The new health exchange provisions of the Patient Protection and Affordable Care Act (PPACA) will usher in some complex and sensitive organizational issues and new interdependencies for state governments. Although the deadlines are still years away, states should begin to examine the situation as soon as possible. These three briefing papers discuss the critical points that state governments need to address in regard to structuring health exchanges, designing health plans and benefits, and setting the terms of participation for both insurance carriers and consumers.