Over the past 20 years, substance use (SU) among adolescents has decreased to the lowest levels in decades. While there has been a decline, these public health successes have not been shared equally. Significant racial and ethnic disparities exist, with Black and Latinx adolescents, as well as adolescents from lower socioeconomic backgrounds, demonstrating smaller SU declines. Additionally, LGBTQ adolescents are more likely than their cisgender heterosexual peers to report recent substance use and problematic use practices. More must be done to equip schools with the resources needed to support students struggling with substance use and/or mental health concerns. Research shows the need for comprehensive attention to equity and well-being, including school culture interventions that improve belonging and a true public health approach to prevention and early intervention. This policy brief focuses on one tool to help transform how schools care for students: leveraging Medicaid to increase access to--and funding for--school health services. It looks specifically at how Medicaid can support health services provided and paid for by school districts, and how states can shape their school Medicaid program to increase school reimbursement for SU prevention, early intervention and treatment services. The report identifies 10 specific actions that states can take to eliminate barriers to reimbursement for school-based substance use services. This additional and sustainable funding can create opportunities for more equitable access to healthcare and improved health and educational outcomes for all students. [Funding provided by the Foundation for Opioid Response Efforts (FORE).]