Federal Medical Assistance Percentages (FMAPs) for FYs 2021-2022 and Relevant Per Capita Income Data for Indian Tribes (Includes Tribes Currently Operating Title IV-E Programs, Tribes with Title IV-E Planning Grants, Tribes with Title IV-E Agreements or Contracts with States, and Those Otherwise Expressing Interest in Operating Title IV-E Programs in the Future)

Per Capita Income FY 2021 Tribal FY 2022 Tribal FY 2022 State for the American FMAP (based FMAP (based FMAP (Rate of Indian/Alaska on American on American the State in Native Alone Community Community Which the Population for 2015- Survey 2014- Survey 2015- Tribe is 2019 (American 2018 data) 2019 data) Located) Community Survey 5-Year Estimate)

Region State Tribe/Tribal Association Notes on Per Capita Income Data

I ME Aroostook Band of Micmacs 83% 83% 64.00 $10,785 NONE I ME Houlton Band of Maliseets 83% 83% 64.00 $10,680 NONE I ME Passamaquoddy Pleasant Point 83% 83% 64.00 $12,964 Listed in ACS data as Pleasant Point Reservation, ME I ME Passamaquoddy Indian Township 83% 83% 64.00 $13,619 Listed in ACS data as Indian Township Reservation, ME I ME Penobscot 83% 83% 64.00 $17,746 NONE

I MA Wampanoag of Gay Head 83% 83% 50.00 $15,162 Listed in ACS data as Wampanoag-Aquinnah Trust Land, MA.

This Tribe is listed in ACS data but with too few observations to calculate a value. Rate shown for FY2022 is based on the per capita income for the entire AI/AN population in the state, which is $24,927 +/- $2,813 for I MA Mashpee Wampanoag 77% 73% 50.00 $26,704 the 5-year ACS estimates for 2015-2019.

Listed in ACS data as Cayuga Nation TDSA, NY. The margin of error for II NY Cayuga Nation of Indians 50% 58% 50.00 $33,060 2015-2019 estimate is +/- $22,720. This Tribe is listed in ACS data but is too small for an estimate to be produced either for the AI/AN alone population or for all persons on tribal lands. The rate shown for FY 2021 is that corresponding to the per capita income of the AI/AN population of the state, which is $23,263 +/- II NY Oneida Nation Social Services 79% 80% 50.00 $23,263 $1,438 in the 5-year ACS estimates for 2015-2019. The Tribe is listed on two reservations: Allegany and Cattagarus. The per capita income shown is weighted by the proportion of the AI/AN II NY Seneca Nation 83% 83% 50.00 $16,909 population living on each reservation. II NY St. Regis Mohawk 83% 83% 50.00 $15,413 NONE

III NONE NONE NONE

Page 1 Tribal FMAP Reference Table for FY 2021 and FY 2022 Per Capita Income FY 2021 Tribal FY 2022 Tribal FY 2022 State for the American FMAP (based FMAP (based FMAP (Rate of Indian/Alaska on American on American the State in Native Alone Community Community Which the Population for 2015- Survey 2014- Survey 2015- Tribe is 2019 (American 2018 data) 2019 data) Located) Community Survey 5-Year Estimate)

Region State Tribe/Tribal Association Notes on Per Capita Income Data Listed in ACS data as Poarch Creek Reservation and Off-Reservation IV AL Poarch Band of Creek Indians 83% 83% 72.37 $12,306 Trust Land, AL--FL IV NC Eastern Band of Cherokee 83% 83% 67.65 $21,053 Listed in ACS data as Eastern Cherokee Reservation.

V MI Bay Mills 83% 81% 65.48 $22,342 NONE Grand Traverse Band of Ottawa & Listed in ACS data as Grand Traverse Reservation and Off-Reservation V MI Chippewa Indians 83% 83% 65.48 $17,754 Trust Land, MI V MI Hannahville Indian Community 83% 83% 65.48 $13,327 Listed ACS data as L'Anse Reservation and Off-Reservation Trust Land, MI. This Tribe's service population is AI/AN persons in a two county area that includes Baraga and Marquette in Michigan. Per negotiations with the tribe on use of alternate data, the per capita income estimate shown is a weighted estimate of the AI/AN population in these two counties. Note for 2015-2019 estimates for both counties and for the tribal lands V MI Keweenaw Bay Indian Community 81% 77% 65.48 $24,642 there are large margins of error (roughly +/- $7,500). Lac Vieux Desert Band of Lake Superior V MI Chippewa Tribal Government 83% 83% 65.48 $11,344 Listed in ACS data as Lac Vieux Desert Reservation, MI Little River Band of Ottawa Indians of Listed in ACS data as Little River Reservation and Off-Reservation Trust V MI Michigan 83% 83% 65.48 $17,613 Land, MI

