I have active campaigns running on Meta Ads Manager that show as paused in GHL. I reported this to the support team and this was the response.
"Pausing or stopping the campaign from HighLevel may not work as expected. This happens due to delays or mismatches in the Meta API sync, which can cause inaccurate campaign status reporting."
And given that I can't do anything other than delete it, I ended the campaign inside of Meta Ads Manager but because there is not an accurate sync, GHL still shows the ad as running.
We can't even rely on the accuracy of the system to show that a campaign is or is not running. Major flaw, in my opinion