Text-to-speech (TTS) refers to technology that reads aloud digital text (Understood, 2019). For years, TTS and its human counterpart--read aloud--have generated controversy about when and for whom these supports should be allowed on state assessments (Thurlow, Christensen, & Rogers, n.d.; Thurlow & Weiner, n.d.; Thurlow, Laitusis, Dillon, Cook, Moen, Abedi, & O'Brien, 2009). The purpose of this report is to provide an updated review of state TTS policies across general assessments of reading, writing, mathematics, and science. The report provides an analysis of TTS by the support tier in which it is placed (i.e., accommodation, designated feature, or universal feature), by the specific parts of tests for which it is allowed (i.e., directions, passages/stimuli, or questions), and by the population of students who can use it (i.e., students with disabilities, English learners, or students without disabilities who are not English learners). Although text read aloud can be delivered to students in different ways, the current review focuses only on state policies for text-to-speech administered in English on computer-based tests. In addition, because the term most often used for technology-delivered read aloud on computer-based tests is TTS, this report uses that term. The results of the TTS policy analysis are presented in two sections. The first section shows policies mapped by content area, indicating the states that allow or prohibit TTS on passages or stimuli by accessibility tier. The second section presents information on the number of states that mention TTS use for student groups (i.e., general education students, students with disabilities, and English learners), by accessibility tier and content area.