Lake Traverse Bay Bands of Odawa Listed in ACS data as LakeTraverse Bay Reservation and Off- V MI Indians 83% 83% 65.48 $12,132 Reservation Trust Land, MI. This Tribe is listed in ACS data but is too small for an estimate to be produced either for the AI/AN alone population or for all persons on tribal lands. The rate shown for FY 2021 is that corresponding to the per Match-E-Be-Nash-She-Wish Band (Gun capita income of the AI/AN population of the state, which is $23,255 +/- V MI Lake Tribe) 76% 80% 65.48 $23,255 $2,063 in the 5-year ACS estimates for 2015-2019.

Listed in ACS data as Pokagon Reservation and Off-Reservation Trust Land, MI. The margin of error for the the 2015-2019 per capita income estimate is +/-$ 17,539. Because the calculated rate for the tribe is lower than that for the state in which it is located, the state rate applies V MI Pokagon Band of Pottawatomi (MI & IN) 77% 65.48% (61%) 65.48 $31,961 (65.48%). The tribe's calculated rate is shown in parentheses.

Page 2 Tribal FMAP Reference Table for FY 2021 and FY 2022 Per Capita Income FY 2021 Tribal FY 2022 Tribal FY 2022 State for the American FMAP (based FMAP (based FMAP (Rate of Indian/Alaska on American on American the State in Native Alone Community Community Which the Population for 2015- Survey 2014- Survey 2015- Tribe is 2019 (American 2018 data) 2019 data) Located) Community Survey 5-Year Estimate)

Region State Tribe/Tribal Association Notes on Per Capita Income Data

Listed in ACS data as Isabella Reservation and Off-Reservation Trust Land, MI. The margin of error for the 2015-2019 per capita income V MI Saginaw Chippewa Tribe of Michigan 69% 69% 65.48 $28,696 estimate is +/-4,006. Listed in ACS data as Sault Ste. Marie Reservation and Off-Reservation V MI Sault St. Marie Chippewa 83% 83% 65.48 $8,541 Trust Land, MI Listed in ACS data as Leech Lake Reservation and Off-Reservation V MN Leech Lake Band of Ojibwe 83% 83% 50.51 $14,529 Trust Land, MN Listed in ACS data as Mille Lacs Reservation and Off-Reservation Trust V MN Mille Lacs Band of Ojibwe Indians 83% 83% 50.51 $14,655 Land, MN V MN Red Lake Band of Chippewa Indians 83% 83% 50.51 $11,761 Listed in ACS data as Red Lake Reservation, MN V MN White Earth Reservation Tribal Council 83% 83% 50.51 $12,589 NONE V WI Bad River 83% 83% 59.88 $16,234 NONE The margin of error for the 2015-2019 per capita income estimate is +/- V WI Forest County Potawatomi Community 66% 65% 59.88 $30,239 $7,713. V WI Ho-Chunk Nation 83% 83% 59.88 $18,149 NONE V WI Lac Courte Oreilles Tribal Gov Board 83% 83% 59.88 $14,124 NONE V WI Lac Du Flambeau 83% 83% 59.88 $15,513 NONE V WI Menominee Indian Tribe of Wisconsin 83% 83% 59.88 $14,412 NONE Red Cliff Band of Lake Superior Listed in ACS data as Red Cliff Reservation and Off-Reservation Trust V WI Chippewas 83% 83% 59.88 $18,200 Land, WI

Listed in ACS data as Stockbridge Munsee Community and Off- V WI Stockbridge-Munsee 83% 83% 59.88 $21,338 Reservation Trust Land, WI.

Listed in ACS data as Acoma Pueblo and Off-Reservation Trust Land, VI NM Acoma Pueblo 83% 83% 73.71 $15,964 NM Listed in ACS data as Jicarilla Apache Nation Reservation and Off- VI NM Jicarilla Apache Nation 83% 83% 73.71 $16,428 Reservation Trust Land, NM VI NM Pueblo of Cochiti 83% 83% 73.71 $16,202 Listed in ACS data as Pueblo de Cochiti, NM

VI NM Pueblo of Nambe 83% 83% 73.71 $19,985 VI NM Pueblo of Picuris 83% 83% 73.71 16,538 Listed in ACS data as Picuris Pueblo, NM

Page 3 Tribal FMAP Reference Table for FY 2021 and FY 2022 Per Capita Income FY 2021 Tribal FY 2022 Tribal FY 2022 State for the American FMAP (based FMAP (based FMAP (Rate of Indian/Alaska on American on American the State in Native Alone Community Community Which the Population for 2015- Survey 2014- Survey 2015- Tribe is 2019 (American 2018 data) 2019 data) Located) Community Survey 5-Year Estimate)

