The reform was approved and made into a law by the lawmakers in the Folketing 26 June 2005 with elections to the 98 municipalities and 5 regions being held Tuesday 15 November 2005.

Lesser powers of the regions include public transport, environmental planning, soil pollution management and some coordination of secondary education.

Regions cannot decide their budgets independently, but must use the block grant for the purposes that are specified by the central government.

It is an advocacy and lobbying organisation speaking on behalf of all of the regions, including negotiating labour contracts, etc.

It was sometimes used to refer to Denmark proper as opposed to the North Atlantic parts of the Danish Realm, the Faroe Islands and Greenland.

They are also responsible for employment policies and public mass transit (buses and a few local railways).

Bornholm Regional Municipality because of its remote location in the Baltic Sea between Sweden and the westernmost part of Poland is its own employment region and is 100% owner of its own public mass transit agency, BAT, which was Bornholms Amts Trafikselskab until the island's county was abolished on 1 January 2003.

The regions own all public hospitals in their areas and also control the primary care sector through contracts with general physicians (family doctors) and specialists.

While the former counties controlled hospitals relatively independently, healthcare policy is now decided by the government, while regions administer it.

The projects, in Denmark known as 'super hospitals' (da: Supersygehus), were intended to increase the quality of care and reduce costs, but have almost uniformly experienced large-scale planning problems including breach of budgets, delays, interior climate problems, unsatisfactory design and last-minute cost cuts such as removing kitchens, decreasing the bed capacity or removing amenities for patients.

In addition, since 1999 the government has obliged Danish hospitals to increase their productivity by 2% per year for the same budget, in the expectation of possible benefits from technical progress, but often leading to cutbacks in services.

Doctors and other employees have demanded the withdrawal of the system, but the regions insist that it will remain in place and errors be corrected.

This is carried out through contracts with general practitioners who for the most part own their clinics and provide treatment free-of-charge for the public, according to specifications laid down by the region.

Since many areas have been affected by physician shortage, the regions have been compelled to open region-owned clinics to fill the gaps.

Health has remained the main issue in regional politics, especially because major changes to Denmark's hospital layout were announced immediately after the municipal reform.

The equivalent name for the upcoming regional councils were preparatory boards (forberedelsesudvalg) and these were likewise elected on 15 November 2005.

24 June 2004 the Danish People's Party decided to back the government's proposal for a structural reform of the public sector, thus securing a majority in the Danish parliament (Folketing), although the party had preferred just abolishing the counties without replacing them with a new administrative level between the central government and the municipalities.

The parties who wanted to limit the regional tier of government prevailed insofar as the regions have no authority to levy taxes, and are not municipalities unlike the former counties (1970–2006) (Danish amtskommune, literally 'county municipality'), and therefore cannot move budgets from one area of expenditure to another but must pay back any money not used, rather like departments or agencies of the central government.

Initially after the reform, effective from 1 January 2007, there were five state administrations, covering the same areas as the five regions.

They also acted as a complaints board for a wider range of decisions taken by municipalities, including social law.

From 1 July 2013, the State Administration was organised with one central office in Aabenraa and eight regional representations.

In media reports, the entity was criticized for bureaucratic handling of cases and negligence of the best interest of children.

Organizations of single fathers claimed that case officers were biased and would often side with the mother, for example when unproven accusations of incest or abuse were made.

A 2017 government plan proposed to abolish the State Administration and replace it with a new entity, the Family Law House (Familieretshuset).

One of the tasks of the State Administration is the technical and economic supervision of the dioceses within the Church of Denmark, along with the bishops.

Peculiarly, since the task is purely administrative and representing the government under the Ministry for Ecclesiastical Affairs, the person does not need to be a member of the Church of Denmark.

On the Faroe Islands and Greenland, after autonomy, the equivalent representative of the Danish government is the High Commissioner, (rigsombudsmand, formerly amtmand, which was often translated as governor).

The general public was mostly familiar with the former statsamt and then statsadministration as the entity dealing with divorce and child custody.