The Cook County Board of Commissioners on Thursday unanimously approved a roughly $9 billion budget for next year, including a new $100 million fund earmarked for “disaster response and recovery.”

About $70 million in that fund would be set aside to provide medical care for the thousands of migrants arriving. That’s in addition to money already budgeted next year to treat this population, budget documents show. About $20 million would flow to suburbs to help cover costs related to providing services for migrants, and about $10 million would be used to help communities with other disaster response and recovery efforts, such as record-setting rainstorms that have inundated many residents’ homes.

The move comes as the county faces “an exceptional year” for disasters, said Ted Berger, executive director for the county’s emergency management and regional security department. The county managed responses to four different major disasters, from the COVID-19 pandemic to migrants arriving, to overwhelming rain and flash flooding over the summer and fall.

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Managing the disasters “comes certainly at a significant cost,” Berger said, adding that the county’s most vulnerable residents are disproportionately affected by disasters and disproportionately at risk.

During a board meeting on Thursday, some commissioners said they were surprised to learn the county didn’t have a fund that could be immediately tapped when the county, state or federal government declares a disaster.

Commissioner Tara Stamps recalled how residents in her West Side district “survived” during flooding this year.

“I had to fish out a double amputee out of the basement where there was nine inches of water,” Stamps said. “Rooms filled with hundreds of Black elderly men and women showed up whose basements had been uninhabitable. … There was no money and there were no resources and there was no help.”

She said she’s glad the county is being proactive.

Commissioner Bridget Gainer, who represents residents on the North Side, emphasized transparency to make sure commissioners understand and have a say in how the county would allocate money to suburban governments in particular.

“We want to make sure that we’re not circumventing the normal checks and balances because we think something is an emergency,” Gainer said. “This is an unprecedented move to set aside $100 million.”

State law allows County Board President Toni Preckwinkle to declare a disaster and spend money to respond to it for up to seven days — without going to commissioners, Berger told the board. If Preckwinkle wants to extend the declaration, she needs commissioners’ approval. Tanya Anthony, the county’s chief financial officer, said commissioners would receive quarterly reports on how the money is spent.

In an interview ahead of the budget vote, Berger said the county can recoup costs when the federal government declares a disaster, but even then the feds don’t always fully reimburse the county for what it spends. And the process can be slow, with much-needed money trickling in.

Sometimes, the county doesn’t qualify for reimbursement. Take the flash flooding in July that soaked basements in Cicero, Berwyn and the West Side of Chicago, for example. Schools took on water, flooded roadways were blocked, and workers in suburban communities racked up overtime collecting wet carpet, furniture and other items residents left on their curbs to pick up, Berger said. Managing all of that was expensive, he said.

“Unfortunately, our communities had to bear all of those costs on their own with no additional cost recovery or financial support,” Berger said.

But now, he said, they might have access to faster help through the $100 million fund, which would be paid for with reserves. The county is still working on the details for how suburban governments would request money from the fund. Berger added that the proposed aid also recognizes how much climate change is impacting the region currently and going forward.

This special set aside was a last-minute add to the proposed budget. So was spending $1 million next year for Cook County Health, the county’s network of hospitals and clinics, to bring on doulas to support pregnant patients.

The goal is to help reduce deaths especially among Black pregnant people. In Illinois they are nearly twice as likely to die from any pregnancy-related condition and almost three times as likely to die from pregnancy-related medical conditions, such as having a heart issue, compared to white women, according to a recent state report.

“They say it takes a village to raise a child,” local OB-GYN Dr. Nicole Williams said during the board meeting in support of doulas. “I believe it takes a village to birth a child as well.”

She pointed to research showing that doulas help women be less dependent on pain medication during labor, deliver their babies faster and have fewer interventions, such as C-sections.

Also next year, Preckwinkle plans to tap about $166 million in reserves to continue some programs the county created with federal pandemic relief dollars after that lifeline runs out in a few years.

She’s expecting to potentially pay more in health care costs as more than 20,000 migrants and asylum seekers mostly from south and central America have arrived in the last year. Cook County Health is one of the biggest public health systems in the nation and is the main health care provider for migrants.

Preckwinkle’s other big goals include pouring another $70 million into the county’s Equity Fund, boosting access to mental health and substance use treatment, expanding the use of body cameras among law enforcement officers to increase accountability, and absorbing an immigration unit that’s now funded by grant dollars.

There are no new taxes, fees or hikes of any kind — nor layoffs of county employees — on the table in 2024. The budget takes effect on Dec. 1.

Kristen Schorsch covers public health and Cook County for WBEZ. Follow her @kschorsch.