The push toward universally designed assessments has influenced several states to modify items from their general achievement tests to improve their accessibility for all test takers. The current study involved the review of 159 items used by one state across four content areas including science, coupled with the review of 261 science items in three other states. The item reviews were conducted using the Accessibility Rating Matrix (Beddow et al. 2009), a tool for systematically identifying access barriers in test items, and for facilitating the subsequent modification process. The design allowed for within-state comparisons across several variables for one state and for within-content area (i.e., science) comparisons across states. Findings indicated that few items were optimally accessible and ratings were consistent across content areas, states, grade bands, and item types. Suggestions for modifying items are discussed and recommendations are offered to guide the development of optimally accessible test items.