Perfluorooctanoic acid (PFOA) is a synthetic, perfluorinated organic acid previously used in fluoropolymer production in the United States. PFOA has been a recent focal point for regulation because of its ubiquitous presence in drinking water throughout the United States. In 2016, the United States Environmental Protection Agency (US EPA) issued a lifetime drinking water Health Advisory (HA) for PFOA of 0.07 μg/L; several states have also implemented their own drinking water guidelines for PFOA. The current study aimed to evaluate the basis and derivation of state and federal guidelines for PFOA in drinking water, with particular emphasis on the exposure parameters utilized. Twelve distinct PFOA drinking water standards were identified ranging from 0.0051 to 2 μg/L. The US EPA HA assumptions were evaluated using a Monte Carlo analysis that included distributions for drinking water intake (DWI) rate and the relative source contribution (RSC). We determined that US EPA's HA of 0.07 μg/L is protective of 99% of the population of lactating women. We also demonstrated that the health-based guidelines were highly variable across states and that the actual RSC of PFOA from drinking water is likely greater than 20%, based on studies of actual PFOA exposures from dust, water, and food. A sensitivity analysis was performed using the same equations as the US EPA, while substituting the RSC and DWI variables; resulting in HAs ranging from 0.074 to 0.346 μg/L. We also evaluated the contribution of PFOA in drinking water to the systemic PFOA body burden of the general population using an available biokinetic model. We conclude that more rigorous efforts are warranted to establish consistent health-based drinking water guidelines for PFOA, given that drinking water is a primary source of human exposure to PFOA in the United States.