The government shutdown is forcing many families to make potentially dangerous decisions about their health.
Local medical offices say they're now getting hit from both sides.
Some patients can't afford to pay deductibles or co-pays while federally funded health care programs are taking longer to reimburse claims.
As the government shutdown marks its 21st day, many federal programs remain in a holding pattern.
And that has health care centers like the Chestnut Medical Group in northeast Fresno scrambling to cover operating costs.
"When there is no federal funding because of the shutdown that trickles down to the provider. We're not getting paid," says Susan Anderson of the Chestnut Medical Group.
Medicare and Medicaid providers and patients are protected but according to medical administrators, the impact of the government shutdown is being felt in the form of delays in reimbursement and other payments as a result of staff shortages at the federal level.
"We're expecting support from Medicare from Medicaid but when we call the agencies we're not able to get through. They're short staffed and we're not getting resolution on our payments," Anderson adds.
Offices like the Chestnut Medical Group have no other choice but to wait for payments.
And continue to provide health care needs for their patients without any interruption of service.
But many federal employees say they're now thinking twice about making any doctor's appointment while the government withholds their paychecks during the shutdown.
Many health care officials tell us they're willing to work with a customer on their medical bills, rather than allow their coverage to lapse if they can't afford care during the government shutdown.
Medical providers scramble to cover costs during government shutdown