Cook County Board President Toni Preckwinkle is proposing a $10 billion budget for next year without a deficit, layoffs or any new taxes, fees or fines.
But she warned of future instability for the county as the federal government threatens to cut health care funding and infrastructure grants.
“We’re in a good place at the moment, but there’s a lot of turbulence in front of us,” Preckwinkle told reporters Wednesday afternoon. “We’re headed into pretty tough waters here, turmoil. … We’re going to be in a very difficult place as the federal government reduces its support for health care.”
Each year, health care makes up roughly half of the county’s budget. For 2026, Preckwinkle projects $5.2 billion will go toward health care, the most of which goes toward Cook County’s Medicaid insurance plan, CountyCare.
But federal funding cuts to Medicaid threaten the county’s stable budget for health care, Preckwinkle said. In response, the budget includes a 10% reduction in expenses to “maintain operations with reduced Medicaid resources.”
Preckwinkle also warned of threats to infrastructure funds given that the Trump administration froze $2.1 billion in funding for Chicago infrastructure projects, including the CTA’s planned Red Line extension.
Federal grants total $315 million in next year’s budget. If any are reduced or eliminated, Preckwinkle’s budget includes a federal grant risk mitigation fund that would help the county cover expenses in 2026 that would have been otherwise covered by federal grants, the county’s chief financial officer, Tanya Anthony, said Wednesday.
“In the event that those grants are reduced and eliminated… the county continues enlisting ourselves to be more prepared,” Anthony said. “However, we know that we can’t completely rely only on our reserves. We need to continue to build budgets with a long-term view, considering future revenue and expense growth.”
Other investments in the budget includes $3 million for a generative AI pilot project to “enhance operational efficiency,” $11.3 million for the construction of modular homes and an additional $15 million to install more solar panels on county facilities. Cook County Health would also expand its mental health services and gastrointestinal care.
Preckwinkle’s proposed 2026 budget is slightly higher than last year’s $9.94 billion budget. For the last decade, the county’s budget has grown by over 8% on average each year.
The county’s staffing levels have also stayed flat over the last 10 years and vacancies remain heading into 2026. As of August, the county has 3,065 vacant positions, with about half belonging to Cook County Health.
Preckwinkle will present her proposed budget Thursday morning. The Cook County Board of Commissioners will hold budget hearings during the last week of October and will vote on a final budget proposal Nov. 20.