State officials in Virginia started warning families this week that the popular Children's Health Insurance Program (CHIP) is about to run out of money.
It's one of several states that have given notice or are preparing to tell families that funding for the program has ended and Congress has failed to renew it.
For many families, that could mean an end to their health care unless they find someone to offer free care to their kids, according to Linda Nablo, chief deputy director at Virginia's Department of Medical Assistance Services.
"I would say most families, their children will go without insurance," Nablo said.
CHIP is a joint state-federal health insurance plan for low-income kids who don't have health insurance any other way. Funding varies from state to state but most of the money comes from the federal government.
Federal funding for the program ran out in September and Congress has failed to renew it. The continuing resolution passed last week keeps the federal government open for business until December 22 and it included a patch for CHIP, but that was just to move money from states that have not yet run out of cash to states whose CHIP programs were about to go broke.
The Centers for Medicare and Medicaid Services has provided no answer to repeated queries about which states will get last-minute finding under the patch.
Virginia's program, known as FAMIS (Family Access to Medical Insurance Security), runs out of money in February.
"We are hopeful that Congress will once again provide the funding to continue this program. However, because Congress has not acted yet, we need to let you know that there is a chance the FAMIS programs may have to shut down," the Virginia letter reads.
"We think of it as an informational letter," Nablo added. "We are trying to give families information if they need to do something for their child. We are trying to give them as much time as we can to understand what's going on, ask their questions, make whatever decisions they have to make and prepare to what extent they can."
"If you have got a medical situation — if your child has cancer, or is in the middle of chemo or is in the hospital or needs surgery, I'd want to know as soon as possible."
Families should get in any medical visits they can, while they can, the letter advises them.
"If any FAMIS members need medical or dental care, make an appointment to visit your doctor or dentist before January 31," it suggests.
"So if your child's healthy and they don't need a doctor's visit or a dentist visit anytime soon then hopefully this letter is just information for you," Nablo said.
"It is truly shameful that gridlock and dysfunction in Congress have left nearly 70,000 Virginians who depend on the FAMIS program hanging in limbo,"Va. Governor Terry McAuliffe, a Democrat, said in a statement.
Other families may need to act now. But if they want to sign up for health insurance on the Affordable Care Act exchange, for instance, they will have to wait until they qualify for a special enrollment period, Nablo said.
Some may need to investigate free or subsidized clinics.
"If you have got a medical situation — if your child has cancer, or is in the middle of chemo or is in the hospital or needs surgery — I'd want to know as soon as possible, and be talking to people about what might be possible," Nablo said.
The hangup in funding CHIP is partly over how to pay for it. Republicans and Democrats disagree on whether to cut other programs. But it's also a casualty of confusion, says Wisconsin Democratic Rep. Mark Pocan.
"Congress can't walk or chew gum on its own or at the same time," Pocan told NBC News. "People look at this and they think Congress is a big old cluster and that these guys can't govern and they're right."
Enerica Rodriguez of Dallas is watching what happens anxiously. She's got a 13-year-old son with ADHD and a 10-year-old daughter with eczema. Both have asthma, too, and she estimates their monthly medical costs run $800.
"The asthma inhaler and the treatment, they are pretty expensive too." said Rodriguez. "Without CHIP, I wouldn't be able to take my daughter to the dermatologist."
Rodriguez, who works at a dry cleaner, and her husband, a painter, buy coverage on an Affordable Care Act exchange but say adding their children to the plan would be prohibitively expensive. "It wouldn't cover their medications," she said.
"Congress can't walk or chew gum on its own or at the same time."
Their 21-year-old son is already on his own, Rodriguez said. "We just work hard to provide our income and to have a decent living. We aren't rich people," she said. "By them taking away CHIP, it's going to be very hard."
Tommie Ogletree of Lewisville, Texas, depends on CHIP to cover two of her three children. She is hoping Congress will pay for the program, which covers 9 million children nationally.
"I would lose everything," she said. "We cannot afford to give them private insurance. It's just not feasible for us. Everything is so expensive in the health care industry," she added.
Her son Bradley, 10, must carry an EpiPen because of a deadly allergy to bee stings.
"With one EpiPen it costs $500. But because we have CHIP it costs $35 for my son's EpiPen," Ogletree said.
"We don't have to worry about what other bills are going to come in because of CHIP."
Other states will send letters soon to families. Connecticut plans to start mailing letters December 15th, according to David Dearborn of the Connecticut Department of Social Services. Alabama's letters are scheduled to go out Dec. 26. Utah will send one at the end of December, a Department of Health spokesman said.
Twelve governors from both parties wrote Congress on Monday urging it to act.
"Since its creation, CHIP has enjoyed strong bipartisan support," they wrote.
"We encourage you to work across the aisle to find common ground that will allow this important program to continue and give the families who rely on CHIP the peace of mind of knowing that their children will be able to get the health care they need in the new year."