Older Driver Licensing Policies
and Practices Database Update
March 2020
607 14th Street, NW, Suite 201 | Washington, DC 20005 | 202-638-5944
Title
Older Driver Licensing Policies and Practices Database Update
(March 2020)
Authors
Lindsey A. Graham, Jenna R. Darrah, and F. Dennis Thomas
Dunlap and Associates, Inc.
© 2020, AAA Foundation for Traffic Safety
Foreword
The safety and mobility of older drivers are important research topics within the AAA
Foundation’s focus area of vulnerable road users. As the number and proportion of older drivers
increases, the policies and practices for managing these drivers, including those who are
medically-at-risk, will be increasingly important.
This report documents the update of the Driver Licensing Policies and Practices database and
highlights commonalities across states and changes since the database was originally compiled
in 2009. This report and the accompanying database should be a useful reference for researchers,
policy makers, older and medically-at-risk drivers, as well as those who may assist or intervene
with such drivers.
C. Y. David Yang, Ph.D.
Executive Director
AAA Foundation for Traffic Safety
Acknowledgements
The authors gratefully acknowledge the assistance provided by the staff at the American
Association of Motor Vehicle Administrators (AAMVA). We also appreciate the time and effort
contributed by the state driver licensing agency personnel who responded to the information
requests. Without the insights provided by these professionals, this project would not have been
possible.
While this study could not have been accomplished without the assistance of these organizations
and individuals, the findings and conclusions presented herein are the responsibility of the
authors and do not necessarily reflect the opinions or policies of the other project participants.
About the Sponsor
AAA Foundation for Traffic Safety
607 14
th
Street, NW, Suite 201
Washington, D.C. 20005
202-638-5944
www.aaafoundation.org
Founded in 1947, the AAA Foundation for Traffic Safety in Washington, D.C., is a nonprofit,
publicly supported charitable research and education organization dedicated to saving lives by
preventing traffic crashes and reducing injuries when crashes occur. Funding for this report was
provided by voluntary contributions from AAA/CAA and their affiliated motor clubs, individual
members, AAA-affiliated insurance companies, and other organizations or sources.
This publication is distributed by the AAA Foundation for Traffic Safety at no charge, as a
public service. It may not be resold or used for commercial purposes without the explicit
permission of the foundation. It may, however, be copied in whole or in part and distributed free
of charge via any medium, provided the Foundation is given appropriate credit as the source of
the material. The AAA Foundation for Traffic Safety assumes no liability for the use or misuse
of any information, opinions, findings, conclusions or recommendations contained in this report.
If trade or manufacturer’s names are mentioned, it is only because they are considered essential
to the object of this report and their mention should not be construed as an endorsement. The
AAA Foundation for Traffic Safety does not endorse products or manufacturers.
Table of Contents
Introduction ..................................................................................................................................... 1
Objective ......................................................................................................................................... 1
Study Approach .............................................................................................................................. 1
Participants .................................................................................................................................. 1
Online Survey ............................................................................................................................. 1
Response Clarifications .............................................................................................................. 2
Results ............................................................................................................................................. 3
Renewal Cycle ............................................................................................................................ 3
In-person Renewal Requirements ............................................................................................... 4
Vision Requirements ................................................................................................................... 6
Reporting of Medical Conditions................................................................................................ 8
Medical Review Process ........................................................................................................... 10
Restrictions on Licenses ........................................................................................................... 12
License Examiner Training ....................................................................................................... 15
Public Outreach ......................................................................................................................... 16
Discussion ..................................................................................................................................... 17
Appendix: Survey Items ............................................................................................................... 18
List of Tables
Table 1. States with age-based renewal cycle length policies ........................................................ 3
Table 2. States with age-based in-person renewal frequency policies ............................................ 5
Table 3. States with age-based visual acuity testing policies ......................................................... 6
Table 4. States with a visual acuity requirement less than 20/40 ................................................... 7
Table 5. States with age-based visual field testing policies ............................................................ 7
Table 6. States including selected topics in specialized training for license examiners ............... 15
List of Figures
Figure 1. Percentage (and number) of jurisdictions using specialists for evaluations .................. 11
Figure 2. Percentage (and number) of jurisdictions using various license restrictions available . 12
Figure 3. Percentage (and number) of jurisdictions using vehicle equipment requirements ........ 13
1
Introduction
Senior driver safety and mobility continue to be priority research areas for the AAA Foundation
for Traffic Safety (AAAFTS). In 2009, AAAFTS conducted a nationwide review of state
licensing policies and practices related to older and medically-at-risk drivers
1
. The review covered
topics such as vision and other license renewal requirements, reporting of medically-at-risk
drivers, the medical review process, restrictions that could be placed on a driver’s license, license
examiner and staff training, and public outreach efforts to older drivers. The information
gathered in the review was used to create the online Driver Licensing Policies and Practices
(DLPP) database, which contained details on each state’s policies and practices. The efforts
described in this report represent the first systematic update of the database since the original
information was published in 2009.
