Mary’s Center, a federally qualified health center with two full-service locations in D.C., serves more than 30,000 patients in the District—about half of whom are enrolled in Medicaid or D.C. Healthcare Alliance, a local public health insurance program.

A week into the federal government shutdown, the center is struggling to figure out how to keep serving these 15,000 primarily low-income patients while still paying its 415 employees. (Mary’s Center also has two facilities in Maryland that serve an additional 10,000 patients.) So far, they haven’t had to turn down any patients who needed care.

Last week, Wayne Turnage, director of D.C.’s Department of Health Care Finance, sent a letter to affected health providers explaining that because DHCF “cannot access the local funds in the District’s budget or draw down federal Medicaid dollars to pay providers,” the department would immediately suspend all Medicaid and similar payments until the government shutdown ends.

Mary’s Center was supposed to have gotten $585,000 from sources like DHCF and the D.C. Department of Health on Oct. 1 as payment for services the center rendered in previous months, says Maria Gomez, president and CEO of the organization. But thanks to the shutdown, it never did.

The center—the second-largest medical provider for low-income patients in the city behind Unity Health Care—has opted to stay open and continue providing services during the shutdown even though it can’t be paid until Congress appropriates funding for the District agencies that will, in turn, pay for care. The clinic is banking on the government retroactively paying it once it reopens for services provided during the shutdown. But that’s far from guaranteed.

Gomez says the center’s next pay period is Oct. 18, and if the government is still closed by that time, Mary’s Center will not be able to pay its employees.

“We will have depleted all of our resources if the government doesn’t open by Oct. 18,” Gomez says. “It’s a mess.”

Mary’s Center is currently trying to determine what services are essential for its patients and deciding whether it will furlough some employees. It’s in talks with a bank to secure a bigger loan, according to Gomez.

And the effects of the shutdown go even further then just the government money for Mary’s Center. Most of the center’s patients are low-income, working hourly wage jobs as custodians and restaurant workers. That means the shutdown is affecting many patients’ paychecks, as many federal facilities are shuttered and furloughed government workers aren’t paying for their typical services, like lunch or dry cleaning, during the workday. So Gomez says Mary’s Center has seen an increase in people seeking mental health services. Many patients also have less money to pay for the care they need, and the center has less cash to help them out.

“I just don’t understand how Congress can go to work everyday know that they are going to get a paycheck,” she says.

Mayor Vince Gray‘s spokesman, Pedro Ribeiro, says there’s not much the local government can do to help.

“We can’t fill every gap for the federal government,” he says. “It’s absolutely unconscionable that this is happening, and people should be up and arms… It’s absurd this is happening to these immensely important organizations.”

People wishing to assist the center can make a donation here.

Correction: Due to a reporting error, this post initially misspelled the acronym for the Department of Health Care Financing.

Photo courtesy Mary’s Center