Specifically, Congress has yet to extend funding for the Children's Health Insurance Program, which fills a gap for children, infants and pregnant women at certain income levels, and for community health centers, which provide a safety net for lower-income individuals who can't afford care elsewhere.

"This is a big deal to Minnesota, because we're going to have to use other funds to shore it up," said state Rep. Jennifer Schultz, DFL-Duluth.

Federal funding for both programs ran out at the end of September. The U.S. House of Representatives last month voted to extend funding for both, but there's no corresponding legislation in the Senate, said Dayle Patterson, CEO of the Lake Superior Community Health Center.

The advocacy nonprofit FamiliesUSA on Friday urged Congress to pass a five-year funding extension for CHIP proposed by Sens. Orrin Hatch, R-Utah, and Ron Wyden, D-Ore.

In the meantime, administrators at the state and local levels have been scrambling to meet immediate or potential shortfalls.

"We call it the funding cliff, and we fell over the cliff," Patterson said.

The health center she leads, which has clinics in West Duluth and Superior, is one of 17 in Minnesota with about 70 sites, said Jonathan Watson, public policy director for the Minnesota Association of Community Health Centers.

Combined, losing federal funding means losing $27 million a year or about 15 percent of the 17 centers' total budgets, Watson said. But some centers are much less dependent on federal help, while others receive as much as 60 or 70 percent of their support from the federal government.

The funding year starts on different dates for different centers, Watson said. In Minnesota, three community health centers will lose federal funding as of Jan. 1 if there's no congressional fix by then.

Lake Superior Community Health Center's funding will end on Feb. 28, Patterson said. If funding isn't extended by then, the center will lose about $80,000 per month, or 12 percent of its $8 million annual budget.

The uncertainty already is affecting decision-making, Patterson said.

"Trying to make decisions about do you fill open positions and potential expansion and wage increases and all the kinds of things that you typically do in running any kind of nonprofit or for-profit organization," she said. "We're operating on tiny, tiny margins."

The potential impact is greater on centers that have been more dependent on federal funding, Watson said.

"Of those 70 sites, I would project at least eight to 10 of those sites would shut their doors," he said. "There's no way they could survive that kind of cut. And I would venture to guess that the majority of those eight to 10 sites is going to be in greater Minnesota."

Meanwhile, Minnesota last month became the first state to run out of CHIP funding, according to the website Stateline. In Minnesota, children covered by CHIP are enrolled in Medical Assistance, the state's Medicaid program, according to the state Department of Human Services, which administers it. This year, 125,000 children whose families fall between 133 percent and 275 percent of the federal poverty line are enrolled; CHIP had been providing 38 percent of the support for those children. It also helped to support much smaller numbers of pregnant women and infants.

The upshot for those 125,000 children is not that they lose coverage but that the federal government covers 50 percent of their care instead of 88 percent. Making up the difference will cost Minnesota about $6 million per month, DHS Commissioner Emily Piper wrote in an Oct. 30 letter to the state's congressional delegation.

"It is impossible for the federal government to force enormous funding losses and create extraordinary uncertainty in our state and assume that no one will be harmed," Piper wrote. "These cuts target programs that serve some of the lowest-income, most vulnerable Minnesota families."

In Wisconsin, funding is expected to run out in March if there's no congressional intervention, the Milwaukee Journal Sentinel reported last week. It would cost the state up to $115 million annually.

Created as part of the Balanced Budget Act of 1997, CHIP serves 9 million children nationwide, according to FamiliesUSA, which reports the program has never gone unfunded before. If Congress doesn't act, funding will run out for a majority of states by March, according to a Nov. 9 bulletin from the federal Center for Medicaid and CHIP Services.

Some states appear to be particularly hard up. Colorado's Department of Health Care Policy and Financing began sending letters to CHIP members last week saying its CHIP money will run out by the end of January and advising them to start researching private health insurance options.

CHIP and community health program monies have been stuck in Congress despite the fact that both enjoy broad bipartisan support, Watson said. During the summer, all eight members of the Minnesota congressional delegation — spearheaded by Rep. Rick Nolan, DFL-Crosby, and Rep. Tom Emmer, R-Delano — sent a letter to the leadership of the House Energy and Commerce Committee calling for a fix to the "primary care cliff," he said.

Just last week, the National Governors Association sent a letter to the House and Senate leadership urging immediate action on CHIP, community health centers and other health care programs.

"It just really demonstrates ... the bipartisan support that these programs have had," Watson said. "And why is that? Because they work. ... This seems like a really easy win for a Congress that's desperate for a win."