Objective
The objective of this project was to document current, relevant driver licensing practices and
policies for all 50 states and the District of Columbia in order to update and expand the DLPP
database.
Study Approach
The basic study approach involved using the 2009 DLPP database as the stimulus material for an
online survey of state licensing personnel that was supplemented with telephone or email follow-
ups by the study staff. Rather than providing all new information, the respondent simply had to
verify the accuracy of the existing DLPP information. If the information was no longer accurate,
the respondent was asked to specify the change and to provide updated information. Information
was collected between January and April 2019.
Participants
Personnel from each state’s driver licensing agency responded to an online survey and, when
necessary, follow-up inquiries via email or phone. Some states had multiple representatives
provide information depending on their area of expertise and knowledge of licensing policies and
practices in that state.
Online Survey
A custom online survey was created for this project because of the need to include each state’s
existing DLPP information in the questions. Representatives from the licensing agencies were
emailed secure login credentials and a link to the survey. The link took the respondent to the
survey homepage with instructions on how to log in. Once logged in, the survey provided
instructions on how to complete the items and a list of links to the survey sections for the
following topic areas:
1
Stutts, J.C. & Wilkins, J.W. (2009). Driver Licensing Policies and Practices: Gearing Up for an Aging Population:
Project Summary Report. Washington, DC: AAA Foundation for Traffic Safety.
2
• Vision requirements
• License renewal requirements
• Reporting of at-risk drivers
• Medical review process
• Restrictions on licenses
• Examiner and staff training
• Outreach
• Licensing data
The entire survey, including flow logic details, can be found in the Appendix to this report. Most
items were the same as those utilized by the original survey conducted in 2009. Any changes or
additions to the survey are noted in the Appendix. Items were presented one at a time and the
response fields were pre-filled with information for the state in question from the existing DLPP.
Respondents were asked to update the information if the pre-filled response was not an accurate
reflection of their state’s current policies. If the pre-filled information was still correct, the
respondent clicked on a button to retain it and move on to the next item. If the respondent made a
change, the survey then asked for more information on when and why the change occurred.
Items could be skipped and returned to later if a respondent was unsure of an answer. The survey
took an average of 15 minutes to complete.
Response Clarifications
Study staff reviewed survey responses for coherence and completeness, and created a list of any
skipped items or responses for each state that needed clarification. The list of items needing
clarification was emailed to the main contact for each state with a request for a brief follow-up
phone conversation. Staff updated the files as appropriate based on the results of the
conversations.
3
Results
The results below summarize the survey findings for all 50 states and the District of Columbia.
Any use of the term “state” applies to all 51 jurisdictions. Policies and practices based on age are
highlighted as well as any updates made by respondents that indicated a policy change.
Individual state responses can be found at http://lpp.seniordrivers.org/. The ensuing information
has been distilled from this web resource and readers are encouraged to consult the full data
tables.
Renewal Cycle
Length of renewal cycle. States have a variety of renewal cycle lengths ranging from every year
to every 12 years. As shown in Table 1, 21 states (41.2%) currently have shorter renewal cycles
(required or optional) based on the age of the driver. The remaining 30 states have standard
renewal cycles for all drivers and do not have age-based license renewal cycle length policies.
