The purpose of this paper is to provide information and insight into how state assessment programs are governed, how individual state and state-consortium assessment programs actually operate, and how key policy and technical decisions on these programs are made. To address these issues, this paper is divided into three sections: First, the New England Common Assessment Program (NECAP) is presented in some detail as an assessment consortium that has struggled with a variety of challenges and, for the most part, has successfully overcome the obstacles. In fact, there are currently no large consortia operating that are tackling comprehensive, multi-grade, multi-subject, high-stakes assessment programs. The only current example is the NECAP Consortium developed originally by three states: New Hampshire, Rhode Island, and Vermont. Second, the Massachusetts Comprehensive Assessment System (MCAS) program is presented as an example of one state's journey in developing, operating, and maintaining a quality, high-stakes assessment program that is considered by many to be one of the best in the nation. Third, relevant features of the assessment programs in three other states (Kentucky, Michigan, and North Carolina) are briefly described to illustrate the different approaches and pressures that have helped to shape those programs.