Two months ago, I wrote in this space about how Congress was threatening to allow funding for the Children’s Health Insurance Program (CHIP) and community health centers to expire. It did. I lamented how this imminent disaster for millions of poor Americans who rely on government assistance for medical care was being utterly neglected. It still is. And we’re now witnessing the consequences of that inaction.

In five states (Arizona, California, Minnesota, Ohio, and Oregon) and the District of Columbia, what funding remained for CHIP will run out by the end of December. Federal officials found $542 million in leftover cash in September, but that is now gone. More than half the states will have no cash for their programs by March 2018.

Officials in eleven states are sending letters to unsuspecting parents as early as this week, warning them that their children will no longer be able to get insurance in the near future, absent congressional action. Instead of using scarce funds to get children vaccinations, they’re spending it on mass mailings delivering the bad news. West Virginia has already voted to close down CHIP on February 28 if nothing is done. Other states are scrambling for alternatives, creating worries for families and mass confusion. Without re-authorization, all 8.9 million children and 370,000 pregnant women enrolled through CHIP would have their coverage put at risk. And given how invisible this issue has been on Capitol Hill, that isn’t an unthinkable scenario.

Meanwhile, the 1,400 local clinics that provide comprehensive primary care to 26 million poor Americans have no idea how they’ll survive without billions in federal aid, which got cut off September 30.

About half of the grant periods for community health centers restart February 1, at which point those clinics will receive less or no money. Officials cannot engage in any long-term planning with the uncertainty about their funding levels. But they will likely see hiring freezes, layoffs, reduced hours, and cancelled expansions. The resulting reduction in access is likely to cost 9 million people their main method of health care. Even if funding miraculously arrives it could be too late for administrators who need to plan budgets.