The purpose of this topical review is to present Educational Policy Reform Research Institute's (EPRRI's) state-level qualitative findings collected during in depth interviews in the four core study states of California, Maryland, New York, and Texas. The data presented reflect the perspectives of state-level personnel who were involved with the creation and implementation of their state accountability systems at the time that the No Child Left Behind Act was written and signed into law. This paper presents a variety of voices, from division directors to parent representatives, and attempts to reveal the strengths and stresses of including students with disabilities in educational accountability reform.