Alex Reagan, a representative of the New York State Association of Counties (NYSAC), told the Tompkins Intergovernmental Relations Committee on Aug. 6 that the federal reconciliation bill under consideration will reduce federal funding for Medicaid and SNAP and is likely to shift substantial costs to New York state and county governments.
Reagan said the package includes what he called “over $1,000,000,000,000 in federal funding cuts over the next decade,” with Medicaid and SNAP identified as the biggest drivers of county fiscal pressure. He told the committee the timeline means many of the most severe cost shifts will take effect in 2027 and 2028.
The potential local impacts are concrete, Reagan said. He estimated that New York could see as many as 1,500,000 residents lose health insurance because of changes tied to Medicaid, and he cited a Congressional Budget Office estimate that about 5,000,000 people nationally could lose Medicaid coverage under expanded work requirements and related changes. Reagan also said New York’s exposure includes provider tax credit reductions and cuts to the state’s Essential Plan funding.
For Tompkins County specifically, Reagan told the committee officials expect an annual administrative cost increase for SNAP of about $500,000 when the federal share for SNAP administrative costs falls from 50% to 25% (effective fiscal year 2027). He also said New York’s current SNAP error rate would trigger a high penalty tier under the proposed rules and that Tompkins County could face roughly $2,700,000 in annual costs tied to benefit‑error penalties. Taken together, Reagan said, the county’s SNAP exposure could be about $3,200,000 annually.
Reagan described three Medicaid impacts: the reinstatement of work requirements taking effect in January 2027, changes to health care provider tax credits starting with a freeze in 2028 and phased reductions thereafter, and reductions in federal support for New York’s Essential Plan. He said the provider tax changes could lead to as much as $2.5 billion in lost annual federal matching funds for New York and that rural hospitals and rural communities could be particularly hard‑hit.
County administration representative Bridget Nugent, who briefed the committee earlier on the county budget, reminded members that Tompkins County is already planning around an $11,000,000 maintenance‑of‑effort budget shortfall. Nugent said county staff are “busy working on the budget” and reviewing departmental expenditures and projected revenues to prepare a proposed budget.
Reagan cautioned that it remains unclear how the state will allocate these new costs between state and local government. “NYAC will advocate for making this a state responsibility and a state cost,” he said, but he added the state’s capacity to absorb administrative burdens is uncertain and that counties also “do not have the capacity” to absorb large new administrative responsibilities without additional funding.
The committee asked several follow‑up questions about who will administer new eligibility and work‑verification paperwork; Reagan said that assignment has not been finalized and that NYSAC will press the state to assume responsibility. He urged county officials to begin scenario planning now, listing options that include cutting services, delaying capital projects, seeking efficiency savings, or increasing local revenues.
The NYSAC presentation also noted federal uncertainty beyond Medicaid and SNAP: the federal government’s continuing resolution funding expires Sept. 30, Reagan said, and other federal program cuts (including to EPA funding) remain possible. He closed by saying NYSAC will provide guidance as details solidify and will continue to monitor policy updates.
The committee took no formal votes on fiscal policy at the meeting; members received the report and asked staff to factor the new federal timing and cost projections into upcoming budget planning.