Table 1. States with age-based renewal cycle length policies
State
Standard Renewal
Period in Years
Age-based Renewal Period in
Years
Arkansas
8
4 or 8 option at 70+
Arizona
12
5 at 65+
Connecticut
4 or 6 option
2, 4, or 6 option at 65+
Florida
8
6 at 80+
Hawaii
8
2 at 72+
Iowa
8
2 at 72+
Idaho
4 or 8 option
4 at 63+
Illinois
4
2 at 81-86; 1 at 87+
Indiana
6
3 at 75-84; 2 at 85+
Kansas
6
4 at 65+
Maine
6
4 at 65+
Missouri
6
3 at 70+
Montana
8
4 at 75+
North Carolina
8
5 at 66+
North Dakota
6
4 at 78+
New Mexico
4 or 8 option
1 at 79+
Nevada
8
4 at 65+
Pennsylvania
4
2 option at 65+
Rhode Island
5
2 at 75+
Texas
6
2 at 85+
Virginia
8
5 at 75+
4
Changes in renewal cycle length:
• Some states indicated that conforming to Real I.D. requirements impacted renewal
cycles.
o South Carolina had to shorten its renewal period from 10 years to 8 years for all
drivers.
o Alaska and Tennessee extended the license renewal period for all drivers from 5
years to 8 years.
o Kentucky went from a 4-year renewal to now having a 4 or 8-year option for all
drivers.
o Older drivers in Arkansas previously had the same 8-year renewal cycle as
standard, but now have a 4 or 8-year option for renewal.
• New Mexico now requires drivers over the age of 79 to renew every year (formerly
applied to age 75+).
In-person Renewal Requirements
In-person renewal at a licensing office is required by 45 states (88.2%). Fourteen of these states
(27.5%) require that every renewal be in person, 29 states (56.9%) require every other renewal
be in person, and two states (3.9%) require every third renewal be in person. The remaining six
states have the following in-person renewal requirements:
• Hawaii requires in-person renewal for every renewal unless the driver is out of state and
renewing by mail.
• Montana requires in-person renewal for every renewal for all drivers except when a
driver is temporarily residing out of Montana, or lives in a county without license
services. When these criteria are met, a driver is required to renew in person every other
renewal.
• New Hampshire requires in-person renewal for every renewal for all drivers unless the
driver is eligible for online renewal as indicated by a Renewal Identification Number on
the license. If eligible, in-person renewal is required for every other renewal.
• New York and Pennsylvania do not require in-person renewal.
• Nevada is unique because it requires in-person renewal every renewal cycle for drivers
under age 65 and every other renewal for drivers 65 and older. While the in-person
renewal requirement differs based on age, the time between in-person renewals is
equivalent in Nevada because older drivers have a shorter renewal cycle (4 years) than
other drivers (8 years).
5
Sixteen states (31.4%) have policies in place requiring older drivers to renew in person more
frequently than their younger counterparts (Table 2).
Table 2. States with age-based in-person renewal frequency policies
A number of states identified special requirements for mail-in or online renewals. Alaska does
not allow drivers who are over the age of 69 on the expiration date of the license to renew by
mail. Colorado allows drivers age 65 and older to renew by mail with a doctor’s approval.
Kansas allows driver’s ages 21-49 to renew online every other renewal, North Dakota allows
drivers to perform every other renewal online until age 65. Drivers 40 and older in Maryland
must submit a report from a vision specialist if renewing by mail. Montana requires a medical
and eye evaluation for all drivers submitting a mail-in or online renewal.
Changes in in-person renewal requirements.
• In-person renewal requirements were impacted in some states because of changes in
renewal cycle lengths related to Real I.D. requirements.
o Alaska (formerly every 10 years), South Carolina (formerly every 20 years), and
Tennessee (formerly every 10 years) now have in-person renewals for all drivers
every 16 years due to changes related to Real I.D. (except if the driver is age 69 or
older in Alaska).
o Kentucky went from having in-person renewals every 4 years to every 8 years for
all drivers.
o Vermont previously did not have an in-person renewal requirement, but now
specifies that photos must be renewed in person for all drivers every 8 years due
to Real I.D. requirements.
