Every state’s Medicaid program has different requirements for reimbursing school mental health (SMH) services. In many cases, expanding coverage of SMH services in Medicaid requires seeking approval from the federal government for a State Plan Amendment (SPA) and/or a Medicaid waiver to make changes to these requirements. In this short report, we introduce SPAs and Medicaid waivers, and we give examples of how states have leveraged SPAs and Medicaid waivers to expand coverage of SMH services in their Medicaid programs.