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D = Dual eligibility exists but individual has income greater than 120% FPL. DOM pays Medicare Part B U = QI only in COE-054. Income is between 120% - 135% FPL. There is no dual eligibility for QI-1 individuals. DOM pays Medicare Part B premiums. Appendix A-4-c INACTIVE CATEGORIES OF ELIGIBILITY Certifying Agency Category of Eligibility (COE) Coverage Group Description Ending Date of COE SSI 006 Protected SSI Child (last child aged out 01/2014) (Mandatory) 1/31/2014 DOM 028 Demonstration to Maintain Independent Employment HIV Demonstration Project limited to 9 MS delta counties) 1115 waiver. (Optional) 9/30/2007 DOM 041 Poverty Level Aged or Disabled (PLAD) < 100% (Optional) 12/31/2005 DOM 042 Poverty Level Aged or Disabled (PLAD)< 120% (Optional) 12/31/2005 DOM 043 Poverty Level Aged or Disabled (PLAD) < 135% (Optional) 12/31/2005 DOM 046 PLAD Waiver - Cancer (1115 Waiver) (Optional) 12/31/2005 DOM 047 PLAD Waiver - Renal (1115 Waiver) (Optional) 12/31/2005 DOM 048 PLAD Waiver - Transplant (1115 Waiver) Ended (Optional) 12/31/2005 DOM 049 PLAD Waiver - Anti-Psychotic (1115 Waiver) (Optional) 12/31/2005 DOM 057 Qualified Individuals (QI)-2* (Mandatory) 12/31/2002 DOM 061 Hospice (Optional) 4/30/2005 DOM 067 HCBS MYPAC Waiver 1915(c) enrollment ended 09/30/2012 (Optional) 9/30/2014 DOM 085 Medical Assistance Intact Family. Effective 01/01/2014, no new applicants were added to this COE. Adults moved to COE-075 and COE-085 children moved to the appropriate new COE of 071, 072 or 073. New COE created for adults DOM 087 Children up to age 6 under 133% of poverty. Effective 01/01/2014, no new applicants were added to this COE. Children transitioned to COE-072. New COE created DOM 090 1973 Grandfathered Case (Mandatory) No remaining grandfathered cases DOM 091 Children under 19 under 100% of poverty. Effective 01/01/2014, no new applicants were added to this COE. Children transitioned to COE073 or 074, as appropriate. New COE created DOM 092 HR-1 - Hurricane Katrina 1115 Waiver 1/31/2006