Despite the contentious debate over national health care reform there seems to be one trend that has gained some degree of consensus at the state level – planning for implementation of state health benefit exchanges. The Patient Protection and Affordable Care Act (PPACA) has already provided $2.8 billion in funding to states to build benefit exchanges, expand Medicaid eligibility and continue prevention efforts. In addition to the substantial amount of funding states have already received, they will receive billions more during 2011 and beyond. The Affordable Care Act provides states with the unique opportunity to either develop and run their own exchange or default to the federal government to establish and operate the exchange. State CIOs will play varying roles in health care reform, but irrespective of their responsibilities it will be imperative to provide sound leadership and provide feedback to governors on any IT gaps that may exist during this momentous time.