Region State Tribe/Tribal Association Notes on Per Capita Income Data

Listed in ACS data as Pueblo of Pojoaque and Off-Reservation Trust VI NM Pueblo of Pojoaque 83% 83% 73.71 $20,965 Land, NM. Listed in ACS data as San Ildefonso Pueblo and Off-Reservation Trust VI NM Pueblo of San Ildefonso 83% 83% 73.71 $19,790 Land, NM VI NM Pueblo of Santa Ana 83% 83% 73.71 $14,651 Listed in ACS data as Santa Ana Pueblo, NM

VI NM Pueblo of Santa Clara 83% 83% 73.71 $17,068 Listed in ACS data as Santa Clara Pueblo, NM. VI NM Pueblo of Taos 83% 83% 73.71 $17,837 Listed in ACS data as Taos Pueblo and Off-Reservation Trust Land, NM. Listed in ACS data as Zuni Reservation and Off-Reservation Trust Land, VI NM Pueblo of Zuni 83% 83% 73.71 $11,839 NM--AZ Listed in ACS as Navajo Nation Reservation and Off-Reservation Trust VI NM Ramah Navajo School Board, Inc. 83% 83% 73.71 $12,431 Land, AZ--NM--UT. This Tribe is not listed in ACS data. Rate shown for FY 2021 is based on the per capita incomes for all AI/AN persons in the State for 2015- VI OK Alabama Quassarte Tribal Town 82% 82% 68.31 $20,973 2019 which is $20,973 +/- $359. Listed in ACS data as Citizen Potawatomi Nation-Absentee Shawnee OTSA, OK. The margin of error for the 2015-2019 per capita income VI OK Absentee Shawnee Tribe 83% 80% 68.31 $23,142 estimate is $3,986. Listed in ACS data as --Apache-Fort Sill Apache OTSA, VI OK Apache Tribe of Oklahoma 83% 83% 68.31 $18,766 OK. VI OK Caddo Indian Tribe 83% 83% 68.31 $20,023 Listed in ACS data as Caddo-Wichita-Delaware OTSA, OK. VI OK Cherokee Nation of Oklahoma 83% 83% 68.31 $19,763 Listed in ACS data as Cherokee OTSA, OK. Listed in ACS data as - OTSA, OK. The margin of VI OK Cheyenne & Arapaho Tribes 80% 82% 68.31 $22,154 error for the 2015-2019 per capita income estimate is +/- $3,966. The margin of error for the 2015-2019 per capita income estimate is +/- VI OK Chickasaw Nation 82% 82% 68.31 $21,710 $1,026. VI OK Choctaw Nation of Oklahoma 83% 83% 68.31 $18,295 Listed in ACS data as Choctaw OTSA, OK

Listed in ACS data as Citizen Potawatomi Nation-Absentee Shawnee VI OK Citizen-Potawatomi Nation 83% 83% 68.31 $20,841 OTSA, OK.. Listed in ACS data as Kiowa-Comanche-Apache-Fort Sill Apache OTSA, VI OK Comanche Tribe 83% 83% 68.31 $18,766 OK. VI OK Delaware Tribe of Indians 83% 83% 68.31 $20,023 Listed in ACS data as Caddo-Wichita-Delaware OTSA, OK

Page 4 Tribal FMAP Reference Table for FY 2021 and FY 2022 Per Capita Income FY 2021 Tribal FY 2022 Tribal FY 2022 State for the American FMAP (based FMAP (based FMAP (Rate of Indian/Alaska on American on American the State in Native Alone Community Community Which the Population for 2015- Survey 2014- Survey 2015- Tribe is 2019 (American 2018 data) 2019 data) Located) Community Survey 5-Year Estimate)

Region State Tribe/Tribal Association Notes on Per Capita Income Data

VI OK Eastern Shawnee 82% 83% 68.31 $21,036 Listed in ACS data as Kiowa-Comanche-Apache-Fort Sill Apache OTSA, VI OK Fort Sill Apache Tribe of Oklahoma 83% 83% 68.31 $18,766 OK.

VI OK Iowa 83% 83% 68.31 $13,048 VI OK Kaw Nation 83% 83% 68.31 $19,736 NONE This Tribe is not listed in ACS data. Rate shown for FY 2021 is based on the per capita incomes for all AI/AN persons in the State for 2015- VI OK Kialegee Tribal Town 82% 82% 68.31 $20,973 2019 which is $20,973 +/- $359. VI OK Kickapoo Tribe of Oklahoma 83% 83% 68.31 $16,407 NONE Listed in ACS data as Kiowa-Comanche-Apache-Fort Sill Apache OTSA, VI OK Kiowa 83% 83% 68.31 $18,766 OK.

