Federal Medical Assistance Percentages (FMAPs) for FYs 2020-2021 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 2020 Tribal FY 2021 Tribal FY 2021 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 2014- Survey 2013- Survey 2014- Tribe is 2018 (American 2017 data) 2018 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% 63.69 $7,889 NONE I ME Houlton Band of Maliseets 83% 83% 63.69 $9,465 NONE I ME Passamaquoddy Pleasant Point 83% 83% 63.69 $14,127 Listed in ACS data as Pleasant Point Reservation, ME I ME Passamaquoddy Indian Township 83% 83% 63.69 $13,786 Listed in ACS data as Indian Township Reservation, ME I ME Penobscot 83% 83% 63.69 $17,013 NONE

I MA Wampanoag of Gay Head 83% 83% 50.00 $11,894 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 FY2021 is based on the per capita income for the entire AI/AN population in the state, which is $23,623 +/- $1,982 for I MA Mashpee Wampanoag 76% 77% 50.00 $23,623 the 5-year ACS estimates for 2014-2018.

Listed in ACS data as Cayuga Nation TDSA, NY. The margin of error for II NY Cayuga Nation of Indians 58% 50% 50.00 $36,380 2014-2018 estimate is +/- $21,097. 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 $22,378 +/- II NY Oneida Nation Social Services 79% 79% 50.00 $22,378 $2,426 in the 5-year ACS estimates for 2014-2018. 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 $16,148 population living on each reservation. II NY St. Regis Mohawk 83% 83% 50.00 $18,560 NONE

III NONE NONE NONE

Page 1 Tribal FMAP Reference Table for FY 2020 and FY 2021 Per Capita Income FY 2020 Tribal FY 2021 Tribal FY 2021 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 2014- Survey 2013- Survey 2014- Tribe is 2018 (American 2017 data) 2018 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% 72.58 $11,231 Trust Land, AL--FL IV NC Eastern Band of Cherokee 83% 83% 67.40 $19,461 Listed in ACS data as Eastern Cherokee Reservation.

V MI Bay Mills 83% 83% $19,627 NONE Grand Traverse Band of Ottawa & Listed in ACS data as Grand Traverse Reservation and Off-Reservation V MI Chippewa Indians 83% 83% 64.08 $17,501 Trust Land, MI V MI Hannahville Indian Community 83% 83% 64.08 $12,954

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 V MI Keweenaw Bay Indian Community 82% 81% 64.08 $21,436 counties. Lac Vieux Desert Band of Lake Superior V MI Chippewa Tribal Government 83% 83% 64.08 $10,619 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% 64.08 $14,960 Land, MI

Lake Traverse Bay Bands of Odawa Listed in ACS data as LakeTraverse Bay Reservation and Off- V MI Indians 83% 83% 64.08 $12,117 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 $23,913 +/- V MI Lake Tribe) 81% 76% 64.08 $23,913 $3,044 in the 5-year ACS estimates for 2014-2018. Listed in ACS data as Pokagon Reservation and Off-Reservation Trust Land, MI. The margin of error for the the 2014-2018 per capita income V MI Pokagon Band of Pottawatomi (MI & IN) 61% (64.06) 77% 64.08 $23,527 estimate is +/-$ 12,215.

Listed in ACS data as Isabella Reservation and Off-Reservation Trust Land, MI. The margin of error for the 2014-2018 per capita income estimate is +/-3,508. Calculated rate for 2020 is based on the Tribe's per capita income is 60% , but applicable rate shown in parenthesis is the V MI Saginaw Chippewa Tribe of Michigan 60% (64.04%) 69% 64.08 $27,404 higher state rate per the hold harmless provision.

Page 2 Tribal FMAP Reference Table for FY 2020 and FY 2021 Per Capita Income FY 2020 Tribal FY 2021 Tribal FY 2021 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 2014- Survey 2013- Survey 2014- Tribe is 2018 (American 2017 data) 2018 data) Located) Community Survey 5-Year Estimate)

