarios in which the health fund's out-year deficits vary considerably depending on DISH (disproportionate share hospital) cuts and other state actions.
The presenters also discussed patient-service revenue yields, directed payments, and the potential for DISH reductions. Staff agreed to follow up with commissioners on historical directed-payment data and how directed payments interact with Medicaid revenue to smooth volatility.
CountyCare and staff said they are taking a conservative posture in out-year projections because of uncertainty about state provider-tax changes, FMAP adjustments and the timing of eligibility redeterminations. The commission asked when the state budget might provide additional clarity; staff said some answers could appear in the governor's budget but other items would require more detailed state data.
The commission did not take formal action on health-fund items at the meeting; commissioners requested additional data to refine assumptions at future meetings.
