CLEVELAND, Ohio -- Cuyahoga County Council is planning to draw down some of its cash reserves to fully fund MetroHealth System's subsidy at $35 million a year -- even though hospital leadership previously said it could survive with less.
The addition accounts for $4.5 million of the $5.5 million council is adding back into the 2026-27 county budget, knocking it out of balance, at least related to Health and Human Services (HHS) Levy spending. The added expense will drive the levy's reserve fund well below the self-imposed minimum council requires.
Council President Dale Miller has suggested the plan stretches the budget "farther than is prudent," but said members prioritized MetroHealth above nearly every other request, "so we did that."
He acknowledged that during prior budget talks, MetroHealth's CEO Dr. Christine Alexander-Rager had told councilmembers that Executive Chris Ronayne's plans to trim their subsidy by $3 million next year and $1.5 million in 2027 would not collapse the system. The dollars were already built into their financial plans, though she'd warned the reduction would require dipping deeper into their cash reserves, potentially putting their county-backed bond at risk.
But Miller and other councilmembers later told cleveland.com and The Plain Dealer that they were persuaded by the broader risks the county's safety-net hospital faces, including rising charity care and federal cuts to Medicaid.
"I think they could have operated with the number that the administration proposed," Miller said. "But we recognized that they're facing a lot of uncertainties in the current landscape and we wanted to help provide them a little bit extra cushion."
In an emailed statement to cleveland.com following the meeting, MetroHealth thanked council for the boost.
"These funds help us deliver healthcare to thousands of county residents who lack the money or insurance to pay for that care," the statement said. "As the healthcare industry navigates significant funding challenges, MetroHealth remains steadfast in our commitment to delivering exceptional care to every patient, regardless of their ability to pay."
Skepticism about MetroHealth's reassurances
Chief among Miller's concerns was a sharp rise in uncompensated care now costing the hospital over $1 million a year. Alexander-Rager previously told council that MetroHealth projected $367 million in charity care costs in 2025 and $446 million in 2026.
Miller worries that number will likely increase because of looming federal changes that could push thousands of low-income residents off Medicaid, which MetroHealth heavily relies on for reimbursements for patient care. MetroHealth will have to make up the difference, he said, further draining revenues and potentially putting them at risk of closing, as some have forecasted.
"It's not like we can single handedly solve Metro's problems, but they are in a difficult situation where every dollar makes a difference," Miller said. "So we reached as far as we could reach and restored their subsidy back to $35 million."
Miller said he also found near-unanimous support among colleagues for the spending.
Councilman Michael Gallagher previously called Ronayne's proposed cuts to MetroHealth "unacceptable" and suggested raising MetroHealth's subsidy to $36 million for the next two years. He drafted a budget amendment to do so, but ultimately withdrew it.
He denied that MetroHealth said it didn't need the money, and said he wanted to add it back after plans for a new Behavioral Health Center in Cleveland forced MetroHealth to close its psychiatric emergency department. Alexander-Rager said the hospital will still provide the same services in its other emergency rooms.
Councilwoman Sunny Simon was equally skeptical that MetroHealth could absorb the cuts without jeopardizing services. She especially worries that rising demand for charity care could outstrip what the hospital has projected.
"I don't know that they've contemplated that fully," Simon told cleveland.com. "I just don't think they're fine."
She also stressed the need for the county to protect itself because it backs the bond for MetroHealth's billion-dollar campus transformation with a $64 million letter of credit -- the value of MetroHealth's annual debt payment. If the hospital ever failed to make its payment, a trustee could draw on the county's credit to cover the bill, though MetroHealth has argued that the county would be made whole eventually.
Little funding left for anything else
The funding for MetroHealth left little room for a dozen other requests that various program leaders have made over the last several weeks, after Ronayne proposed cutting their budgets to help balance the county's budget.
For example, Council did not formally consider restoring funding for the Alcohol, Drug Addiction and Mental Health Services (ADAMHS) Board, which is passing on 20% cuts to the dozens of treatment providers it supports, nor for the men's homeless shelter or board and care of youth in county custody -- among other needs.
Council did, however, squabble over roughly $8 million in funding requests proposed Monday, including $2.4 million that would have helped the county's juvenile court hire more probation officers. Court officials have argued that the added staffing will reduce caseloads, improve outcomes for youth and keep them out of the justice system.
None of those requests were approved. Instead, council added a small amount of funding back to just three other programs, outside of MetroHealth. That money will go to the Canopy Child Advocacy Center, Greater Cleveland Works and the Closing the Achievement Gap program.
"You can have a lot of things but you can't have everything. You have to make choices," Miller told his colleagues at the time.