VI OK Miami Tribe of Oklahoma 83% 83% 68.31 $18,241 VI OK Modoc Tribe of Oklahoma 83% 83% 68.31 $19,144 Listed in ACS data as Creek OTSA, OK. The margin of error for the VI OK Muscogee (Creek) Nation 80% 80% 68.31 $23,264 2015-2019 per capita income estimate is +/- $871. The margin of error for the 2015-2019 per capita income estimate is +/- VI OK Osage Tribe 79% 80% 68.31 $23,204 3,144. VI OK - Tribe 83% 83% 68.31 $13,887 NONE VI OK Ottawa Tribe of Oklahoma 83% 83% 68.31 $14,105 NONE The margin of error for the 2015-2019 per capita income estimate is +/- VI OK Pawnee Nation of Oklahoma 79% 83% 68.31 $21,556 $5,956. The margin of error for the 2015-2019 per capita income estimate is +/- VI OK Peoria Tribe of Oklahoma 79% 79% 68.31 $23,440 $3,147. VI OK Tribe of Oklahoma 83% 83% 68.31 $11,089 NONE VI OK Quapaw Tribe of Oklahoma 83% 83% 68.31 $17,949 NONE VI OK Sac & Fox Nation (Oklahoma) 83% 83% 68.31 $19,625 NONE VI OK Seminole Nation of Oklahoma 83% 83% 68.31 $16,460 NONE VI OK Seneca-Cayuga Tribe of Oklahoma 83% 83% 68.31 $17,506 NONE VI OK Tonkawa Tribe of Oklahoma 83% 83% 68.31 $16,552 NONE

Page 5 Tribal FMAP Reference Table for FY 2021 and FY 2022 Per Capita Income FY 2021 Tribal FY 2022 Tribal FY 2022 State for the American FMAP (based FMAP (based FMAP (Rate of Indian/Alaska on American on American the State in Native Alone Community Community Which the Population for 2015- Survey 2014- Survey 2015- Tribe is 2019 (American 2018 data) 2019 data) Located) Community Survey 5-Year Estimate)

Region State Tribe/Tribal Association Notes on Per Capita Income Data This Tribe is not listed in ACS data. Rate shown for FY 2021 is based United Keetoowah Band of Cherokee on the per capita incomes for all AI/AN persons in the State for 2015- VI OK Indians 82% 82% 68.31 $20,973 2019 which is $20,973 +/- $359. VI OK Wichita and Affiliated Tribes 83% 83% 68.31 $20,023 Listed in ACS data as Caddo-Wichita-Delaware OTSA, OK VI OK Wyandotte Nation 83% 83% 68.31 $15,829 NONE VI TX Kickapoo Traditional Tribe of Texas 83% 83% 60.80 $8,703 NONE Margin of error on the 2015-2019 per capita income estimate is +/- VI TX Alabama-Coushatta Tribe of Texas 83% 83% 60.80 $21,107 11,624.

Sac & Fox Tribe of the Mississippi in Listed in ACS data as Sac and Fox/ Settlement and Off- VII IA Iowa 83% 83% 62.14 $14,987 Reservation Trust Land, IA Listed in ACS data as Prairie Band of Potawatomi Nation Reservation, VII KS Prairie Band Pottawattamie Tribe 83% 83% 60.16 $15,917 KS. VII NE Omaha Tribe of 83% 83% 57.80 $10,063 Listed in ACS data as , NE--IA This Tribe is not listed in ACS data. Rate shown for FY 2021 is based on the per capita incomes for all AI/AN persons in the State for 2015- VII NE 83% 83% 57.80 $16,609 2019 which is $16,609 +/- $1,440. VII NE Santee Sioux of Nebraska 83% 83% 57.80 $14,767 Listed in ACS data as Santee Reservation, NE Listed in ACS data as Winnebago Reservation and Off-Reservation VII NE Winnebago Tribe of Nebraska 83% 83% 57.80 $12,892 Trust Land, NE--IA

VIII CO Ute Mountain Ute Tribe 83% 83% 50.00 $12,318 NONE Listed in ACS data as the Rocky Boy's Reservation and Off-Reservation VIII MT Chippewa Cree Tribe 83% 83% 64.90 $10,962 Trust Land, MT. Confederated Salish and Kootenai VIII MT Tribes of the Flathead Nation 83% 83% 64.90 $15,911 Listed in ACS data as the Flathead Reservation, MT Listed in ACS data as Crow Reservation and Off-Reservation Trust VIII MT Crow Tribe 83% 83% 64.90 $13,056 Land, MT. VIII MT Fort Belknap 83% 83% 64.90 $13,312 NONE Listed in ACS data as Fort Peck and Off-Reservation VIII MT Fort Peck Assiniboine and Sioux Tribes 83% 83% 64.90 $10,845 Trust Land, MT Listed in ACS data as Northern Cheyenne Indian Reservation and Off- VIII MT Northern Cheyenne 83% 83% 64.90 $13,906 Reservation Trust Land, MT--SD.

