Cost?
Location? Downstate is in Brooklyn while Hofstra in Long Island.
Patient population? Downstate much more underserved, Hofstra more insured patients.
Any specific competitive specialty interests? Check out some previous match lists to see how the schools do in general.
Reputation is a wash I'd say though Hofstra might be more on the up and up. I know Downstate is technically "unranked" but it has a good reputation in NYC and northeast. Hofstra is a relatively new school.