State accountability systems assume standards based instruction and test content are highly aligned and opportunities to learn the content exist equally for all students. This alignment between content taught and tested is important to understand achievement, yet it is rarely examined. Teachers from Grades 3 to 8 participated along with students without disabilities (n = 116) and students with a disability (n =104) who received all mathematics instruction in their general education. Teachers recorded over 155 days of instructional information for mathematics and administered an interim mathematics test at the end of the year. We found an average of 44% of mathematics content standards were taught and tested, while 22% were not taught but tested. The results indicated students without disabilities did significantly better than students with disabilities on content taught and tested, but not so on content not taught but tested. Limitations and research needed conclude the article.