Background/Context: Testing accommodations have been widely utilized as a way of increasing the validity of content assessments for English language learner (ELL) students. However, concerns have also arisen regarding the appropriateness of accommodation use, including the accessibility and fairness of accommodations. While many states have developed ELL-specific accommodation policies and guidelines, little research has been available on how the accommodation policies are carried out in practice. Purpose/Objective/Research Question/Focus of Study: The present study investigated two states' accommodation policies, specifically for the states' respective large-scale Grade 8 math assessments, and conducted a case study to examine teachers' understanding of the policies and uses. The study aimed to identify issues to consider for an appropriate use of accommodations and provide useful information for policymakers to improve their accommodation policies. Research Design: The study utilized a qualitative method employing teacher surveys and interviews. The survey and interview instruments were developed based on previous literature and experts' feedback. The interview transcripts were coded by two researchers using a systematic coding scheme. Descriptive statistics of the responses were computed to observe trends across and within districts and schools. The results were also compared between states or between ELL and math teachers when applicable. Conclusions/Recommendations: Despite the limitation of the small sample in this study, the findings of the study offer practical implications for policymakers and educators in the use of accommodations for ELL students. The study found considerable variation reported by teachers with regard to the perception of accommodation decision makers, selection criteria, and the types of accommodations allowed in each state's math assessment. This variation raised serious concerns regarding the adequacy of the accommodation uses and the comparability of accommodated test results across schools. In this paper, we discussed a number of possible reasons for teachers' reported difficulty in keeping up with state policies: (a) lack of clear guidelines in making accommodation decisions and implementing accommodations in a standardized way, (b) lack of or limited opportunities in receiving information and communicating about accommodations among decision makers and teachers, and (c) limited resources and logistical difficulties. To support an appropriate use of accommodations for teachers, we recommend that states make efforts to provide comprehensive, operationalized guidelines for ELL accommodations, monitor the use of the guidelines, and hold regular professional meetings for ELL and content teachers.