How states authorize postsecondary institutions to operate within their boundaries is one of the least well documented topics in higher education today. No two states do this the same way and jurisdictional boundaries among the state agencies that perform these functions are sometimes uncertain (Goldstein, Lacey, and Janiga 2006). The role of institutional accreditation in helping to ground these decisions is equally murky. Is accreditation required to apply for authorization to operate? If so, is there a defined window of time in which an institution must obtain accreditation? Or is there no relationship with accreditation whatsoever? Similarly, for programmatic or specialized accreditation in licensed occupations such as education or the health professions, is the completion of an accredited course of study required for an individual to obtain a license to practice or to sit for a licensing examination? Is appropriate programmatic or specialized accreditation required for institutions that only teach these fields to be authorized to operate within the state? The Council for Higher Education Accreditation (CHEA) wanted to shed more light on these matters on a state-by-state basis. In particular, it sought information on how states use accredited status in the decision to authorize postsecondary institutions--both newly created and existing out-of-state--to offer instruction and grant degrees in the state. At the same time, it wished to determine the various roles that state agencies play that look like accreditation--for example periodic quality monitoring or review through site visits or desk reviews--how these activities are described, and how they are related to institutional accreditation. Finally, CHEA wanted to determine the role that accredited status plays in state decisions about which institutions can receive state funds and how it affects an institution's ability to have its transfer credits accepted as part of any statewide transfer or articulation policy. To gather information around these questions, CHEA contracted the National Center for Higher Education Management Systems (NCHEMS) to conduct a fifty-state inventory of how states use accreditation. This report presents the results of this study in three main sections. The first section describes the broad picture of agency regulation by noting which state agencies are responsible for what. The second section looks specifically at the role of institutional accreditation in governing decisions about authorization to operate. The third section explores state connections with professional or specialized accreditation in connection with individual licenses to practice. A brief concluding section summarizes the major implications for policy. Individual State Summaries is appended. (Contains 5 tables and 11 footnotes.)