Federal Health Officials Urge States to Stop Covering Mercury Amalgam Fillings

In a notable regulatory development, the Centers for Medicare & Medicaid Services (CMS) sent a letter on July 22, 2026 to Medicaid directors in all fifty states, urging them to restrict or eliminate reimbursement for dental amalgam fillings. Amalgam is a cavity-filling material that combines mercury with other metals and has been used in dentistry for well over a century. The guidance asks states to consider cutting coverage for amalgam procedure codes or creating financial incentives for dentists to use composite resin and other mercury-free materials instead.

Importantly, this move is not a legal ban. The federal guidance does not immediately prohibit dentists from placing amalgam fillings, and each state retains the authority to set its own Medicaid coverage policies. Because Medicaid is jointly funded by federal and state governments, how quickly — or whether — individual states respond will vary considerably.

The push is not entirely new. The FDA has previously advised that certain groups, including children under six, pregnant women, and people with specific health conditions, consider avoiding amalgam whenever possible. The U.S. Indian Health Service separately announced earlier in 2026 that it would stop using amalgam altogether by 2027. Some countries party to the international Minamata Convention on Mercury have already phased out amalgam use nationally.

The American Dental Association has maintained that amalgam fillings are safe and notes they remain a practical option in certain clinical situations, particularly where moisture control or cost is a concern. Patients with questions about their existing fillings or future cavity treatment options are encouraged to speak with their dentist about what material is most appropriate for their individual circumstances.