English language learners (ELLs) with disabilities are an increasing presence in schools in the United States. Title I and Title III of the Elementary and Secondary Education Act require that these students meet the same academic grade-level standards and participate in content assessments as their fluent-English speaking peers without disabilities. Nevertheless, ELLs with disabilities are among the lowest achieving students. In addition to taking content assessments, they must also meet English proficiency standards and participate in English proficiency assessments. Still, many states do not have established assessment participation criteria and accommodation policies for ELLs with disabilities in their accountability systems in spite of this growing student population in schools across the states. The Improving the Validity of Assessment Results for ELLs with Disabilities (IVARED) project is a consortium of the five states of Arizona, Maine, Michigan, Minnesota, and Washington, led by Minnesota. In collaboration with the National Center on Educational Outcomes (NCEO), these states sought to understand ways to make state accountability assessments more valid and reliable for ELLs with disabilities. This report describes one of the project's activities undertaken to better understand the current assessment and accommodation decision-making process, test score use practices, and issues and challenges educators face in making appropriate decisions for ELLs with disabilities. Online focus groups of 232 school and district practitioners were conducted in each of the five states. Four major themes from the study's findings are highlighted in this report. These were common in the responses of participants from all five states: assessment validity, assessment participation decision making, accommodations decision making, and leadership: (1) Participants questioned the validity of standardized tests, particularly state academic content assessments. This was especially true because the educators believed that the cultural and linguistic complexity of the test items and test format were not designed for ELLs with disabilities; (2) Participants expressed confusion about federal assessment policies and their states' exemption practices for assessment participation requirements. The Individualized Education Program (IEP) was the primary process used for assessment participation decision making. Although, the IEP was typically idealized as collaborative and multi-disciplinary, this was not consistently realized in practice according to focus group participants; (3) Participants stated that the IEP process served primarily to make decisions about accommodations on content assessments, but less so for state English language proficiency assessments and accommodations; and (4) Participants described needs specific to ELLs with disabilities for support and guidance from school and state education leaders on assessment and accommodations. The needs were for additional qualified staff and training, clear and consistent written assessment policies, and appropriate uses of state accountability test scores. Based on the focus group findings, several recommendations for state departments of education are provided. "Focus Group Questions" are appended. [This report was produced by the Improving the Validity of Assessment Results for English Language Learners with Disabilities (IVARED) project of the National Center on Educational Outcomes. Alternate Title: "Voices from the Field: State Assessments for ELLs with Disabilities."]