However, five regions (Friuli-Venezia Giulia, Sardinia, Sicily, Trentino-South Tyrol, and the Aosta Valley) have been granted a special status of autonomy to establish their own regional legislation on some specific local matters; based on cultural grounds, geographical location and on the presence of important ethnic minorities. The other 15 ordinary regions were effectively established only in the early 1970s.

Each region has an elected council and a Giunta Regionale (executive committee) headed by a directly elected president. The Giunta is responsible to the council and is required to resign if it fails to retain the council's confidence.

The regions primarily served to decentralize the state government machinery. A constitutional reform in 2001 remarkably widened the competences of the Regions, in particular concerning legislative powers and most of state controls were abolished.

In 2005 the centre-right government led by Silvio Berlusconi proposed a major reform of the constitution which would have entailed greatly increasing the powers of the regions in areas such as health and education. In June 2006, the proposals, which had been particularly associated with Berlusconi’s partners in government the Northern League, and seen by some as leading the way to a federal state, were rejected in a referendum by a margin of 61.7% to 38.3%.

Provincial and communal governments follow similar principles: councils and giunte headed by provincial presidents or communal mayors.
Regional autonomy (Federalism) has been made an issue in Italian politics in recent years, no doubt aided by the emergence of parties such as the Lega Nord.