The use of alternate English language proficiency (Alt-ELP) assessments is an emerging phenomenon with real-life consequences for students with complex support needs from language minority homes. Our examination of U.S. state practices during the 2017-2018 academic year for the identification of English learners (ELs) with complex support needs revealed that only 36 states and the District of Columbia used an Alt-ELP assessment. In addition, some states provided criteria for students to exit EL services, but others did not report or have established redesignation criteria. We found that a wide range of redesignation criteria were adopted by states, revealing a lack of consensus about what constitutes ELP for students with complex support needs. These data suggested substantial challenges remain in developing and implementing Alt-ELP assessments. [This article was presented orally at the Diversity and Cultural Competence Research Colloquium at the 2019 TASH Conference on December 5, 2019.]