Chicago Department of Public Health – BGA Policy 2025 Budget Snapshot

Departmental Highlights

Snapshot: Appropriation & Staffing Changes from 2024 Budget

• CDPH saw some of the largest departmental cuts in budgeted appropriations and headcount, both as a net change and as a percentage of the previous year's budget.
• Expiring and spent pandemic relief funding drove the bulk of the cuts. CDPH's COVID-19 grant and Coronavirus Local Fiscal Recovery funds are down -34.6% and -21.9% respectively, an overall reduction of -$151.7 million from the previous year's budget.
• The largest headcount reductions come from the elimination of clerk, project administration, and social worker positions.
• New programmatic positions include the addition of 20 emergency medical technicians and two EMS supervisors, as well as four community intervention specialists.
• CDPH has no major new appropriations or appropriations increase other than the addition of the new reserve balance category, an appropriation that appears in several departmental budgets and was also applied retroactively to 2024 budget data. Better Government Association has reached out to the Office of Budget and Management for clarification of this appropriation's purpose and has not yet received a reply.
• The next-largest appropriation increase is a new cultural programming grants category, for which only $154,601 was budgeted.
• The largest cuts relate to the department's pass-through and contract spending:
  • Delegate agency spending is down -$27.2 million from the previous year's budget, mostly due to cuts in appropriations from the pandemic relief funds.
  • Professional and technical services saw the largest cut by far, down -$397.8 million from 2024, again primarily driven by cuts in the pandemic relief funds, with significant reductions in appropriations from the federal grants fund as well.
  • While a considerably smaller appropriation overall, the department's matching and supplemental grants appropriation has been almost completely eliminated, down to $29,113 in this year's budget from $820,000 in 2024.
• As of October 28, 2024, when the new ARPA dashboard and associated datasets were made available, CDPH had $142.1 million in allocated ARPA funds, of which $75.5 million (53.1%) had been obligated and $55.5 million (39.1%) had been spent.

Historical Context

As the city's point department for infectious disease response, the Department of Public Health's responsibilities and budget increased dramatically during the COVID-19 pandemic. The CDPH budgets for 2022 and 2023 more than quadrupled the department's pre-pandemic allocation, driven primarily by federal grants.

Prior to the pandemic, the department's budget had averaged a 2011-2020 growth rate of 1.8% per year. Departmental budgets overall increased an average of 1.5% per year over the same time period, while the total city budget including Finance General appropriations grew at an average rate of 4.5% annually.

The department's pre-pandemic budgeted workforce shrank at a rate of roughly -3.8% annually from 2011-2020. Overall budgeted positions for the city remained relatively flat across the same time periods, with minor year-to-year fluctuations averaging out to an overall growth rate of -0.002%.

Staffing

CDPH saw a large increase in budgeted positions in the previous year's budget, up a net 70 positions and FTEs, driven primarily by an increase in budgeted nursing and clinical staff positions.

This year's net headcount reduction of -124 positions and FTEs includes cuts to clinical staff - including the elimination of 24 nurse practitioner, 16 mental health crisis clinician, and 29 public health nurse positions across various titles - but also adds 14 supervising public health nurse and 12 associate mental health crisis clinicians, offsetting some of the the cuts.

Significant new programmatic roles budgeted include 20 emergency medical technicians and two EMS supervisors, as well as four community intervention specialists.

Positions that were entirely eliminated and not directly replaced by retitling include the department's social worker and clerk positions.

Appropriations

A -$129.9 million decrease in appropriations from COVID-19 grand funding and another -$21.8 million from the Coronavirus Local Fiscal Recovery Fund drive the bulk of the decrease in this year's CDPH budget.

Largest Appropriations

The largest CDPH appropriation by far in this year's budget is a $397.4 million "reserve balance" appropriation from the pandemic relief funds and the federal, state, and local grant funds.

This appropriation, which appears in several department's budgets and has been retroactively added to 2024 appropriations data as well, was not used in the previous year's budget at the time of its passage. Better Government Association has reached out to the Office of Budget and Management for clarification of this appropriation's purpose and has not yet received a reply.

Salaries and wages are the next-largest appropriation. Unlike most city departments, however, CDPH budgets more funds for pass-through spending than direct personnel salaries - the delegate agencies appropriation (used for third-party groups providing services on behalf of the city) and professional and technical services appropriation (used for contracted services provided to the city) are the third- and fourth-largest CDPH appropriations, and combined exceed the in-house salaries and wages.

Also unusually for departmental budgets, CDPH has several appropriation accounts specific to a single program or category of programs, including the violence reduction program and reproductive health initiative, both of which also appear in the department's largest appropriations.

Out of the largest 10 appropriations categories, only the new reserve balance category and scheduled salary increases saw a larger appropriation this year than in the 2024 budget. The violence reduction program and reproductive health initiative appropriations remained unchanged, while the other top ten categories saw decreases from their previous year's appropriation.

Change from Previous Year

CDPH has no major new appropriations or appropriations increase other than the addition of the new reserve balance category. The next-largest appropriation increase is a new cultural programming grants category, for which only $154,601 was budgeted.

While still among the department's largest appropriations categories, pass-through spending via delegate agencies and outside contracting via the professional and technical services appropriations both saw significant cuts.

Delegate agency spending is down -$27.2 million from the previous year's budget, mostly due to cuts in appropriations from the pandemic relief funds. Professional and technical services saw the largest cut by far, down -$397.8 million from 2024, again primarily driven by cuts in the pandemic relief funds, with significant reductions in appropriations from the federal grants fund as well.

While a considerably smaller appropriation overall, the department's matching and supplemental grants appropriation has been almost completely eliminated, down to $29,113 in this year's budget from $820,000 in 2024.

ARPA Allocations

The city budget does not typically break down budget appropriations to the programmatic level. However, this year the Office of Budget and Management has made available a new ARPA dashboard and associated datasets that detail the allocations, obligations, and expenditures made towards ARPA-funded programs.

As of October 28, 2024, when the dashboards were made available, CDPH had $142.1 million in allocated ARPA funds, of which $75.5 million (53.1%) had been obligated and $55.5 million (39.1%) had been spent.

Two CDPH program categories, a sobering center and an "essential city services" category, have not received any ARPA allocations.

The COVID-19 vaccinations program has expended nearly all its allocated ARPA funds (98.6%), with the environmental hazard reduction program and community resource navigator programs the next-closest to expending all allocated funds, at 74.3% and 73.6% expended respectively.

ARPA funds must be obligated by December 31, 2024. The city can obligate funds by entering a contract, order for services, or similar award or transaction; by entering into an interagency agreement; by dedicating the funds to certain personnel costs for positions that existed and were filled prior to December 31, 2024; or by using them to cover the legal or administrative costs of ARPA itself.

As of the October 28, 2024 data, the city had allocated roughly $1.9 billion in ARPA funds, of which 91.8%, roughly $1.7 billion, had been obligated.

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