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NYSAC briefing: Medicaid uncertainty, county infrastructure program and EMS proposals top state budget risks for counties
Summary
Ryan Gregoire of the New York State Association of Counties told Tompkins County officials the governor’s FY2026 executive budget proposes a $252 billion plan but leaves Medicaid and several county priorities exposed to federal changes; NYSAC urged counties to press the congressional delegation and state legislators on funding.
Ryan Gregoire, legislative director for the New York State Association of Counties (NYSAC), gave Tompkins County’s Intergovernmental Relations Committee a detailed overview of Gov. Kathy Hochul’s proposed FY2026 executive budget and what NYSAC sees as the key items affecting counties.
"Medicaid is the single largest program that keeps me up at night. It it scares the death out of me," Gregoire said, explaining the risk that federal changes to Medicaid financing or to reconciliation negotiations in Washington could shift costs to the state and, ultimately, to counties. He told the committee New York receives substantial federal Medicaid funding and that counties together provide roughly $8.5 billion a year toward the state share.
Gregoire described several budget provisions that matter locally: the executive budget totals about $252 billion, and it…
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