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

Listed in ACS data as Sault Ste. Marie Reservation and Off-Reservation V MI Sault St. Marie Chippewa 83% 83% 64.08 $8,342 Trust Land, MI Listed in ACS data as Leech Lake Reservation and Off-Reservation V MN Leech Lake Band of Ojibwe 83% 83% 50.00 $14,322 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% 50.00 $14,461 Land, MN V MN Red Lake Band of Chippewa Indians 83% 83% 50.00 $11,180 Listed in ACS data as Red Lake Reservation, MN V MN White Earth Reservation Tribal Council 83% 83% 50.00 $13,042 NONE V WI Bad River 83% 83% 59.37 $18,166 NONE The margin of error for the 2014-2018 per capita income estimate is +/- V WI Forest County Potawatomi Community 61% 66% 59.37 $28,535 $4,935. V WI Ho-Chunk Nation 83% 83% 59.37 $19,288 NONE V WI Lac Courte Oreilles Tribal Gov Board 83% 83% 59.37 $13,641 NONE V WI Lac Du Flambeau 83% 83% 59.37 $15,096 NONE V WI Menominee Indian Tribe of Wisconsin 83% 83% 59.37 $14,979 NONE Red Cliff Band of Lake Superior Listed in ACS data as Red Cliff Reservation and Off-Reservation Trust V WI Chippewas 83% 83% 59.37 $17,821 Land, WI

Listed in ACS data as Stockbridge Munsee Community and Off- V WI Stockbridge-Munsee 83% 83% 59.37 $19,672 Reservation Trust Land, WI.

Listed in ACS data as Acoma Pueblo and Off-Reservation Trust Land, VI NM Acoma Pueblo 83% 83% 73.46 $13,709 NM Listed in ACS data as Jicarilla Apache Nation Reservation and Off- VI NM Jicarilla Apache Nation 83% 83% 73.46 $15,205 Reservation Trust Land, NM VI NM Pueblo of Cochiti 83% 83% 73.46 $15,719 Listed in ACS data as Pueblo de Cochiti, NM

VI NM Pueblo of Nambe 83% 83% 73.46 $17,360 VI NM Pueblo of Picuris 83% 83% 73.46 16,314 Listed in ACS data as Picuris Pueblo, NM Listed in ACS data as Pueblo of Pojoaque and Off-Reservation Trust Land, NM. The margin of error for the 2012-2016 per capita income VI NM Pueblo of Pojoaque 83% 83% 73.46 $18,824 estimate is +/- $3,719.

Page 3 Tribal FMAP Reference Table for FY 2020 and FY 2021 Per Capita Income FY 2020 Tribal FY 2021 Tribal FY 2021 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 2014- Survey 2013- Survey 2014- Tribe is 2018 (American 2017 data) 2018 data) Located) Community Survey 5-Year Estimate)

Region State Tribe/Tribal Association Notes on Per Capita Income Data Listed in ACS data as San Ildefonso Pueblo and Off-Reservation Trust VI NM Pueblo of San Ildefonso 83% 83% 73.46 $16,931 Land, NM VI NM Pueblo of Santa Ana 83% 83% 73.46 $14,968 Listed in ACS data as Santa Ana Pueblo, NM

VI NM Pueblo of Santa Clara 83% 83% 73.46 insufficent sample Listed in ACS data as Santa Clara Pueblo, NM. VI NM Pueblo of Taos 83% 83% 73.46 $16,698 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% 73.46 $11,439 NM--AZ Listed in ACS as Navajo Nation Reservation and Off-Reservation Trust VI NM Ramah Navajo School Board, Inc. 83% 83% 73.46 $11,770 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 2014- VI OK Alabama Quassarte Tribal Town 83% 82% 67.99 $21,092 2018 which is $21,902 +/- $670.

Listed in ACS data as Citizen Potawatomi Nation-Absentee Shawnee VI OK Absentee Shawnee Tribe 83% 83% 67.99 $19,423 OTSA, OK. Listed in ACS data as --Apache-Fort Sill Apache OTSA, VI OK Apache Tribe of Oklahoma 83% 83% 67.99 $17,271 OK. VI OK Caddo Indian Tribe 83% 83% 67.99 $14,623 Listed in ACS data as Caddo-Wichita-Delaware OTSA, OK. VI OK Cherokee Nation of Oklahoma 83% 83% 67.99 $19,066 Listed in ACS data as Cherokee OTSA, OK. Listed in ACS data as - OTSA, OK. The margin of VI OK Cheyenne & Arapaho Tribes 77% 80% 67.99 $22,103 error for the 2014-2018 per capita income estimate is +/- $3,956. The margin of error for the 2014-2018 per capita income estimate is +/- VI OK Chickasaw Nation 83% 82% 67.99 $20,633 $1,222 VI OK Choctaw Nation of Oklahoma 83% 83% 67.99 $17,643 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% 67.99 $19,423 OTSA, OK.. Listed in ACS data as Kiowa-Comanche-Apache-Fort Sill Apache OTSA, VI OK Comanche Tribe 83% 83% 67.99 $17,271 OK. VI OK Delaware Tribe of Indians 83% 83% 67.99 $14,623 Listed in ACS data as Caddo-Wichita-Delaware OTSA, OK