State
Standard In-Person
Renewal Frequency
Age-based In-Person
Renewal Frequency
Alaska
Every other
Every at 69+
California
Every third
Every at 70+
District of
Columbia
Every other
Every at 70+
Iowa
Every other
Every at 70+
Idaho
Every other
Every at 63+
Illinois
Every other
Every at 75+
Indiana
Every other
Every at 75+
Kansas
Every other
Every at 50+
Louisiana
Every other
Every at 70+
Massachusetts
Every other
Every at 75+
Maine
Every other
Every at 62+
Mississippi
Every other
Every at 71+
North Dakota
Every other
Every at 65+
Texas
Every other
Every at 79+
Virginia
Every other
Every at 75+
Washington
Every other
Every at 70+
6
• Colorado shifted in-person renewal for all drivers from every other renewal to every
third, or any time a photo is more than 10 years old.
• Georgia changed in-person renewal requirements from every 8 years to 16 years for all
drivers.
• Idaho lowered the age at which every renewal must be in person from 70 to 63.
• Indiana increased the age at which every renewal must be in person from 70 to 75.
• Iowa changed standard in-person renewal frequency from every 8 years to every 16 years
if a driver is under age 70, and now requires all renewals for ages 70 and older to be in
person (formerly 72 and up).
• Kansas now requires in-person renewals for drivers 50 and older (formerly 70 and older).
• New Jersey, Utah, and West Virginia decreased the frequency of in-person renewal from
every renewal to every other renewal for all drivers.
• Nevada now requires every renewal to be in person for all drivers under the age 65
(formerly every other renewal).
• North Dakota created an online renewal option, and drivers may perform every other
renewal online until age 65.
Vision Requirements
Visual acuity. On-site visual acuity testing is conducted by 37 states (72.5%) for drivers of all
ages during routine in-person license renewal. Four states (7.8%) only test visual acuity when
drivers reach a prescribed age, and Florida requires older drivers to pass a vision test or submit a
Mature Driver Vision Test form at every renewal regardless of location (see Table 3). Nine states
(17.6%) maintain visual acuity requirements but do not test visual acuity as a part of standard in-
person renewals.
Table 3. States with age-based visual acuity testing policies
Age-Based Testing
65+
80+
64+
First renewal after 40, 52, 62; Every renewal after 65
50+
7
Most states have a visual acuity requirement for all drivers of 20/40 (N = 40, 78.4%) to drive
without restrictions. Other similar requirements are 20/40 in at least one eye (N = 4, 7.8%), or
20/40 in both eyes (N = 2, 3.9%) for licensure without restrictions. The requirements for the five
states (9.8%) requiring less than 20/40 acuity are shown in Table 4. These visual acuity
requirements apply to all drivers regardless of age.
Table 4. States with a visual acuity requirement less than 20/40
State
Visual Acuity Requirement for
Licensure without Restrictions
Georgia
20/60
Kentucky
20/60 in at least one eye
Michigan
20/50
New Jersey
20/50
Oklahoma
20/50
Changes in visual acuity requirements:
• Colorado no longer has age-based vision testing requirements.
• Georgia now tests visual acuity during routine license renewals starting at age 64
(formerly starting at age 65).
• Michigan changed its visual acuity requirement from 20/40 to 20/50 for licensure without
restriction for all drivers.
• South Carolina no longer tests visual acuity during routine in-person license renewal.
Visual field testing. Twenty-three states (45.1%) perform visual field testing during in-person
license renewal for all ages. Three states (5.9%) only conduct visual field testing for older
drivers (see Table 5). Montana only tests applicants for a commercial driver’s license.
Table 5. States with age-based visual field testing policies
State
Age at which Visual Field Testing
Starts
Arizona
65+
Georgia
64+
Oregon
50+
Changes in visual field testing:
• Alaska and Montana added visual field testing to in-person renewals.
