This paper will provide the school-based speech-language pathologist (SLP) with an overview of the federal requirements for Medicaid, including provider qualifications, “under the direction of” rule, medical necessity, and covered services. Billing, documentation, and reimbursement issues at the state level will be examined. A summary of the findings of the Office of Inspector General audits of state Medicaid plans is included as well as what SLPs need to do in order to ensure that services are delivered appropriately. Emerging trends and advocacy tools will complete the primer on Medicaid services in school settings.