VI OK Eastern Shawnee 83% 82% 67.99 $20,822

Page 4 Tribal FMAP Reference Table for FY 2020 and FY 2021 Per Capita Income FY 2020 Tribal FY 2021 Tribal FY 2021 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 2014- Survey 2013- Survey 2014- Tribe is 2018 (American 2017 data) 2018 data) Located) Community Survey 5-Year Estimate)

Region State Tribe/Tribal Association Notes on Per Capita Income Data Listed in ACS data as Kiowa-Comanche-Apache-Fort Sill Apache OTSA, VI OK Fort Sill Apache Tribe of Oklahoma 83% 83% 67.99 $17,271 OK.

VI OK Iowa 79% 83% 67.99 $16,848 VI OK Kaw Nation 83% 83% 67.99 $20,610 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 2014- VI OK Kialegee Tribal Town 83% 82% 67.99 $21,092 2018 which is $21,902 +/- $670. VI OK Kickapoo Tribe of Oklahoma 83% 83% 67.99 $15,545 NONE Listed in ACS data as Kiowa-Comanche-Apache-Fort Sill Apache OTSA, VI OK Kiowa 83% 83% 67.99 $17,271 OK. VI OK Miami Tribe of Oklahoma 83% 83% 67.99 $19,181 VI OK Modoc Tribe of Oklahoma 83% 83% 67.99 $17,994 Listed in ACS data as Creek OTSA, OK. The margin of error for the 2014- VI OK Muscogee (Creek) Nation 80% 80% 67.99 $22,121 2018 per capita income estimate is +/- $686. The margin of error for the 2014-2018 per capita income estimate is +/- VI OK Osage Tribe 80% 79% 67.99 $22,359 2,820. VI OK - Tribe 83% 83% 67.99 $14,625 NONE VI OK Ottawa Tribe of Oklahoma 83% 83% 67.99 $14,342 NONE The margin of error for the 2014-2018 per capita income estimate is +/- VI OK Pawnee Nation of Oklahoma 77% 79% 67.99 $22,300 $4,491. The margin of error for the 2014-2018 per capita income estimate is +/- VI OK Peoria Tribe of Oklahoma 77% 79% 67.99 $23,434 $5,147. VI OK Tribe of Oklahoma 83% 83% 67.99 $10,119 NONE VI OK Quapaw Tribe of Oklahoma 83% 83% 67.99 $18,573 NONE VI OK Sac & Fox Nation (Oklahoma) 83% 83% 67.99 $19,502 NONE VI OK Seminole Nation of Oklahoma 83% 83% 67.99 $15,885 NONE VI OK Seneca-Cayuga Tribe of Oklahoma 83% 83% 67.99 $17,854 NONE VI OK Tonkawa Tribe of Oklahoma 83% 83% 67.99 $15,327 NONE 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 2014- VI OK Indians 83% 82% 67.99 $21,092 2018 which is $21,902 +/- $670.

Page 5 Tribal FMAP Reference Table for FY 2020 and FY 2021 Per Capita Income FY 2020 Tribal FY 2021 Tribal FY 2021 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 2014- Survey 2013- Survey 2014- Tribe is 2018 (American 2017 data) 2018 data) Located) Community Survey 5-Year Estimate)

Region State Tribe/Tribal Association Notes on Per Capita Income Data VI OK Wichita and Affiliated Tribes 83% 83% 67.99 $14,623 Listed in ACS data as Caddo-Wichita-Delaware OTSA, OK VI OK Wyandotte Nation 83% 83% 67.99 $15,350 NONE VI TX Kickapoo Traditional Tribe of Texas 83% 83% 61.81 $8,990 NONE

VI TX Alabama-Coushatta Tribe of Texas 82% 83% 61.81 $20,282

Sac & Fox Tribe of the Mississippi in Listed in ACS data as Sac and Fox/ Settlement and Off- VII IA Iowa 83% 83% 61.75 $13,886 Reservation Trust Land, IA Listed in ACS data as Prairie Band of Potawatomi Nation Reservation, VII KS Prairie Band Pottawattamie Tribe 50% (59.16%) 83% 59.68 $17,448 KS. VII NE Omaha Tribe of 83% 83% 56.47 $9,509 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 2014- VII NE 83% 83% 56.47 $15,874 2018 which is $15,874 +/- $2,720. VII NE Santee Sioux of Nebraska 83% 83% 56.47 $13,539 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% 56.47 $12,074 Trust Land, NE--IA

