Not long after the shelter-in-place order went into effect in California in March, Melissa Santos and her wife established new rules: they'd eat breakfast, try to get by with snacks, suppress hunger with coffee, and then have dinner.

Santos is a student at the University of California, Berkeley. At 32, she's older than most of her undergraduate peers; she spent years taking care of a grandmother with Alzheimer's before considering her own education and career.

The shelter-in-place order means Santos is allowed to go out to grocery stores, but her obesity puts her in a high-risk category for COVID-19, and her doctor advised her to stay home.

Santos is one of the nearly 40 million Americans on SNAP, the Supplemental Nutrition Assistance Program commonly known as food stamps, and that number is rising with the coronavirus-related layoffs. But few online grocery delivery services will accept SNAP payments.

So Santos has faced a stark choice: go out, risk getting severe COVID-19 or starve.

She goes out as little as possible and tries to stock up as much as possible on $194 a month. As students they already lived frugal lives, she explains, then breaks into tears.

"We're just having to make sure that we have enough for, you know, the next day," she says.

The fact that SNAP recipients can't get delivery has been a problem; after all, many have disabilities or restrictive medical conditions. In 2016, the U.S. Department of Agriculture, which oversees SNAP, started a pilot program to enable online purchases. In a statement the USDA told NPR they approved all six states that wanted to join.

But Kristina Herrmann, director for underserved populations at Amazon, says it's much more more complicated than it should be.

There are a series of technology hurdles — from stores needing new systems online that differentiate between food and non-food items to states needing new systems to handle new payment processors. They're not unsolvable problems, they just haven't been done; food stamp issues don't tend to be top-of-mind for most technologists.

Because of COVID-19, the USDA now says it'll fast-track any state that wants to join the pilot. Eleven more were just approved, including California. Many should be online with authorized retailers by some point in May. In those states, Walmart will accept SNAP for grocery pickup but not delivery (and did not respond to NPR's requests for explanation); Amazon and Amazon Fresh will accept SNAP for online grocery orders, but SNAP customers of Amazon's Whole Foods chain will still have to shop in person.

So, even where delivery is possible, options are limited, and for the majority of SNAP recipients, still not possible.

The elephant in the room is, of course, Instacart, the leader in U.S. grocery delivery. Their app lets customers buy from around 25,000 stores in 5,200 cities. But the government says that because Instacart is not a retailer itself, it can't join the program.

Eliza Kinsey, who researches public health at Columbia University, points out that this is about more than food security. If high-risk people have to go out to get groceries, "potentially getting exposure, the more pressure we're going to be putting on the whole healthcare system," she says. It could mean more severe COVID-19 cases. In other words: this isn't a problem that merely affects poor people or those with medical conditions. It's a big problem for everyone.

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