Title IV-E of the Social Security Act provides federal support for foster care and adoption assistance programs. Since 2008, 5 tribes have been approved to operate their own title IV-E foster care programs, although more than 80 tribes initially expressed an interest in doing so. The Department of Health and Human Services (HHS) provides development grants and technical assistance to tribes interested in establishing a title IV-E program. This book examines obstacles facing tribes interested in directly operating a title IV-E program; and the assistance HHS has provided. Under title IV-E, states are entitled to open-ended reimbursement for the cost of providing foster care, adoption assistance, and (in states that choose to provide it) kinship guardianship assistance. Additional mandatory funding is available, on a capped basis, for services to youth who “age out” of foster care, or are expected to, and for Tribal Title IV-E plan development and technical assistance. The conclusion of this title provides information on child welfare proposals under the Title IV-E program.