Page 6 Tribal FMAP Reference Table for FY 2021 and FY 2022 Per Capita Income FY 2021 Tribal FY 2022 Tribal FY 2022 State for the American FMAP (based FMAP (based FMAP (Rate of Indian/Alaska on American on American the State in Native Alone Community Community Which the Population for 2015- Survey 2014- Survey 2015- Tribe is 2019 (American 2018 data) 2019 data) Located) Community Survey 5-Year Estimate)

Region State Tribe/Tribal Association Notes on Per Capita Income Data

VIII ND Spirit Lake Tribal Social Services 83% 83% 53.59 $9,559 NONE VIII ND Standing Rock Sioux Tribe 83% 83% 53.59 $10,793 Listed in ACS data as Standing Rock Reservation, SD--ND

Three Affiliated Tribes - Fort Berthold Indian Reservation (Mandan, Hidatsa VIII ND and Nation) 82% 83% 53.59 $21,297 Listed in ACS data as Fort Berthold Reservation, ND Listed in ACS data as Turtle Mountain Reservation and Off-Reservation VIII ND Turtle Mt. Chippewa 83% 83% 53.59 $17,152 Trust Land, MT--ND--SD Listed in ACS data as Cheyenne River Reservation and Off-Reservation VIII SD Cheyenne River Sioux Tribe 83% 83% 58.69 $11,423 Trust Land, SD VIII SD Crow Creek Sioux 83% 83% 58.69 $10,904 Listed in ACS data as Crow Creek Reservation, SD. The margin of error on the 2015-2019 per capita income estimate is +/- VIII SD Flandreau Santee Sioux 83% 71% 58.69 $27,549 $18,549. VIII SD Lower Brule Sioux 83% 83% 58.69 $10,352 NONE VIII SD Sioux Tribe 83% 83% 58.69 $9,501 Listed in ACS data as Pine Ridge Reservation, SD--NE Listed in ACS data as Rosebud Indian Reservation and Off-Reservation VIII SD Rosebud Sioux 83% 83% 58.69 $8,563 Trust Land, SD Listed in ACS data as Lake Traverse Reservation and Off-Reservation VIII SD Sisseton-Wahpeton Oyate 83% 83% 58.69 $12,132 Trust Land, SD--ND VIII SD Yankton Sioux 83% 83% 58.69 $9,669 NONE Listed in ACS data as Uintah and Ouray Reservation and Off- Reservation Trust Land, UT. This Tribe's service population is AI/AN persons in a seven county area that includes Carbon, Duchesne, Emery, Grand, Uintah, Utah, and Wasatch counties in Utah. Per negotiations with the tribe on use of alternate data, the per capita income estimate shown is a weighted estimate of the AI/AN population in these seven VIII UT Ute Indian Tribe 79% 81% 66.83 $22,500 counties. Listed in ACS data as Wind River Reservation and Off-Reservation Trust VIII WY Eastern Shoshone Tribe 83% 83% 50.00 $14,626 Land, WY Listed in ACS data as Wind River Reservation and Off-Reservation Trust VIII WY Northern Arapaho Business Council 83% 83% 50.00 $14,626 Land, WY

Listed in ACS data as Navajo Nation Reservation and Off-Reservation IX AZ Navajo Nation 83% 83% 70.01 $12,431 Trust Land, AZ--NM--UT.

Page 7 Tribal FMAP Reference Table for FY 2021 and FY 2022 Per Capita Income FY 2021 Tribal FY 2022 Tribal FY 2022 State for the American FMAP (based FMAP (based FMAP (Rate of Indian/Alaska on American on American the State in Native Alone Community Community Which the Population for 2015- Survey 2014- Survey 2015- Tribe is 2019 (American 2018 data) 2019 data) Located) Community Survey 5-Year Estimate)

Region State Tribe/Tribal Association Notes on Per Capita Income Data Listed in ACS data as Pascua Pueblo Yaqui Reservation and Off- IX AZ Pascua Yaqui Tribe 83% 83% 70.01 $11,553 Reservation Trust Land, AZ. IX AZ Salt River Pima Maricopa Community 83% 83% 70.01 $14,488 Listed in ACS data as Salt River Reservation, AZ. Listed in ACS data as Tohono O'odham Nation Reservation and Off- IX AZ Tohono O'odham Nation 83% 83% 70.01 $16,609 Reservation Trust Land, AZ.

