After Medicaid expansion passes, next question is when to take effect Updated: Thursday, August 29, 2013 | LANSING, Mich. (NEWSCHANNEL 3) - Government provided health care is coming to hundreds of thousands of low-income people in Michigan.But the question now, is when.Tuesday night, the Michigan Senate narrowly approved a House bill that expands Medicaid in Michigan.It's part of the Federal Affordable Care Act, and the vote comes three months after the House approved the bill.All summer, Governor Snyder had been pressuring Senators to return to the Capitol for a vote.It's something both sides worked on for much of the summer, and Tuesday it came down to two votes, lots of negotiating, and multiple recesses, but the bill finally passed.However, there is still more work to be done, and more questions about what comes next.Scott Gilman, the Director of Network 180, a mental health clinic in Grand Rapids, knows just how important insurance coverage is."The need is huge--we're estimating that there's about 28,000 people in Kent County that will be eligible for the new Medicaid benefit," he said.But those benefits won't kick in right away.Tuesday night, the Senate defeated a motion to give the bill immediate effect, meaning the expansion won't happen until April."It's concerning to those people who are on waiting lists, and it's concerning to those people who have serious medical conditions and they're waiting for medication," Gilman said. "It also has some pretty serious financial implications for the state."The Michigan Department of Community Health has estimated that cost could be as high as $7 million per day in federal funds left on the table that would be used for the expansion."Immediate effect presents some challenges, but as a practical matter, I believe that's something we can talk to the federal government about," said Governor Rick Snyder. "I would hope we can get a positive response and it just means it could be delayed in terms of when it goes into effect."The Governor has said he hopes the legislature will revisit the immediate effect question."It's not the way I would have planned it, but at this point in time, we'll have a discussion about it and see if we need to do something about it," said Senate Majority Leader Randy Richardville. "It's a renewable motion, so--I don't want to get too technical there--but we can bring this back up and ask for immediate effect at any time."For now, though, the more than 400,000 who stand to benefit will have to wait and see.The bill now heads to the house, where it will be taken up next week.