Listed in ACS data as the Rocky Boy's Reservation and Off-Reservation VIII MT Chippewa Cree Tribe 83% 83% 65.60 $10,920 Trust Land, MT. Confederated Salish and Kootenai VIII MT Tribes of the Flathead Nation 83% 83% 65.60 $15,938 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% 65.60 $13,344 Land, MT. VIII MT Fort Belknap 83% 83% 65.60 $12,717 NONE Listed in ACS data as Fort Peck and Off-Reservation VIII MT Fort Peck Assiniboine and Sioux Tribes 83% 83% 65.60 $10,940 Trust Land, MT Listed in ACS data as Northern Cheyenne Indian Reservation and Off- VIII MT Northern Cheyenne 83% 83% 65.60 $12,847 Reservation Trust Land, MT--SD. Listed in ACS data as Lake Traverse Reservation and Off-Reservation VIII ND Sisseton-Wahpeton Oyate 83% 83% 52.40 $12,117 Trust Land, SD--ND VIII ND Spirit Lake Tribal Social Services 83% 83% 52.40 $8,615 NONE VIII ND Standing Rock Sioux Tribe 83% 83% 52.40 $11,629 Listed in ACS data as Standing Rock Reservation, SD--ND

Page 6 Tribal FMAP Reference Table for FY 2020 and FY 2021 Per Capita Income FY 2020 Tribal FY 2021 Tribal FY 2021 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 2014- Survey 2013- Survey 2014- Tribe is 2018 (American 2017 data) 2018 data) Located) Community Survey 5-Year Estimate)

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

Three Affiliated Tribes - Fort Berthold Indian Reservation (Mandan, Hidatsa VIII ND and Nation) 83% 82% 52.40 $20,803 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% 52.40 $16,008 Trust Land, MT--ND--SD Listed in ACS data as Cheyenne River Reservation and Off-Reservation VIII SD Cheyenne River Sioux Tribe 83% 83% 58.28 $11,522 Trust Land, SD VIII SD Crow Creek Sioux 83% 83% 58.28 $10,358 Listed in ACS data as Crow Creek Reservation, SD. The margin of error on the 2014-2018 per capita income estimate is +/- VIII SD Flandreau Santee Sioux 77% 83% 58.28 $19,616 $9,774. VIII SD Lower Brule Sioux 83% 83% 58.28 $10,309 NONE VIII SD Sioux Tribe 83% 83% 58.28 $9,242 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% 58.28 $8,321 Trust Land, SD VIII SD Yankton Sioux 83% 83% 58.28 $9,013 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 78% 79% 67.52 $22,445 counties. VIII UT Ute Mountain Ute Tribe 83% 83% 67.52 $12,414 NONE Listed in ACS data as Wind River Reservation and Off-Reservation Trust VIII WY Eastern Shoshone Tribe 83% 83% 50.00 $14,339 Land, WY Listed in ACS data as Wind River Reservation and Off-Reservation Trust VIII WY Northern Arapaho Business Council 83% 83% 50.00 $14,339 Land, WY

Listed in ACS data as Navajo Nation Reservation and Off-Reservation IX AZ Navajo Nation 83% 83% 70.01 $11,770 Trust Land, AZ--NM--UT. Listed in ACS data as Pascua Pueblo Yaqui Reservation and Off- IX AZ Pascua Yaqui Tribe 83% 83% 70.01 $10,274 Reservation Trust Land, AZ. IX AZ Salt River Pima Maricopa Community 83% 83% 70.01 $15,374 Listed in ACS data as Salt River Reservation, AZ.

