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Appendix A-4- a Certifying Agency Category of Eligibility (COE) Coverage Group Description Mandatory or Optional SSI 001 SSI Individual Mandatory DOM 002 SSI Retro Eligibility Mandatory DHS 003 Adult refugees eligible under Refugee Resettlement Grant (identifiable with a Money Pay Indicator of "0") Mandatory Under the Grant CPS 003 Limited to IV-e foster children up to age 21 (identifiable on MMIS with a Money Pay Indicator of "3") Mandatory Limited to IV-e adoption assistance children up to age 21 (identifiable on MMIS with a Money Pay Indicator of "4") Mandatory SSI 005 SSI Only - Institution Mandatory DHS 007 Protected Foster Care Child to Age 26 Mandatory DOM 010 Nursing Facility - under 300% (SSI FBR) Optional DOM 011 Long Term Hospitalization - under 300% (SSI FBR) Optional DOM 012 Swing-Bed - under 300% (SSI FBR) Optional DOM 013 Nursing Facility - would be SSI if at home Optional DOM 014 Long Term Hospitalization - would be SSI if at home Optional DOM 015 Swing Bed-would be SSI if at home Optional DOM 019 Katie Beckett Program Optional DOM 020 Emergency - SSI limitations case Mandatory DOM 021 Emergency Services for Immigrants Not Otherwise Eligible Mandatory DOM 025 Working Disabled Optional CPS 026 Foster Care Child (non-Ive) (identifiable on MMIS with a Money Pay Indicator of "2") Optional Adoption Assistance (non-IVe) (identifiable on MMIS with a Money Pay Indicator of "5") Optional DOM 027 Uninsured Women with Breast/Cervical Cancer Optional DOM 029 Family Planning 1115 Waiver* Optional DOM 031 Qualified Medicare Beneficiaries (QMB)* Mandatory DOM 035 Qualifed Working Disabled Individual (QWDI)* (pays Medicare Part A) Mandatory DOM 045 Healthier MS 1115 Waiver - Aged & Disabled with no Medicare Optional DOM 051 Specified Low Income Medicare Beneficiares (SLMB)* Mandatory DOM 054 Qualified Individuals (QI)-1* Mandatory DOM 062 HCBS Assisted Living Waiver - 1915 (c) Optional