School sealant programs (SSPs) increase sealant prevalence among children lacking access to oral health care. SSPs, however, are substantially underused. From 2013 through 2018, the Centers for Disease Control and Prevention funded 18 states for SSP activities in high-need schools (>= 50% free and reduced-price meal program participation). From 2019 through 2020, the authors assessed SSPs’ impact in reducing caries and how states expanded SSPs. The authors also discuss potential barriers to expansion.