Page 7 Tribal FMAP Reference Table for FY 2020 and FY 2021 Per Capita Income FY 2020 Tribal FY 2021 Tribal FY 2021 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 2014- Survey 2013- Survey 2014- Tribe is 2018 (American 2017 data) 2018 data) Located) Community Survey 5-Year Estimate)

Region State Tribe/Tribal Association Notes on Per Capita Income Data Listed in ACS data as Tohono O'odham Nation Reservation and Off- IX AZ Tohono O'odham Nation 83% 83% 70.01 $10,708 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 23,641 +/- $546 in the ACS 5-year estimates for 2014- IX CA Dry Creek Rancheria 78% 77% 50.00 $23,641 2018. 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 23,641 +/- $546 in the ACS 5-year estimates for 2014- IX CA Enterprise Rancheria 78% 70% 50.00 $23,641 This2018. 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 23,641 +/- $546 in the ACS 5-year estimates for 2014- IX CA Hopland Band of Pomo Indians 78% 77% 50.00 $23,641 2018. 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 23,641 +/- $546 in the ACS 5-year estimates for 2014- IX CA Ione Band of Miwok Indians 78% 77% 50.00 $23,641 2018. IX CA Karuk Tribe 83% 83% 50.00 $12,670 NONE Kashia Band of Pomo Indians of the IX CA Stewarts Point Rancheria 83% 83% 50.00 $10,252 Listed in ACS data as Stewarts Point Rancheria, CA

IX CA LaJolla Band of Luiseno Indians 81% 83% 50.00 $19,696 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 23,641 +/- $546 in the ACS 5-year estimates for 2014- IX CA Middletown Rancheria 78% 77% 50.00 $23,641 2018.

IX CA Paiute-Shoshone Indians of Bishop 83% 83% 50.00 $19,319 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 $16,246 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 23,641 +/- $546 in the ACS 5-year estimates for 2014- IX CA Scotts Valley Band of Pomo Indians 78% 77% 50.00 $23,641 2018.

Page 8 Tribal FMAP Reference Table for FY 2020 and FY 2021 Per Capita Income FY 2020 Tribal FY 2021 Tribal FY 2021 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 2014- Survey 2013- Survey 2014- Tribe is 2018 (American 2017 data) 2018 data) Located) Community Survey 5-Year Estimate)

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

Tolowa Dee-ni’ Nation of Smith River, IX CA California 83% 83% 50.00 $13,810 Listed in ACS data as Tule River Reservation and Off-Reservation Trust IX CA Tule River Tribal Council 83% 83% 50.00 $20,056 Land, CA. 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 83% 82% 50.00 $21,183 $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 23,641 +/- $546 in the ACS 5-year estimates for 2014- IX CA Wilton Rancheria 75% 77% 50.00 $23,641 2018.

IX CA Wiyot Tribe 83% 83% 50.00 $12,051 Listed in ACS data as the Table Bluff Reservation

IX CA Yurok Tribe 83% 83% 50.00 $13,628 Listed in ACS data as Yurok Reservation, CA.

IX NV Moapa Band of Paiutes 83% 83% 63.30 $13,645 Listed in ACS data as Moapa River Indian Reservation, NV IX NV Pyramid Lake Paiute 83% 83% 63.30 $17,444

X AK Asa'Carsarmiut Tribal Council 83% 83% 50.00 $9,136 Listed in ACS data as Napakiak ANVSA, AK.

Identified in ACS data as the Bristol Bay Alaska Native Regional Corporation. The margin of error for the per capita income estimate for X AK Bristol Bay Native Association 59% 70% 50.00 $27,707 2014-2018 is +/- $1,468.

X AK Chevak Native Village 83% 83% 50.00 $9,373 NONE The Copper River Native Association serves the villages of Kluti-Kaah (Copper Center), Tazlina, Gakonka, 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 83% 81% 50.00 $21,276 sizes.

Page 9 Tribal FMAP Reference Table for FY 2020 and FY 2021 Per Capita Income FY 2020 Tribal FY 2021 Tribal FY 2021 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 2014- Survey 2013- Survey 2014- Tribe is 2018 (American 2017 data) 2018 data) Located) Community Survey 5-Year Estimate)

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

X AK Kawerak, Inc. 83% 79% 50.00 Listed in ACS data as Nome Census Area, AK. X AK Kenaitze Tribe of Alaska 80% 81% 50.00 $21,448 Listed in ACS data as the Kenaitze ANVSA, AK Listed in ACS data as Ketchikan ANVSA, AK. The margin of error for the X AK Ketchikan Indian Community 82% 78% 50.00 $23,291 per capita income estimate for 2014-2018 is +/- $6,496 The margin of error for the 2014-2018 per capita income estimate is +/- X AK Knik Tribal Council 77% 82% 50.00 $20,616 $3,096.

X AK Kodiak Area Native Association 83% 83% 50.00 $20,338 Listed in ACS data as Kodiak Island Borough.

