Background: Behavioral, social, emotional, and educational risks among children and youth with school identified disabilities served in residential care have been well documented. However, the health care needs and medical service utilization of this high-risk population are less well known. Given the risks associated with children with disabilities, one might expect that medical care usage is elevated and will continue to be a need when children return home or age out of the system. The purpose of this study was to evaluate if medical service utilization differed between youth with and without school-identified disabilities in care, and whether certain correlates (e.g., demographic characteristics and mental health functioning) would be associated with medical service use among youth with disabilities. Method: Hierarchical multiple regression models were used to explore the role of disability status in the utilization of medical services as well as to predict the effects of mental health functioning on utilization while controlling for other known factors. Results: Results indicated that medical service usage for youth with school identified disabilities was statistically higher than usage for peers without disabilities after accounting for other factors associated with utilization, and internalizing and externalizing behavior severity were significantly related to medical service utilization for youth with disabilities. Conclusions: As expected, the findings suggest that youth with disabilities use more medical services than peers without disabilities regardless of the presence of a physical health condition, but might be due to differences in the severity of the physical health conditions.