• Georgia changed from requiring visual field testing across all ages to beginning testing at
age 64.
• Indiana no longer tests visual fields during routine in-person renewal.
• Wyoming no longer tests if the driver presents a valid vision evaluation form.
Contrast sensitivity testing. No states reported testing contrast sensitivity during routine in-
person license renewal.
8
On-road Testing. Illinois is the only state that requires a road test for older drivers to renew their
license (starting at age 75).
Changes in age-based on-road testing requirements:
• New Hampshire removed its road test requirement for drivers over the age of 75 when
renewing a license.
Reporting of Medical Conditions
Self-reporting. Forty-seven states (92.2%) ask an applicant to self-report medical conditions
during license renewal regardless of age. Of these, 17 (33.3%) ask an applicant to self-report
irrespective of whether the renewal is in person, online, or via mail. The other 30 (58.8%) only
inquire if the renewal is in person. The remaining four states (7.8%) (Arkansas, Connecticut,
New Hampshire, and Pennsylvania) do not ever ask an applicant to self-report medical
conditions during license renewal.
Changes in self-reporting:
• Seventeen states (33.3%) (Alaska, California, Colorado, Georgia, Hawaii, Iowa, Maine,
Michigan, Nebraska, Nevada, New Mexico, New York, North Dakota, Utah, Vermont,
Virginia, and Wyoming) changed the requirement for reporting of medical conditions to
all renewals instead of only at in-person renewals.
• Connecticut no longer asks drivers to self-report during any routine license renewals.
Physician reporting. All states allow physicians to report a medically-at-risk driver, and those
reports are generally kept confidential. Exceptions to confidentiality are sometimes made when
reports are subpoenaed, admitted as evidence in review, or requested by the driver who was
reported. Six states (California, Delaware, Nevada, New Jersey, Oregon, and Pennsylvania) also
have circumstances under which physicians are required to report a medically-at-risk driver.
Most states (N = 37, 72.6%) protect physicians from civil damages as a result of a lawsuit for
reporting medically-at-risk drivers. States provide several methods for physicians to report
medically-at-risk drivers. The great majority of states (N = 42, 82.4%) have a physician reporting
form available to submit to the agency. Most of the states (N= 38, 74.5%) that allow physicians
to report have the form available online. In California, the form for reporting is also available
from the local county health officer. Almost all states (N = 48, 94.1%) will accept a letter from a
physician reporting a medically-at-risk driver.
Changes in physician reporting:
• Alaska, Indiana, Iowa, Maine, Michigan, and Montana now have fewer exceptions that
allow access to confidential reports made by physicians.
• Colorado, Iowa, Kansas, and Oklahoma now have a physician reporting form available
online.
• Georgia still accepts forms, but they are now only available online.
• Indiana still has forms available online, but removed the option for physicians to report
at-risk drivers by letter, and paper forms are no longer available from central or local
branch driver licensing offices.
• Kentucky and Michigan now protect physicians from civil damages.
9
Family, friend, and anonymous reporting. Almost all states (N = 46, 90.2%) allow family
members to report a medically-at-risk driver, with slightly fewer (N = 38, 74.5%) allowing
friends or acquaintances to report a driver. Very few states (N = 5, 9.8%) accept anonymous
reports. Nevada and South Carolina do not permit family or friends to report, but they are
allowed to ask the medically-at-risk driver’s physician to report the individual. Most states that
allow family and friend reporting keep these reports and the identity of the person reporting
confidential unless subpoenaed, admitted as evidence in review, or requested by driver. Twenty-
four states (47.1%) provide paper reporting forms at the central driver licensing office. Nineteen
states (37.3%) make paper forms available at local branch driver licensing offices. Forms are
available electronically in 25 states (49.0%). Thirty-eight states (74.5%) allow family and friends
to report by writing a letter.
Changes in family, friend, and anonymous reporting requirements:
• The District of Columbia now accepts reports from relatives.
• Hawaii and Nevada no longer accept reports from family.
