Texas to Be Hit Hardest by Medicaid Expansion

Texas, Idaho, Mississippi and Oklahoma will be additionally hard hit as they currently pay larger-than-normal Medicaid fees in order to retain doctors. And despite increases in those fees as the reform-imposed changes loom larger over the next two years, access is not expected to improve immediately.

And, according to the report, despite the existing needs, very little is being done in the state to train or recruit additional doctors. As part of the state's $27 billion budget shortfall, Texas legislators recently imposed a two-year budget which cut Medicaid by $2 billion, as well as saving money by only  funding the program though March 2013.

Medicaid fees for hospitals, mental health professionals, therapists and case managers were also cut by 8 percent. And millions of dollars were also slashed from graduate and undergraduate medical education loan repayment programs.

Existing physician participation in Medicaid is also an issue. Back in 1998, 78 percent of Texas doctors accepted all new Medicaid patients; the number has recently shrunk to 42 percent, according to a Texas Medical Association survey last year.