When Melissa Oates’ husband was laid off about four years ago, she started going to Winchester Family Health Center.

The primary care center, part of the Shenandoah Valley Medical System, offers a sliding fee system where patients with lower incomes pay less to receive care than patients whose incomes are higher. Because Oates had six children under the age of 18 at the time, the fee structure allowed Oates to be able to receive care at a time when she was uninsured and offered her a sense of relief.

“It takes a lot less pressure, a lot less stress on you,” Oates said.

Now, a major source of the Shenandoah Valley Medical System’s funding is tied to uncertainty about whether or not Congress passes a budget.

The Shenandoah Valley Medical System is a “community health center” and is partially funded by the federal government. That funding has received bipartisan support, with the Republican Rep. Barbara Comstock, R-McLean, and the former Virginia governor Terry McAuliffe, a Democrat, both issuing support for extending funding.

But the funding has been caught up in congressional politics and technically expired on Oct. 1, along with the Children’s Health Insurance program.

The temporary lapse in funding has not hit the Shenandoah Valley Medical System yet, due to technicalities in the funding’s allocation. But the system’s CEO, Mark Hassing, said that the funding uncertainty has still affected community health centers across the country.

“It is very unsettling to be in a position where you’re never quite sure whether or not you’re going to have to make some really difficult decisions about what services you’re going to continue to offer if the funding goes away,” Hassing said.

For the most part, Hassing declined to comment on how the current situation would specifically affect the Shenandoah Valley Medical System; he has only been on the job for 14 days, he explained, entering into the position in the midst of this funding uncertainty.

But he did say that most of the costs for community health centers come in the form of salary costs. That makes the centers particularly vulnerable to budget cuts, because it leaves them with few things they can cut besides salaries.

The problem is particularly acute because of how much these health centers rely on federal funding. According to the nonprofit Kaiser Family Foundation, about 20 percent of community health center revenues come from the federal grants.

“The primary place that you have to look at (for cuts) is cutting programs, discontinuing programs,” Hassing said. “And you do that by having to lay off staff.”

For Hassing, the entire period of uncertainty has felt unfair to the community health centers and to the patients, like Oates, who rely upon them.

“I don’t think it feels really good to mess around with the lives of your staff but also of your patients in trying to provide services to them,” Hassing said. “It’s not very comfortable.”