This Tribe is not listed in ACS data. The rate shown for FY 2021 is based on the per capita income for the entire AI/AN population in the state which is 24,930 +/- $502 in the ACS 5-year estimates for 2015- IX CA Dry Creek Rancheria 77% 76% 50.00 $24,930 2019. This Tribe is not listed in ACS data. The rate shown for FY 2021 is based on the per capita income for the entire AI/AN population in the state which is 24,930 +/- $502 in the ACS 5-year estimates for 2015- IX CA Enterprise Rancheria 77% 76% 50.00 $24,930 2019. This Tribe is not listed in ACS data. The rate shown for FY 2021 is based on the per capita income for the entire AI/AN population in the state which is 24,930 +/- $502 in the ACS 5-year estimates for 2015- IX CA Hopland Band of Pomo Indians 77% 76% 50.00 $24,930 2019. This Tribe is not listed in ACS data. The rate shown for FY 2021 is based on the per capita income for the entire AI/AN population in the state which is 24,930 +/- $502 in the ACS 5-year estimates for 2015- IX CA Ione Band of Miwok Indians 77% 76% 50.00 $24,930 2019. IX CA Karuk Tribe 83% 83% 50.00 $15,323 NONE Kashia Band of Pomo Indians of the IX CA Stewarts Point Rancheria 83% 83% 50.00 $9,483 Listed in ACS data as Stewarts Point Rancheria, CA

IX CA LaJolla Band of Luiseno Indians 83% 83% 50.00 $19,139 Listed in ACS data as the LaJolla Reservation, CA This Tribe is not listed in ACS data. The rate shown for FY 2021 is based on the per capita income for the entire AI/AN population in the state which is 24,930 +/- $502 in the ACS 5-year estimates for 2015- IX CA Middletown Rancheria 77% 76% 50.00 $24,930 2019.

The margin of error on the 2015-2019 per capita income estimate is +/- IX CA Pala Band of Mission Indians 50% 50% 50.00 $55,829 $9,078

Page 8 Tribal FMAP Reference Table for FY 2021 and FY 2022 Per Capita Income FY 2021 Tribal FY 2022 Tribal FY 2022 State for the American FMAP (based FMAP (based FMAP (Rate of Indian/Alaska on American on American the State in Native Alone Community Community Which the Population for 2015- Survey 2014- Survey 2015- Tribe is 2019 (American 2018 data) 2019 data) Located) Community Survey 5-Year Estimate)

Region State Tribe/Tribal Association Notes on Per Capita Income Data

IX CA Paiute-Shoshone Indians of Bishop 83% 83% 50.00 $19,332 Listed in ACS data as Bishop Reservation. Listed in ACS data as Round Valley Reservation and Off-Reservation IX CA Round Valley Indian Tribes 83% 83% 50.00 $16,995 Trust Land, CA. This Tribe is not listed in ACS data. The rate shown for FY 2021 is based on the per capita income for the entire AI/AN population in the state which is 24,930 +/- $502 in the ACS 5-year estimates for 2015- IX CA Scotts Valley Band of Pomo Indians 77% 76% 50.00 $24,930 2019.

Tolowa Dee-ni’ Nation of Smith River, IX CA California 83% 83% 50.00 $20,952 Listed in ACS data as Smith River Rancheria, CA

Listed in ACS data as Tule River Reservation and Off-Reservation Trust Land, CA. The margin of error for the 2015-2019 per capita income IX CA Tule River Tribal Council 83% 78% 50.00 $24,084 estimate is $13,728, CA Listed in ACS data as Washoe Ranches Trust Land, NV--CA. The and margin of error for the 2014-2018 per capita income estimate is +/- IX NV Washoe Tribe of Nevada and California 82% 83% 50.00 $19,764 $9,595. This Tribe is not listed in ACS data. The rate shown for FY 2021 is based on the per capita income for the entire AI/AN population in the state which is 24,930 +/- $502 in the ACS 5-year estimates for 2015- IX CA Wilton Rancheria 77% 76% 50.00 $24,930 2019.

IX CA Wiyot Tribe 83% 83% 50.00 $13,320 Listed in ACS data as the Table Bluff Reservation

IX CA Yurok Tribe 83% 83% 50.00 $13,707 Listed in ACS data as Yurok Reservation, CA.

