| Course | INHE 4009 Cultural Humility and Diversity |
|---|---|
| Week | Week 9 |
| Paper type | Policy review |
| Length | About 510 words, 4 pages |
| Format | APA 7 student paper |
| School | Walden University |
| Program | BS in Integrative Health |
| Updated | October 2026 |
Free sample paper for INHE 4009 Week 9
Who a Sliding Scale Leaves Out: A Policy Review of a Community Integrative Clinic's Requirement of a Social Security Number and Last Year's Tax Return for Reduced Fees
Student Name
Walden University
INHE 4009: Cultural Humility and Diversity
Instructor Name
Month Day, Year
Who a Sliding Scale Leaves Out: A Policy Review of a Community Integrative Clinic's Requirement of a Social Security Number and Last Year's Tax Return for Reduced Fees
The Policy
A composite community integrative clinic offers acupuncture, massage and nutrition counseling on a sliding scale. To qualify for reduced fees, a client must provide a Social Security number and a copy of the previous year's federal tax return. The policy's stated purpose is to make sure discounts go to people with low incomes and to prevent misuse. Nothing in it mentions immigration status, employment type or family circumstances. This review reads the policy for whom it excludes, intended or not.
Who Qualifies Easily
The policy works smoothly for a client with a Social Security number, steady wage employment last year, a filed tax return and stable income since. For that client, the documents are routine.
Who It Leaves Out
Four groups face barriers the policy's authors probably did not intend.
Undocumented immigrants generally have no Social Security number, and many fear that providing identifying documents to any institution could expose them to immigration enforcement. A literature review of barriers to care for undocumented immigrants found that fear of deportation, along with cost, is among the main reasons people avoid health services (Hacker et al., 2015). Requiring a Social Security number excludes this group entirely.
People with informal or cash income, such as day laborers, domestic workers and some small-business owners, may not have filed a return, or their return may not reflect their actual income.
People whose income dropped recently, through job loss, illness or divorce, are judged on last year's income, when they may have had more. The policy fails exactly the clients whose need has just increased.
People who cannot reach their documents, such as survivors of domestic violence who left home quickly, may have no access to last year's return.
Why It Matters for an Integrative Clinic
The clinic presents itself as accessible to the whole community, and its reduced fees are the main way it reaches people who could not otherwise pay. A policy that excludes those most likely to need discounts works against that purpose. Federally funded health centers, by comparison, are required to offer sliding fee discounts based on income and family size, with their own policies on how income is documented (Health Resources and Services Administration [HRSA], 2018), and many accept a range of evidence, including self-declaration where documents are not available.
Recommendations
The clinic should remove the Social Security number requirement, accept a range of income evidence, including recent pay stubs, a letter from an employer or a signed self-declaration, and base eligibility on current income rather than last year's. It should state plainly that it does not share client information with immigration authorities, and train front desk staff to explain the policy without asking about status. Cultural humility includes examining institutional practices for the power they exercise over clients (Tervalon & Murray-García, 1998), and a fee policy is one of the clearest places where that power shows.
References
Hacker, K., Anies, M., Folb, B. L., & Zallman, L. (2015). Barriers to health care for undocumented immigrants: A literature review. Risk Management and Healthcare Policy, 8, 175-183. https://doi.org/10.2147/RMHP.S70173
Health Resources and Services Administration. (2018). Health center program compliance manual: Chapter 9, sliding fee discount program. https://bphc.hrsa.gov/compliance/compliance-manual/chapter9
Tervalon, M., & Murray-García, J. (1998). Cultural humility versus cultural competence: A critical distinction in defining physician training outcomes in multicultural education. Journal of Health Care for the Poor and Underserved, 9(2), 117-125. https://doi.org/10.1353/hpu.2010.0233
The Walden INHE 4009 Week 9 instructions
Policy review assignments ask students to evaluate an institutional policy for its effects on different groups. Prompts usually ask students to identify who the policy serves, who it may exclude, whether the effect is intended, and what changes would make it fairer. Some ask students to compare the policy with a standard or benchmark. Instructors look for analysis of effects grounded in evidence and practical recommendations. Reviews that criticize the policy's authors, or that list concerns without showing which groups are affected and how, tend to earn less credit. A few instructors also want a redrafted policy attached.
How this INHE 4009 Week 9 example is built
The review states the policy and its purpose fairly. A section describes who qualifies easily. A section names four groups the policy excludes, explaining the mechanism for each and citing a literature review on undocumented immigrants. A section explains why exclusion matters for this clinic's mission and compares the policy with federal health center sliding fee standards. A final section gives specific recommendations, from accepting self-declaration to training front desk staff, and ties them to cultural humility's attention to institutional power. Each excluded group gets its own short paragraph explaining how the requirement affects it. The benchmark comparison uses the federal health center program's published standard rather than an opinion. Recommendations are listed in the order a clinic could adopt them. The review stays under two pages. Its comparison uses a published federal standard.
Reading the INHE 4009 Week 9 rubric
Instructors generally reward analysis of effects over intentions, and stating the policy's purpose fairly before critiquing it secures credit. Naming four specific groups, with the mechanism of exclusion for each, earns substantial credit. Using evidence for at least one group shows the analysis rests on more than assumption. Comparing the policy with a public benchmark is often what distinguishes strong reviews. Specific, implementable recommendations complete the work, with accurate citations for the literature review, the federal compliance manual and the humility article. One paragraph per group keeps the analysis organized and easy to follow. Using a published public standard as the benchmark makes the critique of the policy concrete. Recommendations ordered for adoption show practical sense.
Common INHE 4009 Week 9 mistakes, and how to avoid them
Read the policy carefully and state its purpose as its authors would. Then picture the people who would struggle to meet each requirement, and name them. Look for evidence about at least one group. Find a benchmark, such as a public program's standard, to compare against. Recommend specific changes, including wording and training. Avoid assuming bad intent. If you are unsure which groups a policy affects, a sample review of your policy can help. Give each affected group its own paragraph. Use a published standard as your benchmark where one exists. List recommendations in the order they could be adopted.
Get a INHE 4009 Week 9 example written to your instructions
Send the policy or document your section assigned, the prompt and the rubric, and a review of that text comes back within 24-48h, with no fee for the first. Where your prompt asks you to review a document from your own workplace, the sample works on a composite so that nothing internal to an employer is shared or needed.
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INHE 4009 Week 9 questions, answered
Where can I find a free INHE 4009 Week 9 sample paper?
The review of the sliding-scale fee policy appears in full on this page.
Who does the policy exclude?
Undocumented immigrants, people with informal income, people whose income just dropped and people who cannot reach their documents.
Why does requiring a Social Security number matter?
It excludes undocumented immigrants entirely and can deter them through fear of enforcement.
How do federal health centers handle sliding fees?
They base discounts on income and family size, with their own policies on how income is documented.
What does the review recommend?
Accept a range of income evidence, judge current income and state that information is not shared with immigration authorities.