This bill requires each state to designate a single individual responsible for overseeing key fiscal and integrity functions in their Medicaid programs, effective January 1, 2028. That designated agent would be accountable for ensuring claims are processed accurately and timely, preventing fraud and waste, maintaining proper financial controls, and providing accurate financial reports to the federal government. The requirement applies to all state Medicaid plans and waivers, affecting state health officials and the administration of the Medicaid program in all states. The bill does not include any new federal funding or appropriations; it simply establishes an organizational and accountability requirement for states. By consolidating responsibility in a single fiscal agent, the legislation aims to improve oversight and reduce improper payments in the Medicaid program.