The use of English as a medium of instruction (EMI) has been expanding in higher education institutions across the globe. While this approach is associated with many benefits related to internationalization (de Wit, 2019), EMI poses difficulties for students with lower levels of English proficiency (Lasagabaster, 2022). To support students’ readiness for EMI, preparatory year programs (PYPs) are often used in Saudi Arabia to enhance students’ English language skills and prepare them to learn content in English (Curle et al., 2020). Previous studies conducted within Saudi institutions have described challenges related to students’ comprehension and achievement in PYPs (Alfehaid, 2018; Shamim et al., 2016) and shortcomings in student preparation for their disciplinary EMI programs (Aburizaizah, 2015). However, few studies investigate the integration of language into preparatory content courses and practices that support students’ linguistic development (see Eltoum, 2019). This study explores the strengths and weaknesses of PYPs to outline trends and recommendations for language support in Saudi higher education. Considering the continuous growth of EMI and the use of PYPs in other contexts, this research also describes how content and language teachers can promote students’ language development in foundation programs.