IX NV Moapa Band of Paiutes 83% 83% 62.59 $14,489 Listed in ACS data as Moapa River Indian Reservation, NV

IX NV Pyramid Lake Paiute 83% 83% 62.59 $19,379

X AK Asa'Carsarmiut Tribal Council 83% 83% 50.00 $9,748 Listed in ACS data as Napakiak ANVSA, AK. Identified in ACS data as the Bristol Bay Alaska Native Regional X AK Bristol Bay Native Association 70% 83% 50.00 $19,480 Corporation.

X AK Chevak Native Village 83% 83% 50.00 $8,994 NONE

Page 9 Tribal FMAP Reference Table for FY 2021 and FY 2022 Per Capita Income FY 2021 Tribal FY 2022 Tribal FY 2022 State for the American FMAP (based FMAP (based FMAP (Rate of Indian/Alaska on American on American the State in Native Alone Community Community Which the Population for 2015- Survey 2014- Survey 2015- Tribe is 2019 (American 2018 data) 2019 data) Located) Community Survey 5-Year Estimate)

Region State Tribe/Tribal Association Notes on Per Capita Income Data The Copper River Native Association serves the villages of Kluti-Kaah (Copper Center), Tazlina, Gakona, Gulkana, and Cantwell. Figures shown are combined per capita incomes derived by weighting these villages' individual per capita incomes by their respective population X AK Copper River Native Association 81% 83% 50.00 $10,332 sizes. Listed in ACS data as Nome Census Area, AK. The margin of error for X AK Kawerak, Inc. 79% 76% 50.00 $25,199 the 2015-2019 per capita income estimate is $2,541. Listed in ACS data as the Kenaitze ANVSA, AK. The margin of error for X AK Kenaitze Tribe of Alaska 81% 76% 50.00 $25,067 the per capita income estimate for 2015-2019 is +/- $5,147. Listed in ACS data as Ketchikan ANVSA, AK. The margin of error for the X AK Ketchikan Indian Community 78% 63% 50.00 $31,108 per capita income estimate for 2015-2019 is +/- $9,224. The margin of error for the 2015-2019 per capita income estimate is +/- X AK Knik Tribal Council 82% 83% 50.00 $20,694 $3,229.

X AK Kodiak Area Native Association 83% 83% 50.00 $19,662 Listed in ACS data as Kodiak Island Borough.

X AK Maniilaq Association 83% 83% 50.00 $16,022 Listed in ACS data as Northwest Arctic Borough. Native Village of Barrow (Inupiat Listed in ACS data as Barrow ANVSA, AK. The margin of error on ACS X AK Community of the Arctic Slope) 78% 80% 50.00 $22,935 5-year per capita income estimate for 2015-2019 is +/- $3,416.

Listed in ACS data as Kotzebue ANVSA, AK. The margin of error for the X AK Native Village of Kotzebue 78% 81% 50.00 $22,549 per capita income estimate for 2015-2019 is +/- $2,712. Listed in ACS data as Bethel ANVSA, AK. The margin of error for the X AK Orutsararmiut Native Council 79% 83% 50.00 $21,479 Thisper capita Tribe's income service estimate area includes for 2015-2019 St. Paul isIsland +/- $3,271. as well as the Anchorage Metropolitan Area. Per discussion with tribal officials, the FMAP is based on a weighted combination of these two census areas. St. Paul Island is listed in ACS data as St. Paul ANVSA, AK and the Anchorage Metropolitan Area is listed both under MSAs or under X AK St. Paul 76% 78% 50.00 $23,932 Counties.

X AK Sun'aq' Tribe of Kodiak 83% 83% 50.00 $19,662 Listed in ACS data as Kodiak Island Borough. Listed in ACS data as Tanana ANVSA, AK. The margin of error for the X AK Tanana Chiefs Conference 83% 74% 50.00 $26,030 2015-2019 per capita income estimate is $7,762. X AK Tlingit and Haida Indian Tribes of Alaska 83% 83% 50.00 $20,183 Identified in ACS data as the Hoonah ANVSA, AK.