X AK Maniilaq Association 83% 83% 50.00 $16,499 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 5- X AK Community of the Arctic Slope) 78% 78% 50.00 $23,133 year per capita income estimate for 2014-2018 is +/- $2,975.

Listed in ACS data as Kotzebue ANVSA, AK. The margin of error for the X AK Native Village of Kotzebue 78% 78% 50.00 $23,214 per capita income estimate for 2014-2018 is +/- $2,626. Listed in ACS data as Bethel ANVSA, AK. The margin of error for the per X AK Orutsararmiut Native Council 83% 79% 50.00 $22,642 Thiscapita Tribe's income service estimate area for includes 2014-2018 St. Paul is +/- Island $2,601. 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% 76% 50.00 $24,259 Counties.

Listed in ACS data as Kodiak Island Borough. The margin of error for X AK Sun'aq' Tribe of Kodiak 83% 83% 50.00 $20,388 the 2014-2018 per capita income estimate is +/- $2,853.

X AK Tanana Chiefs Conference 81% 83% 50.00 $19,266 Listed in ACS data as Tanana ANVSA, AK X AK Tlingit and Haida Indian Tribes of Alaska 77% 83% 50.00 $19,581 Identified in ACS data as the Hoonah ANVSA, AK.

Page 10 Tribal FMAP Reference Table for FY 2020 and FY 2021 Per Capita Income FY 2020 Tribal FY 2021 Tribal FY 2021 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 2014- Survey 2013- Survey 2014- Tribe is 2018 (American 2017 data) 2018 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% 70.41 $13,647 NONE X ID Nez Perce Tribe 83% 83% 70.41 $13,844 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% 70.41 18,279 $18,279 +/- $5,530 for 2014-2018.

Listed in ACS data as Fort Hall Reservation and Off-Reservation Trust X ID Shoshone-Bannock Tribes 83% 83% 70.41 13,444 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% 67.99 12,552 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% 67.99 19,512 Trust Land, OR. Listed in ACS data as Siletz Reservation and Off-Reservation Trust X OR Confederated Tribe of Siletz Indians 83% 83% 67.99 12,949 Land, OR. Listed in ACS data as Umatilla Reservation and Off-Reservation Trust X OR Confederated Tribes of the Umatilla 83% 83% 67.99 15,729 Land, OR. Listed in ACS data as Warm Springs Reservation and Off-Reservation X OR Confederated Tribe of Warm Springs 83% 83% 67.99 13,385 Trust Land, OR. X OR Coquille 83% 83% 67.99 20,348 NONE X OR Klamath Tribes 83% 83% 67.99 10,504 NONE Confederated Tribes of the Chehalis Listed in ACS data as Chehalis Reservation and Off-Reservation Trust X WA Reservation 83% 83% 50.00 $16,852 Land, WA Confederated Tribe of the Colville Listed in ACS data as Colville Reservation and Off-Reservation Trust X WA Reservation 83% 83% 50.00 $19,773 Land, WA. 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 52% 75% 50.00 $24,567 persons on tribal lands in 2014 -2018 is $24,567 +/-29,582

X WA Lummi Nation 83% 83% 50.00 $16,931 NONE X WA Muckleshoot Tribe 83% 83% 50.00 $17,401 NONE X WA Nisqually Indian Tribe 81% 76% 50.00 $24,084 Margin of error is +/- $5,379 X WA Nooksack 83% 83% 50.00 $14,349 NONE

Page 11 Tribal FMAP Reference Table for FY 2020 and FY 2021 Per Capita Income FY 2020 Tribal FY 2021 Tribal FY 2021 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 2014- Survey 2013- Survey 2014- Tribe is 2018 (American 2017 data) 2018 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 Community) Trust Land, WA. X WA 83% 83% 50.00 $16,990 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 $20,536 population.

X WA Squaxin Island Tribe 83% 83% 50.00 $13,774 NONE

X WA Skokomish 83% 83% 50.00 $13,695 NONE Listed in ACS data as Tulalip Reservation and Off-Reservation Trust Land, WA. The margin of error for the 2014-2018 per capita income X WA Tulalip Tribes of Washington 72% 74% 50.00 $24,827 estimate is +/- $3,201.

Listed in ACS data as Port Madison Reservation, WA. The margin of X WA Suquamish Indian Tribe 74% 75% 50.00 $24,727 error for the 2014-2018 per capita income estimate is +/- $3,249.

X WA Yakama 83% 83% 50.00 $13,851 NONE

Page 12 Tribal FMAP Reference Table for FY 2020 and FY 2021