Expect some serious financial impact in just two years in the Lone Star State as the health care reform-mandated expansions to Medicaid kick in — with access to doctors not projected to magically appear overnight, as well.

With the lowest rate of insured residents in the country (24.6 percent) and a low physician supply, estimates are that the 1.8 million new Medicaid enrollees will require $2.6 billion in new state spending between 2014 and 2019, and another $52.6 billion in federal spending during the same period.

As a result, nearly 5 million Texans would be on Medicaid, despite already existing shortfalls in access to both primary care and specialist physicians. The 3.3 million currently under Medicaid care already have issues getting access to doctors, especially in rural areas.

The news, taken from this week’s American Medical News and based on Kaiser Family Foundation research, indicates that Texas is just one of many states (especially in the West and the South) where 16 million citizens are projected to join the Medicaid ranks in 2014.

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.