Federal Health Officials Urge States to Drop Mercury Fillings From Medicaid Coverage

On July 22, 2026, the Centers for Medicare & Medicaid Services took a notable step in the long-running debate over dental amalgam. The agency sent letters directly to Medicaid directors in every state, asking them to restrict or end reimbursement for amalgam-based fillings. Dental amalgam is a material that has been used for well over a century to fill cavities; it is composed of mercury combined with other metals such as silver, tin, and copper.

The guidance is not a federal mandate. Each state retains authority over its own Medicaid coverage decisions, and the letters are framed as encouragement rather than a requirement. Alongside phasing out amalgam coverage, CMS suggested that states consider creating financial incentives for dentists who use tooth-colored composite resin instead. The Indian Health Service, which provides dental care to American Indian and Alaska Native communities, had already announced plans earlier this year to stop using mercury amalgam by 2027.

The American Dental Association responded with some caution. The ADA's Council on Scientific Affairs noted that amalgam fillings remain a clinically appropriate option for certain patients — particularly in situations where moisture control is difficult, where cost is a limiting factor, or where other clinical conditions make composite materials less practical. That position reflects a broader concern among some dental professionals that a rapid, policy-driven shift away from amalgam could create access gaps for lower-income patients who rely on Medicaid.

For patients, the practical takeaway is that this guidance does not require anyone to remove existing amalgam fillings, and no federal ban is in place. What the CMS letter does signal is a shift in direction at the federal level, one that aligns with international trends — the European Union, for example, has already restricted amalgam use for children and pregnant women. How individual states respond, and how quickly, will vary. If you have questions about your own fillings or what materials your dentist uses, it is always reasonable to raise those concerns at your next appointment.