Page 10 Tribal FMAP Reference Table for FY 2021 and FY 2022 Per Capita Income FY 2021 Tribal FY 2022 Tribal FY 2022 State for the American FMAP (based FMAP (based FMAP (Rate of Indian/Alaska on American on American the State in Native Alone Community Community Which the Population for 2015- Survey 2014- Survey 2015- Tribe is 2019 (American 2018 data) 2019 data) Located) Community Survey 5-Year Estimate)

Region State Tribe/Tribal Association Notes on Per Capita Income Data X ID Coeur D'Alene Tribe 83% 83% 70.21 $16,467 NONE X ID Nez Perce Tribe 83% 83% 70.21 $14,855 NONE This Tribe is not listed in ACS data. The rate shown for FY 2021 is based on the per capita income of all AI/AN persons in the state which is X ID Northwest Band of the Shoshone Nation 83% 83% 70.21 18,339 $18,339 +/- $1,851 for 2015-2019. Listed in ACS data as Fort Hall Reservation and Off-Reservation Trust X ID Shoshone-Bannock Tribes 83% 83% 70.21 14,481 Land, ID Confederated Tribes of Coos, Lower Listed in ACS data as Coos, Lower Umpqua, and Siuslaw Reservation X OR Umpqua and Siuslaw Indians 83% 83% 60.22 13,253 and Off-Reservation Trust Land, OR. Listed in ACS data as Grand Ronde Community and Off-Reservation X OR Confederated Tribes of the Grand Ronde 83% 83% 60.22 17,364 Trust Land, OR. Listed in ACS data as Siletz Reservation and Off-Reservation Trust X OR Confederated Tribe of Siletz Indians 83% 83% 60.22 13,232 Land, OR. Listed in ACS data as Umatilla Reservation and Off-Reservation Trust X OR Confederated Tribes of the Umatilla 83% 83% 60.22 17,276 Land, OR. Listed in ACS data as Warm Springs Reservation and Off-Reservation X OR Confederated Tribe of Warm Springs 83% 83% 60.22 14,236 Trust Land, OR. The margin of error for the 2015-2019 per capital income estimate is X OR Coquille 83% 80% 60.22 22,956 $7,486. X OR Klamath Tribes 83% 83% 60.22 11,937 NONE Confederated Tribes of the Chehalis Listed in ACS data as Chehalis Reservation and Off-Reservation Trust X WA Reservation 83% 83% 50.00 $18,367 Land, WA Listed in ACS data as Colville Reservation and Off-Reservation Trust Confederated Tribe of the Colville Land, WA. The margin of error for the 2015-2019 per capita income X WA Reservation 83% 83% 50.00 $21,144 estimate is +/-$1,968. This Tribe is listed in ACS data but is too small for estimates to be generated for the AI/AN alone population. The per capita income for all X WA Jamestown S'Klallam Tribe 75% 80% 50.00 $23,237 persons on tribal lands in 2015-2019 is $23,237 +/-13,185.

X WA Lummi Nation 83% 83% 50.00 $13,737 NONE X WA Muckleshoot Tribe 83% 83% 50.00 $12,152 NONE X WA Nisqually Indian Tribe 76% 76% 50.00 $16,110 X WA Nooksack 83% 83% 50.00 $14,898 NONE

Page 11 Tribal FMAP Reference Table for FY 2021 and FY 2022 Per Capita Income FY 2021 Tribal FY 2022 Tribal FY 2022 State for the American FMAP (based FMAP (based FMAP (Rate of Indian/Alaska on American on American the State in Native Alone Community Community Which the Population for 2015- Survey 2014- Survey 2015- Tribe is 2019 (American 2018 data) 2019 data) Located) Community Survey 5-Year Estimate)

Region State Tribe/Tribal Association Notes on Per Capita Income Data Port Gamble S'Klallam Tribe (federally recognized as Port Gamble Indian Listed in ACS data as Port Gamble Reservation and Off-Reservation X WA Community) 83% 83% 50.00 $14,068 Trust Land, WA. SPIPA is comprised of five Tribes: Chehalis, Nisqually, Shoalwater Bay, Skokomish and Squaxin Island. However only two of the Tribes (Nisqually and Squaxin Island) are participating in the consortium's title IV-E planning grant and thus make up the consortium's title IV-E service population. The per capita income shown is a weighted estimate including only the two Tribes that make up the title IV-E service X WA South Puget Intertribal Planning Agency 83% 83% 50.00 $15,929 population.

X WA Squaxin Island Tribe 83% 83% 50.00 $15,587 NONE

X WA Skokomish 83% 83% 50.00 $18,369 NONE

Listed in ACS data as Tulalip Reservation and Off-Reservation Trust X WA Tulalip Tribes of Washington 74% 74% 50.00 $18,126 Land, WA.

Listed in ACS data as Port Madison Reservation, WA. The margin of X WA Suquamish Indian Tribe 75% 75% 50.00 $19,282 error for the 2014-2018 per capita income estimate is +/- $3,249.

X WA Yakama 83% 83% 50.00 $11,304 NONE

Page 12 Tribal FMAP Reference Table for FY 2021 and FY 2022