Accommodations have been widely utilized as a way of increasing the validity of content assessments for ELL students. However, concerns have also arisen regarding the validity of accommodation use, as well as accessibility and fairness. 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. 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 of accommodations in their respective schools. Results indicated a wide variation in applying the policies in practice, which raises a validity concern for providing accommodations and interpreting accommodated test results. Based on the findings, implications and recommendations for an appropriate use of accommodations are offered. Summary tables for teacher survey responses are appended. (Contains 36 tables, 4 figures and 3 footnotes.)