What Federal Policy Is Actually Doing to Tioga County

Why This Matters for NY-23

Tioga County has no hospital, no public transit, and one in four residents over 65. Nearly a quarter of the population depends on Medicaid. The county spends $8.32 million on its Medicaid share — roughly 30% of the property tax levy. When federal policy changes how these programs work, a rural county with no buffer absorbs the impact directly. Understanding what’s actually happening to these systems — not just what’s announced — is essential for residents trying to plan their care, their finances, and their futures.

What keeps rural systems running

Tioga County sits in New York’s Southern Tier with 47,574 residents, no hospital, no public transit, and a population that has been shrinking for over two decades. Nearly one in four residents is 65 or older. The median age of 44.8 exceeds the state figure by five years. The county is not just aging — it is aging faster than it can replace the workers, volunteers, and tax base that hold its systems together.

Federal programs are not abstractions here. They are the Medicaid that covers one in four residents, the SNAP benefits that feed one in nine, the FEMA grants that protect against floods in communities still recovering from Tropical Storm Lee, and the EMS system that depends on a shrinking pool of certified volunteers to answer emergency calls.

While Tioga County administers many of these services, the funding formulas and eligibility rules are largely set at the federal level. When Washington changes how these programs work, rural counties like Tioga absorb the consequences — with the least capacity to adapt.

This summary documents what federal policy changes mean for Tioga County using county budget data, federal agency records, and the county’s own community health assessment.

A. Healthcare: No hospital, shrinking safety net

Tioga County has no hospital within its borders. Residents requiring emergency or specialty care must travel to Binghamton, Elmira, or Sayre, Pennsylvania. The county is federally designated as a Health Professional Shortage Area for primary care, specialty care, and dental care.

Who depends on Medicaid

• 11,160 residents — 23.2% of the population — are enrolled in Medicaid
• The county’s share of Medicaid costs: $8.32 million in 2026, consuming roughly 30% of the entire property tax levy
• This is after New York capped county Medicaid contributions in 2005; before the cap, the trajectory was unsustainable

What’s changing

The OBBBA introduces Medicaid work requirements of 80 hours per month. The precise number of Tioga County residents who will be disenrolled has not been modeled at the county level — the state has not yet finalized implementation. Governor Hochul’s office estimates 66,000 people in Langworthy’s district will lose healthcare coverage under the law.

Mental health is the county’s top concern

The 2025-2030 Community Health Assessment identifies mental health as the #1 community health priority. Self-inflicted injury hospitalizations among adolescents aged 15-19 run at 16.1 per 10,000, exceeding the state average. The county operates mental health clinics in Owego and Waverly, but the 2026 budget shows a $807,000 adverse swing in net mental health costs — from a revenue-generating position to a net cost — suggesting lost state reimbursement or program restructuring.

No 24/7 behavioral health crisis stabilization center exists. Residents in psychiatric crisis rely on hotlines and out-of-county facilities.

In plain language: One in four Tioga County residents depends on Medicaid. The county has no hospital. Federal work requirements will remove an unknown number from coverage, and the state hasn’t said how it will allocate the resulting costs. Meanwhile, the county’s mental health system — its stated top priority — just lost $807,000 in a single budget year.

B. Fiscal reality: Mandated costs already exceed the tax levy

The county’s structural budget tells a story that tax cuts alone cannot address.

The numbers

The county is spending $3.65 million more on mandated services than it collects in property taxes. It closes the gap by drawing down reserves — a declining resource that cannot sustain repeated draws. Under New York’s property tax cap, now in its 14th consecutive year, the county has limited ability to raise additional revenue.

New costs heading to the county

• SNAP administrative cost shift: Federal share drops from 50% to 25%, estimated to cost the county $150,000-$300,000 annually starting October 2026
• SNAP benefit erosion: Frozen benefit formula will erode purchasing power by 3-5% per year as food prices rise
• Potential Medicaid cost pass-through: If the state allocates new costs to localities, Tioga faces an estimated $500,000 to $2 million+ per year in additional burden
• Federal contract decline: Cornell ILR identified Tioga County as one of the hardest-hit counties in New York for federal contract spending cuts
• USDA Rural Development: The primary federal agency serving communities like Tioga has lost 36% of its staff since January 2025, slowing rural housing, water, and business development loans

In plain language: The county already spends more on state- and federally-mandated programs than it collects in taxes. It’s burning through reserves at an accelerating rate. The new federal law adds costs — SNAP administration, potential Medicaid pass-throughs — to a budget that’s already upside down. There is no replacement funding stream.

C. Infrastructure: EMS crisis and flood exposure

The EMS system cannot reliably answer calls

A 2022 Center for Governmental Research study documented the scale of the crisis:

Nine independent transport agencies operate with minimal inter-agency coordination. About 90% of calls that do get answered are handled by agencies with at least some paid staff. The EMS Coordinator position has been vacant for years, and dispatch equipment is considered outdated by providers.

As the 65-plus population grows by a projected 20% over the next 15 years, emergency call volume will increase — while the volunteer base continues to shrink.

