Arizona children covered by AHCCCS experience increased poor oral health outcomes in comparison to their higher-income counterparts despite receiving comprehensive dental service coverage under the state Medicaid program. The dental health disparities consistently present among this population allude that other barriers are in place preventing pediatric AHCCCS recipients from accessing guaranteed dental care. This thesis addresses the gaps faced by AHCCCS recipients in utilizing dental insurance coverage on behalf of provider availability in proximity and time. A “secret shopper” study was executed to reveal the accessibility barriers experienced by AHCCCS patients in comparison to privately insured patients and the adequacy of AHCCCS contracted providers in maintaining availability for this population. Based on the collected data, AHCCCS patients generally experience increased lengths of time until the next available appointment in comparison to the privately insured, suggesting that despite AHCCCS contracting, there are not currently adequate protective standards ensuring that child AHCCCS patients receive equitable opportunity for good dental health. Furthermore, this study revealed the significant obstructions to accessing dental care for rural Arizonans covered by AHCCCS, as four separate counties were notably found to not have a single AHCCCS provider. State policy must evolve to better support this demographic in achieving equitable oral health, working towards the relief of social determinants oppressing the wellbeing of lower-income families regarding distance to contracted practices and provider availability for the population of AHCCCS recipients.

Growing hotspots of unvaccinated children corroborate with states that have highly permissive vaccination policies. State-based nonmedical exemption (NME) policies such as religious or philosophical exemptions make it easy for parents to opt out of vaccinating their children thus lowering herd immunity and increasing the risk of outbreaks. Recent studies have revealed that Phoenix is the metropolitan area with the highest number of nonmedical exemptions in the country with vaccination rates below herd immunity. This thesis investigates the role of the law in enabling low vaccination rates and develops a set of policy recommendations that lawmakers may use as a tool to restore these rates to herd immunity levels. To do this, an in-depth literature review was performed and supplemented with a case study of California’s policy response to the 2014 Disneyland measles outbreak. This information was synthesized into an in-depth policy analysis addressing the political, social, practical, and economic factors of the issue and four potential policy responses for state lawmakers. Based on the analysis and California’s example, eliminating nonmedical vaccine exemptions was identified as the most effective policy option to reach the intended goal of restoring vaccination rates to herd immunity levels. This policy option is both the most cost-effective and productive in reaching herd immunity but infringes the most on parental rights and will be met with the most significant political pushback. Despite these challenges, lawmakers should take this policy step to protect our community and the most vulnerable among us.