• There are now fewer exceptions that allow access to confidential reports made by family
and friends in Alaska, Indiana, and Iowa.
• There are now more exceptions that allow access to confidential reports in Georgia,
Michigan, Rhode Island, and Vermont.
• Connecticut, Iowa, and Kansas made a report form available for download.
• Georgia and Indiana no longer have paper forms available at licensing offices as the
forms are only available online.
• Indiana no longer accepts letters from family or friends, while Kansas now has a letter
option that was previously not available.
Law enforcement reporting. Forty-seven states (92.2%) allow law enforcement to report at-risk
drivers using a paper form retrieved from the law enforcement agency, driver licensing office, or
online. Only six states (11.8%) (Iowa, Maryland, Massachusetts, Michigan, Texas, and
Wisconsin) have an online reporting system available. Law enforcement can also write letters in
19 states (37.3%). Seventeen states (33.3%) allow law enforcement to report a medically-at-risk
driver as part of a crash report. Arkansas is the only state that does not accept law enforcement
reports of medically-at-risk drivers via any method. In 19 states (37.3%), law enforcement
officers receive training to identify and report medically-at-risk drivers.
Changes in law enforcement reporting:
• Oklahoma law enforcement personnel now receive training to identify and report
medically-at-risk drivers.
• The driver licensing agencies in Maryland, Oklahoma, and Oregon now have a role in the
at-risk driver training provided to law enforcement.
• Alaska, Kentucky, South Carolina, and Vermont now have paper forms available for law
enforcement at local branch licensing offices.
• South Carolina no longer has forms available at law enforcement agencies.
• Iowa and Kansas now have online forms available for download. Idaho now accepts a
form for reporting and makes it available at the central licensing offices.
10
• Indiana no longer has paper forms available at the central or local branch licensing
offices, but the forms are still available on Indiana’s website.
• Iowa, Maryland, Massachusetts, Michigan, Texas, and Wisconsin have new online
systems for reporting.
Medical Review Process
Medical Advisory Board. A Medical Advisory Board (MAB) is currently active in 35 states
(68.6%). Thirty-one of these active MABs both advise on general policy for medically-at-risk
drivers and review individual cases regarding driving privileges. MABs in Minnesota and North
Carolina do not advise on general policy for medically-at-risk drivers but do advise on individual
cases. MABs in New York and Oklahoma only advise on general policy but do not review
individual cases. All states with an active MAB have an appeals process for drivers whose
licenses are revoked or restricted as part of the medical review process.
Among the 16 states (31.4%) with no active MAB, six have another mechanism for seeking
medical input on general policy for at-risk drivers. These six states either rely on standards set by
a previously active MAB, reactivate the old MAB if needed, seek input from the state medical
association and physicians, or employ part-time physicians. Fifteen states (29.4%) without an
active MAB obtain medical input on individual medically-at-risk drivers from the driver’s own
physician. Some of the 16 states have physicians (N = 4, 16.0%), nurses (N = 1, 2.0%), or nurse
practitioners on staff (N = 2, 3.9%) to review cases. All 16 states without an active MAB offer an
appeals or administrative hearing process for drivers whose privileges are revoked or restricted.
Currently, only Mississippi has no mechanism in place for the review of medically-at-risk
drivers.
Changes in the Medical Review Process:
• Michigan and Mississippi no longer have an active MAB.
o Michigan now obtains medical input on individual medically-at-risk drivers from
the driver’s own physician and/or driver evaluation/rehabilitation specialists.
o Mississippi does not have another mechanism in place for seeking input on
general policy or individual at-risk drivers.
• Three non-MAB states, Alaska, California, and Washington, now allow medical input
from physicians on the licensing agency staff.
• California and Washington now allow medical input from nurse practitioners on staff and
driver evaluation/rehabilitation specialists.
Referring drivers for medical or driving evaluation. As shown in Figure 1, the most common
referral approach across all 51 jurisdictions is to send drivers in need of medical evaluation to
their own physician (N = 49, 96.1%) or vision specialist (N = 43, 84.3%) for an exam. Figure 1
also shows that medical review staff in many states utilize other outside resources such as driver
rehabilitation specialists or occupational therapists for drivers in need of further evaluation.
