State Exchange Accountability Act - Amends the Patient Protection and Affordable Care Act to require a state to reimburse the federal government for the amount of establishment or early innovator grants the state received to operate a health care exchange if it operated an exchange in 2014 but subsequently elected to provide for enrollment in qualified health plans solely through the federal health care exchange.

Requires that: (1) reimbursement be made in full within 10 years of such election, pursuant to an agreement with the Department of Health and Human Services (HHS); and (2) in case of failure to enter such an agreement, the Secretary of HHS shall reduce the state's Medicaid funding for 10 fiscal years in an aggregate amount equal to the reimbursement amount.