The article analyzes the role of the states in coordinating the response of the Unified Health System (SUS) to the COVID-19 pandemic. This documentary research was based on the 26 state contingency plans published between February 2020 and October 2021. The state governments acted in most dimensions analyzed: health emergency coordination, federative articulation, regulation, technical support, communication, integrated planning, service provision, financing, and cooperation. The results suggest the leading role of state governments in SUS management, emphasizing the search for integration, alignment, and cooperation between the sectors involved, besides decision-making based on scientific guidance and evidence. In a context of polarization and federative dispute, the state experience valued federative autonomy, a cooperative stance, and the institutional capacities in the SUS.