Some states specified that drivers can also be referred for geriatric assessments or to adult
protective services.
11
Changes in referring drivers for evaluation or assistance:
• Alaska no longer refers drivers to driver rehabilitation specialists, but now refers drivers
to local DMV examiners for a road test or other evaluation.
• Hawaii now refers drivers to their own physicians for evaluations or assistance but did
not refer drivers for any evaluations previously.
• Medical review staff in Washington can now refer drivers to physicians and vision
specialists for specific exam needs.
• Wyoming now refers drivers to local DMV examiners instead of to occupational
therapists or driver rehabilitation specialists.
Figure 1. Percentage (and number) of jurisdictions using specialists for evaluations
N = 49
N= 33
N = 43
N = 32
N = 31
N = 12
N = 11
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Driver's own
physician
Other
specialty
physician
Vision
specialists
Occupational
therapists
Driving
Rehabilitation
specialists
Driving
schools
Local DMV
examiners
12
Restrictions on Licenses
Types of restrictions available. All states, except New Jersey, can impose some form of driving
restriction(s) on the license of a medically-at-risk driver. Figure 2 shows how many states can
implement different types of restrictions. Notably, 50 states (98.0%) (all but New Jersey) can
impose a daylight/daytime only restriction; 48 (94.1%) can require some type of special vehicle
equipment (see Figure 3 for types of equipment); 32 (62.8%) have a maximum speed restriction;
and 32 (62.8%) have a no driving on highway/freeway/interstates restriction. Other types of
restrictions include time of day, distance from home, trip duration, trip destination, passenger
required, passenger prohibited, and telescopic devices required.
Figure 2. Percentage (and number) of jurisdictions using various license restrictions
available
N=50
N=8
N=32 N=32
N=30
N=12
N=13
N=15
N=8
N=48
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
13
Figure 3. Percentage (and number) of jurisdictions using vehicle equipment requirements
Changes in types of license restrictions available:
• Connecticut, Georgia, Indiana, and Maine no longer implement speed restrictions.
Indiana, Maine, and Utah stopped implementing restrictions on
highway/freeway/interstate driving.
• California and Ohio added distance from home as a license restriction, but Florida,
Indiana, and New Mexico stopped using this type of restriction.
• Florida, Georgia, New Mexico, and Wyoming removed trip purpose from the available
restrictions, but Indiana added it as an option.
• Florida, Maine, and Wyoming stopped applying trip duration restrictions.
• Florida no longer issues license restrictions that require or prohibit passengers, and
Indiana can no longer require a passenger be present.
• Michigan and Virginia now have restrictions prohibiting passengers.
• North Carolina added a restriction to require a passenger.
• Arkansas and Mississippi can no longer require special vehicle equipment.
Who can impose restrictions. In 45 states (88.2%), medical review staff make decisions about
imposing restrictions or conditions on licenses of medically-at-risk drivers. Seventeen states
(33.3%) indicated that central licensing office staff can make decisions related to restrictions.
Local examiners can make decisions about imposing restrictions on medically-at-risk drivers in
30 states (58.8%), but their level of discretion varies depending on the state. Twenty of the states
that allow local examiners to make restriction decisions allow the examiner some level of
discretion while 8 states have standard guidelines that must be followed exactly. South Dakota is
the only state that allows local examiners full discretion when imposing license restrictions.
N=33
N=31
N=16
N=45
N=40
N=4
N=39
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Additional
mirrors
Pedal
extensions
Seat pads/
cushions
Hand controls Adaptive
steering wheel
Steering wheel
covers
Automatic
transmission
14
Changes in who can impose restrictions:
• Medical review staff in Arkansas, Iowa, and Rhode Island now make decisions on
restrictions.
• While local examiners still make these decisions in Kansas, medical review staff no
longer do.
• Central licensing staff in Indiana and Iowa make license restriction decisions now, and
local examiners no longer have that authority in Indiana.
