Medicaid is a federal-state partnership. States run their programs, but they must follow federal law and an approved state plan. CMS is the federal anchor: it reviews state plans and waivers, issues program requirements and guidance, monitors performance, and can require corrective action. That does not mean CMS decides every individual service dispute, enforces every civil-rights claim, or validates every complaint. HHS's Office for Civil Rights has a separate civil-rights role, while states handle eligibility, authorizations, providers, notices, and appeals. To make oversight possible, save the approved plan or waiver, service authorization, notices, appeal decisions, accessibility requests, claims data, and agency responses. A complaint is a lead, not a finding; speech is not an audit; an improper payment is not proof of fraud. Read the source-linked record at david-medeiros.com.