Medeiros's report asks whether care-management actors exercised authority beyond approved program boundaries. That is sharper than calling every contractor a government actor. Constitutional claims usually require conduct attributable to the state; funding, licensing, or contracting alone is not enough. Yet Medicaid law can still leave the state responsible for its program. Under 2026 HCBS grievance rules, contractors may administer complaints, but the state retains responsibility. People served need accessible, impartial review. Medeiros retains speech and petition interests. ABI Resources may have separate process or contract rights. Delegation agreements, waiver terms, authorizations, billing, supervision, and the identity of the decision-maker determine accountability. Function and proof—not labels—control.