Flood exposure remains catastrophic

Tropical Storm Lee in September 2011 caused an estimated $478 million in losses within Tioga County alone, submerging 95% of the Village of Owego and forcing the evacuation of over 20,000 residents. Most core settlements sit within historical floodplains.

The county’s 2024 Hazard Mitigation Plan — which won a national planning innovation award — identified critical facility retrofitting as a priority but stated explicitly that “no local resources available” exist to fund engineering design and construction. All major flood mitigation depends on FEMA grants, which require an approved hazard mitigation plan to access.

No public transit

Ride Tioga, the county’s only bus service, ceased operations in November 2014 after Medicaid transportation was redirected to private contractors, collapsing ridership. Today, 81.1% of workers drive alone; the county averages two cars per household. For anyone without a reliable vehicle — the elderly, the disabled, low-income workers — reaching employment, healthcare, or grocery stores becomes a logistical crisis with no systemic solution.

In plain language: More than one in three emergency calls go unanswered in parts of the county. There is no hospital. There is no bus. The county’s flood plan says it has no local money for mitigation. Every one of these systems depends on federal funding — and the agencies that administer that funding are being cut.

The math for a typical Tioga County household

Consider a household at the county median: two working adults, combined income around $90,000, a home valued at $153,000, two children, two cars (because there is no bus service).

What they gain from the OBBBA

That covers about one day of childcare, three-quarters of a tank of gas, or 1.5 days of groceries. It represents 0.5% of monthly expenses.

What’s at risk in the same bill

• Medicaid coverage costs $7,000-12,000 to replace on the individual market
• SNAP provides $250-300/month for families who qualify
• Each dollar of SNAP generates $1.40-1.80 in local economic activity
• The senior bonus deduction ($720/year) expires after 2028

The asymmetry

Tax savings are distributed broadly but thinly across all households. Service cuts concentrate on the residents who can least absorb them. A $500 annual tax cut does not offset losing Medicaid coverage. A $42-per-month benefit does not compensate for a food bank that has lost hundreds of thousands of dollars in federal support.

The county legislature understood this. In late 2025, it allocated $100,000 from the contingent fund to the Food Bank of the Southern Tier, explicitly citing “federal reductions to the SNAP benefits program that have resulted in a direct and measurable hardship for many county residents.” That is local taxpayers backfilling a gap created by federal action.

What is still unaddressed

The representation gap

Rep. Nick Langworthy voted for the OBBBA on May 22, 2025, calling it “a generational win for the American people.” He stated that “not a single person” among seniors, the disabled, or pregnant women would lose coverage — a claim rated misleading based on CBO projections of 1.3 million dually eligible individuals losing Medicaid nationally.

Langworthy has held no in-person town halls since taking office in January 2023, conducting monthly telephone town halls instead. At the April 2025 telephone event — approximately 7,000 participants, 9 caller questions — none of the callers were from Tioga County. Requests for in-person constituent meetings were characterized as “a political astroturf move” by “leftist activists.”

When AFSCME members and healthcare workers protested Medicaid cuts at his Corning office, Langworthy responded: “I will not answer to a small and angry group of constituents that are constantly harping on this topic.”

Meanwhile, the neighboring Steuben County legislature — same congressional district, Republican leadership — sent a letter to Langworthy urging “an immediate bipartisan agreement that ensures continued federal funding for essential nutrition and home energy assistance programs.”

The bottom line

Tioga County is not a place with fiscal slack or service redundancy. It is a county where mandated costs already exceed the tax levy, where reserves are being drawn down at an accelerating rate, where one in four residents depends on Medicaid, where there is no hospital, and where the emergency medical system cannot reliably answer calls.

The federal policy changes enacted in 2025 deliver modest, broadly distributed tax benefits while imposing concentrated losses on the healthcare, nutrition, and administrative systems that hold the community together. Costs are shifting downward to the level of government least equipped to absorb them.

Rural residents don’t need to be told what to think. They need the full picture to decide for themselves.

Sources

• Tioga County 2026 Adopted Budget
• Tioga County 2025-2030 Community Health Assessment
• Tioga County 2024 Hazard Mitigation Plan (FEMA-approved)
• Center for Governmental Research: Tioga County EMS Study (2022)
• U.S. Census Bureau / American Community Survey: Population, demographics, income data
• Cornell ILR: Federal contract spending analysis by county
• Congressional Budget Office: H.R. 1 budgetary effects analysis (May 2025)
• MIT Living Wage Calculator: Tioga County estimates
• FEMA: Disaster records for Tioga County (DR-4031-NY, Tropical Storm Lee)
• Governor Hochul’s Office: OBBBA healthcare coverage impact estimates
• Tioga County Legislature: $100,000 emergency Food Bank allocation (2025)
• HRSA: Health Professional Shortage Area designations

Note: This entry documents publicly available information from county government records, federal agency data, and independent analyses. Readers may draw their own conclusions.

Last updated: February 10, 2026