Cook County Board President Toni Preckwinkle publicly unveiled her $10.1 billion 2026 budget Thursday, a slight increase from last year’s proposal that also girds against potential federal cuts and a pending lawsuit that could upend how the county funds its public safety offices.
Sticking with a now yearslong trend, Preckwinkle’s proposal does not include any new taxes, fines or fees, and eliminates a projected $211 million shortfall thanks in large part to better-than-expected revenues.
While she said the county is well-suited for now, federal cuts are sure to eventually hit Cook County Health, which runs a Medicaid managed care program and hospitals and clinics that treat patients regardless of their ability to pay. Expanded federal support for safety net hospitals and insurance coverage have brought the county’s hospital system into the black over the last decade, but the tides could be turning, Preckwinkle and CCH leadership warned.
In her budget speech, Preckwinkle took several shots at President Donald Trump. She said his immigration raids, efforts to cut Medicaid and other local grants and sow misinformation about crime locally “threaten the safety, security, and stability of millions of Americans, including the residents of Cook County” and stoke fear “for political gain.”
“We see federal overreach and neglect,” Preckwinkle said. “Shutdowns that grind services to a halt, troops deployed into our cities as if our neighborhoods were battlefields and ICE raids that tear families apart. This is not leadership. Let’s call it what it really is. Intimidation masquerading as strength. Cruelty disguised as policy. And a shameful time in American history.”
Preckwinkle was blunt in a briefing with reporters Wednesday afternoon. “We’re headed into pretty tough waters here, turmoil,” she said.
“And I would anticipate that in the out-years — next year’s (budget) and particularly in the years after next — we’re going to be in a very difficult place as the federal government reduces its support for healthcare. We’re in a good place at the moment, but there’s a lot of turbulence in front of us.”
The county is projecting a nearly $300 million deficit in 2027 and $402.2 million in 2028.
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The political stakes are high as well: this budget is Preckwinkle’s last before the March primary election. She so far faces downtown Ald. Brendan Reilly in the Democratic contest, where she is bidding for a fifth term as board president.
In his early campaign interviews, Reilly criticized the growth of the county’s bottom line under Preckwinkle, arguing county taxpayers have little to show for that additional spending. Preckwinkle’s team acknowledged the county’s overall budget doubled over the past decade, but noted it’s largely owed to the explosion of CountyCare, boosted capital spending on infrastructure projects, and an infusion of federal pandemic relief money.
Reilly has also suggested Preckwinkle shortchanged public safety offices, including the sheriff and state’s attorney. She directly addressed both in her address, noting that since 2016, the combined budgets of public safety offices have grown from about $1 billion dollars to nearly $1.8 billion. $300 million of that increase went to the sheriff, while the state’s attorney’s office saw its budget double.
Even so, Preckwinkle said the proposal was short of what State’s Attorney Eileen O’Neill Burke requested. O’Neill Burke had asked for a 40% boost compared to this year’s budget, requesting just over 380 additional staff. The office, she has argued, was still short of the attorneys it needed to handle heavy workloads and had a “glaring lack of forensic capability.”Preckwinkle recommended instead a 10% boost and 80 new employees. The office already had 96 vacancies to fill.
“In our view, that meets her needs,” Preckwinkle said in an interview with the Tribune’s editorial board. “Nobody else is getting a 10% increase in their staff.”
O’Neill Burke spokesman Matt McGrath said the office’s initial request “addressed the most pressing needs of the office, particularly personnel, a case management system, and enhanced digital forensic capability, which will help us build on the momentum of the past year in driving down violent crime by holding violent offenders accountable and getting guns off the street,” but said the process with the president and budget office had so far been collaborative.
The office’s goal is to reach that 382 figure over the next three years and to still push for the new case management system, he added. “The work of rebuilding this office will take time, and we are grateful for the positive first step this budget represents.”
Chief Judge Timothy Evans was also dissatisfied with Preckwinkle’s initial proposal, she said. The office, which is in the process of fully taking on the county’s electronic monitoring program, requested 220 positions. Preckwinkle recommended 160 and noted they still had roughly 200 vacancies to fill.
Sheriff Tom Dart, whose office is shedding the electronic monitoring program, will see nearly 260 position cuts. Officers that were working on electronic monitoring will be moved over to corrections, Preckwinkle said.
Unlike the city, the county has built up its rainy day funds and received boosts from ratings agencies that lower its borrowing costs. Now, Preckwinkle is proposing tapping those reserves to help weather this year’s minor budgetary storm and prepare for the future.
The county amassed a roughly $1.8 billion reserve by the end of 2024, according to its annual financial reports and Wednesday’s briefing.
Eight hundred forty-two million of that pot was “assigned,” or set aside to cover a range of emergencies and long-term projects: $200 million for pension contributions, about $159 million to keep paying for programs initially launched with federal pandemic relief money, $124 million for other equity programming, $80 million for infrastructure and equipment, $65 million for other disasters, and $108 million for other special projects.That still leaves $958 million in “unassigned” reserve dollars. Preckwinkle proposes taking about $55 million of that balance and moving it over to the “assigned” pension and infrastructure reserves and using another $65 million to create a “grant risk mitigation fund” in case the Trump administration claws back federal grants.
The county is expecting to receive about $316 million in federal grants in 2026 and will tap that mitigation fund if the Trump administration claws back grants “considered essential to County operations,” according to a Preckwinkle administration budget presentation.
Seventy-six million would move over to the self-insurance fund that the county uses to pay for medical malpractice and civil lawsuits, workers compensation, and certain employee healthcare claims.But the biggest draw — $197.6 million — would be pulled out to help contend with the aftermath of a lawsuit brought by Illinois Roadbuilders. In a protracted legal back-and-forth, the roadbuilders have alleged the county improperly spent money that should have been reserved for transportation projects, a violation of the state’s “transportation lockbox” constitutional amendment.
The county spent some of that money on public safety offices, including the sheriff, arguing they enforced and detained people for violating the rules of the road. Attorneys made their final arguments in that case late last month, and a final verdict is expected in the coming weeks.
“We don’t know yet for sure what the outcome of the litigation is going to be,” Chief Financial Officer Tanya Anthony said Wednesday. $189 million of that $197 million transfer is being set aside for that verdict. “So we are preparing to be able to plug those public safety expenses with this funding, which will also give us time to prepare for a more long term, sustainable solution for fiscal year ‘27 and beyond.”
Even after those transfers, the county still expects to have a $1.4 billion fund balance at the end of 2026, according to the county’s Bureau of Finance.
With the cuts to Medicaid, Cook County Health CEO Dr. Erik Mikaitis said he anticipates the cost of caring for patients without insurance or who don’t pay their bills to rise back to pre-pandemic levels for CCH, which already provides the biggest share of charity care of any local hospital. The system provided $398 million in that care in 2018, which fell to $134 million in 2022 and $156 million in 2023. CCH is projecting those costs to rise to $380 million next year.
Mikaitis noted other safety net hospitals are already struggling or on the brink of closure, which could send more patients their way.
Between federal uncertainty over payments to “disproportionate share hospitals” that serve low-income patients, new work requirements and re-enrollment for Medicaid participants, and an unclear future for the state’s health benefits For immigrant seniors program, there’s a “real possibility that by the end of 2027 we’ll have experienced north of $400 million hit to the bottom line, just in the health care space,” Mikaitis said.
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Budget hearings on Preckwinkle’s proposal kick off Oct. 27, and a final vote is tentatively scheduled for Nov. 20.