Cook County Board President Toni Preckwinkle has rolled out her annual budget forecast, an early look at the county’s year-end projections for spending and revenue in 2023 and a look ahead at 2024. The expected shortfall heading into next year: $85.6 million.

That anticipated gap — among the lowest during her time in office — represents less than 1% of last year’s total adopted budget. As has been recent tradition, Preckwinkle anticipated the shortfall could be addressed without new taxes, fees or layoffs of county workers.

“We’ve made hard decisions along the way. We raised the sales tax in the summer of 2015 so we could meet our pension obligations. I think of the publicly funded pensions in the state, we’re doing pretty well,” Preckwinkle told reporters during a Wednesday briefing. “We’ve managed, too, to deal with some pretty significant bumps in the road during the pandemic.”

The county is expecting a $214.7 million surplus for the end of 2023, thanks to a one-time boost in personal property replacement tax, or PPRT, revenues from the state and higher-than-expected sales tax receipts, due in part to higher inflation.

The county has also struggled to make a dent in the roughly 4,000 job vacancies it had on the books at the time of the 2023 budget’s passing. The upside is payroll savings.

“We haven’t made much progress” in filling vacancies across county positions, Chief Financial Officer Tanya Anthony said. “We’re seeing some difficulties across the board.”

Preckwinkle said the staffing shortages are among the county’s biggest challenges, but “we’re not unique in this respect. This is what’s happening all across the country, not just in government but in the private sector, too.”

The county’s reliance on contract workers at its hospital system — there are 700 registered nurse vacancies and the county is using 500 agency RNs, a spokeswoman said earlier this month — has led to flare-ups with its unionized workers, who say not filling empty roles with full-time employees has lowered the quality of care.

County health spokeswoman Alex Normington said hiring nursing staff “is a top priority,” and that leadership “closely monitors our staffing and volumes to ensure we are in compliance with the Safe Patient Limits Act.” Cook County Health has held hiring fairs, established an externship program, offers tuition reimbursement for nursing-related programs and is piloting a recruitment and retention bonus program.

Driving the gap next year: an expected dip in PPRT receipts from the state and a pickup in hiring. Fresh off the passage of reforms in Springfield, the county will be making a pension payment that is $22 million higher than in 2023.

Among the unknowns: the cost of a recent rule change involving reimbursements for immigrants enrolled in a state insurance plan, and the ongoing expense of caring for recently arrived asylum-seekers not eligible for insurance.

Gov. J.B. Pritzker is closing enrollment for the state-funded health insurance program for immigrants under 65 and capping enrollment for those 65 and older on July 1. Among other changes to the program to control ballooning costs, Cook County Health is on the hook to “reimburse the State for any excess payment in a method and amount as determined by the Department,” according to a state release. As a public health system, CCH had been paid higher rates than other providers.

Preckwinkle and CCH CEO Israel Rocha said they expect the changes will affect only reimbursements going forward, and that the county will not be required to pay back any of the $328 million it has received in reimbursements since 2020.

“Our staff is meeting with the state on Friday so it’s still a little murky,” Preckwinkle said, and until then the fiscal impact is unclear.

It’s similarly unclear how much the county will get out of a total $42 million state set-aside for asylum-seeker aid included in the recent state budget. This spring, the county requested $8 million for care already delivered between January and June, and $20 million more through the rest of the state’s fiscal year. Cook County officials estimate they spend roughly $1.8 million a month to care for asylum-seekers at CCH’s Northwest Side clinic and at Stroger Hospital, but that varies based on the volume of new arrivals.

Among the brightest spots for this year and next: The vast majority of the county’s planned spending of federal pandemic funding is yet to come. Of the $1 billion in American Rescue Plan Act money Cook County received directly, just $230 million has been spent to date. More than $700 million has been allocated but not yet spent.

“This is a once-in-a-lifetime opportunity to do good work, and I’m proud of the work we’ve begun and we’ll get accomplished before 2026,” Preckwinkle said.

Despite fears about a clawback of unspent ARPA funds earlier this year, county officials confirmed the federal bipartisan budget deal will not affect the county’s allocation. Rather than taking back unspent State and Local Fiscal Recovery Fund dollars — like the $65.1 billion provided directly to counties like Cook — the clawbacks are limited to a number of federal agencies.

Midyear budget hearings will be held next month, and Preckwinkle will release her official budget recommendation in early October, with a final vote by the County Board in November.