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Medicalization is a central topic of concern in the sociology of disability and of health and illness. In this paper, I examine how medicalization is inequitably applied and circulates in the context of schools, specifically in serving students with educational disabilities. My aim is to advance understandings of medicalization through this case. Using a mixed-methods design, I first show, descriptively, how race and gender intersectionally predict educational disability status in a dataset of all Wisconsin public school students. Next, I examine how racial and gender disparities in disability status are produced at the micro level, using interviews with 27 Wisconsin teachers, including in-depth discussions of 73 individual students that were struggling academically or behaviorally. My quantitative findings show variation by race, gender, and disability category: White children have higher probability of special education receipt than comparable children of color for academic difficulties, but lower probability for behavioral difficulties, and girls have lower probability than comparable boys overall. My interview data suggest that these disparate outcomes reflect stratified medicalization processes, in which institutional constraints, status beliefs, and cultural discourses of race and gender shape both stratified noticing of schooling difficulties and stratified interpretation of those difficulties as medicalized conditions. • White children and boys are more likely than comparable peers to receive special education for higher-status disabilities. • Children of color and boys are more likely than comparable peers to receive special education for lower-status disabilities. • These inequalities are explained by stratified definitional processes of medicalization by teachers. • Institutional constraints and cultural discourses of race and gender shape stratified medicalization processes. • These processes include stratified noticing and stratified interpretation of students' difficulties. [ABSTRACT FROM AUTHOR]