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And, even then, the future of the controversial law backed by Missouri’s Republican-led Legislature remains in limbo.

Lawmakers last week allowing for the late fees and giving doctors the ability to refuse to schedule new appointments until the missed appointment fee is paid.

The charge would be $5 for the first missed appointment, $10 for the second and $20 for the third.

The law also would allow $8 co-pays if a Medicaid recipient seeks treatment in an emergency room for a non-emergency health issue.

While , Republicans said it would help them.

“I contend it will increase the health of the recipients by getting them to their appointment with the doctor,� said Sen. David Sater, R-Cassville, during a more than hour-long debate in the Senate on Sept. 14.

The successful override of Nixon’s veto started the clock ticking on what could be a lengthy approval process that will wind its way through the back channels of state and federal bureaucracies before it can be formally implemented.

At the Missouri Department of Social Services, officials are waiting for Oct. 14, which is when the law goes into effect. At that point, the agency will have to ask the federal government for a waiver.

This spring, a number of it is doubtful the federal government will approve the changes, based on the Obama’s administration response to similar requests by other states.

In any case, the federal Centers for Medicare and Medicaid Services has 90 days to respond to the state request, sending the next step in the process into at least January, depending on how fast the state applies.

If the state does convince the feds to allow the late fees, the state would then have to write formal rules for the new law. That’s where the process could slow down significantly. A timeline for the rule-making process shows it can take anywhere from six to nine months for a new law to go into effect, meaning it could be September 2017 before anything happens.

“A year is probably a good estimate,� said Rep. Jay Barnes, a Jefferson City Republican who sits on the committee that will oversee the rule-making process.

Barnes said the timeline could be significantly shorter if the panel of lawmakers agrees that the rule matches with the intent of the law.

But even that process could be affected by the political winds.

Democrat Chris Koster and Republican Eric Greitens are running in the Nov. 8 election to replace the term-limited Nixon as governor. Each of them have already staked out different positions when it comes to expanding Medicaid in Missouri, with Koster supporting expansion and Greitens opposing it.

"A Gov. Greitens will have that moving forward as quickly as possible," said Rep. Sue Allen, R-Chesterfield, who sponsored the law in the House.

The next president – Democrat Hillary Clinton or Republican Donald Trump -- also could have a say in whether Missouri’s request for a waiver is approved or rejected.

The Nixon administration wouldn’t say how long they would wait before submitting the waiver request to the federal government, but one of the governor’s point people on health care issues indicated earlier this year that officials may not be in much of a hurry to get the law on the books.

“Only one state has ever been granted authority to charge for missed appointments,� said MO HealthNet Director Joe Parks.

Said Allen, "I have no inclination to believe Nixon wouldn't wait for the last possible minute to apply for a waiver."