Cook County forecast: one-time FY26 boost masks larger deficits; health fund steps up reserves

The Independent Revenue Forecasting Commission on Thursday reviewed updated revenue forecasts showing a one‑time lift in FY26 but growing structural deficits from FY27 forward.

Staff told commissioners the FY26 general‑fund projection was revised upward by about $222 million — producing a revised FY26 forecast near $2.9 billion — driven largely by a $115 million cigarette‑settlement payment and stronger‑than‑expected sales‑tax collections. "YTD, we are higher by 7.7%, or 44,900,000 year to date," Michael, the staff analyst leading the general‑fund forecast presentation, said.

The commission’s long‑term forecast, however, shows widening deficits starting in fiscal year 2027. Staff pointed to a recent court ruling that removed transportation fund revenues from the general‑fund comparisons and to state policy changes that reallocate revenues (including PPRT and other adjustments) as contributors to the budget gap. "For the out years, expenses are projected to increase faster than revenue," the staff presentation said.

Why it matters: the upward revision gives the county more one‑time flexibility for FY26, but staff and commissioners emphasized that one‑time receipts do not solve structural mismatches between spending and revenue. Commissioners urged adherence to the county’s fund‑balance policies and earlier engagement with elected officials about long‑term solutions.

Health fund changes and risks

Staff also presented a detailed update on the county27s health fund and CountyCare program. The health fund is now projected to finish 2025 with a surplus of roughly $165 million; staff revised the 2026 projected deficit for health plan services to about $41 million, down from a prior $100 million estimate largely because of continuing appropriations and short‑term cash support.

As part of the FY26 budget resolution, the county established a working cash balance target for CountyCare equal to about 1.5 months of expenses and a separate cash reserve for managed‑care claims. "We have $158,000,000 in reserve that we intend to use over 4 years to sustain a set of those ARPA programs," Lindsey, a staff presenter, said when summarizing ARPA and reserve planning.

Staff also described an "adjusted fund balance" calculation for the health fund (deducting pension and other nonoperating items) that produces an adjusted balance of about $165 million for FY26. Under the policy27s floor/ceiling rules, roughly $15 million would be available to Cook County Health for appropriation in FY27 if officials choose to do so; staff said they had not assumed that availability in the FY27 revenue projections.

Projected CountyCare enrollment declines are a principal long‑run risk. Staff presented three scenarios for CountyCare membership and warned that provisions tied to state policy changes (described in the presentation as OBA/OBAA/OPA provisions) will likely reduce enrollment among ACA adults and dual‑eligible MLTSS populations beginning January 2027. That enrollment loss, staff said, drives a sharp drop in CountyCare revenue in 2027 and reduces average per‑member per‑month revenue (PMPM).

"We're anticipating a pretty large impact CountyCare side here from those provisions," the presenter said. Staff also showed collection‑rate projections for Cook County Health, with a baseline net patient service revenue collection rate of roughly 24% in 2026 declining modestly in out years as the payer mix shifts toward self‑pay and uninsured patients.

Other technical updates

Staff noted several policy and accounting factors that affect the picture: (1) recent state legislation and fee changes have already reduced some county revenue streams (PPRT reallocations, cannabis licensing impacts, and modifications to sheriff process‑server fees); (2) a court ruling changed how transportation revenues are treated in the general‑fund comparisons; and (3) staff revised the DISH (disproportionate share hospital) forecast for 2026 from about $200 million to $236 million based on monthly state payments.

Commissioners asked for additional assumptions documentation — including Moody27s inputs that drive the revenue scenarios — and requested further breakout data to better trace the payer mix and uncompensated care trends.

Procedural actions

Commissioners approved the minutes from the Jan. 28, 2026 meeting by voice vote and later moved to adjourn; both motions were announced as carried by the chair. There were no registered public speakers.

The commission scheduled its next meeting for Thursday, June 25, 2026, at 5:30 p.m.