• Conversely, central licensing staff in Michigan no longer make license restriction
decisions, but local examiners now can make such decisions.
• Alaska and New Hampshire no longer allow local examiners to make restriction
decisions, but Oklahoma now does.
• South Carolina now allows certified driver rehabilitation specialists to make decisions on
license restrictions.
• Local examiners in Florida and Utah now must follow guidelines for imposing
restrictions and no longer have discretion.
• Florida, Idaho, and Kansas no longer allow local examiners to revoke licenses.
• Local examiners in Idaho did not follow guidelines previously but now impose
restrictions based on physician evaluations.
• Idaho and Maine no longer allow drivers to appeal license restrictions imposed by local
examiners.
• Michigan and Oklahoma previously did not allow local examiners to make decisions but
now allow them to impose restrictions by following standardized guidelines.
• Michigan may also allow local examiners to impose additional restrictions when they feel
a need exists.
• A local examiner’s decision to restrict or revoke a license can now be appealed in
Michigan and Oklahoma.
15
License Examiner Training
Twenty-five states (49.0%) have specialized examiners who complete training specifically on
older and/or medically-at-risk driver issues. Another eight states (15.7%) provide some form of
specialized training to all local examiners. Eighteen states (35.3%) do not require examiners to
complete any training on older or medically-at-risk driver issues. The states indicated a wide
variety of training content. Table 6 shows how many states cover selected topics in their
training for license examiners.
Table 6. States including selected topics in specialized training for license examiners
Training Topics
Number of
States
Percent of
States with
Specialized
Training
Medical conditions that may affect driving ability
23
69.7%
Medications that may affect driving ability
9
27.3%
Effects of normal aging on driving ability
17
51.5%
Aging sensitivity training
15
45.5%
Crash and injury rates or crash characteristics of older drivers
5
15.2%
Uses and benefits of restricted or customized licensing
18
54.5%
When and how to refer drivers for comprehensive driving evaluation
19
57.6%
How to counsel older adults unable to renew their license
10
30.3%
Resource materials for older/medically-at-risk drivers and families
11
33.3%
How to observe for potential medical impairments
28
84.8%
Note: Percent based on the 33 states with any specialized training.
Changes in license examiner training:
• Georgia and Michigan have started providing specialized training to all local examiners.
• Nevada previously had training for specialized examiners, but no longer offers training
for any examiners.
• California, Maine, and North Dakota added coverage of the effects of normal aging on
driving ability to its training while Florida dropped this topic.
• North Dakota added, and Florida removed, a topic on medications affecting driving
ability.
• North Dakota and Oregon added, and Florida and Maine removed, topics about when and
how to refer drivers for evaluation.
• New Hampshire and North Dakota no longer provide training on the types of resource
materials available to older and/or medically impaired drivers and their families, but
Oregon has started training on the availability and types of resources.
• Oregon and Virginia added, and Florida removed, a topic on how to counsel adults
unable to renew their license.
• New Hampshire, North Dakota, and Virginia now cover medical conditions.
• North Dakota and Oregon also added aging sensitivity training for examiners.
• North Dakota now covers uses and benefits of restricted licenses.
• Florida no longer reviews crash and injury characteristics during training.
16
Public Outreach
State driver licensing handbook. Twenty-four states (47.1%) provide information about general
health and driving fitness in their state driver licensing handbook. Other topics covered less
frequently include aging and driving (N = 11, 21.6%), how to report an at-risk driver (N = 11,
21.6%), the decision to stop driving and surrender a license (N = 4, 7.8%), and driving
alternatives (N = 3, 5.9%).
Changes to the state driver license handbook:
• Hawaii and Oregon added health and driving fitness topics to their licensing handbooks.
• Florida and New Hampshire added aging and driving topics.
• Indiana removed the topic covering how to report at-risk drivers.
• Georgia removed health and fitness.
• Iowa removed health and driving fitness, aging and driving, decision to stop driving, and
driving alternatives topics.
• Michigan added health and driving fitness, aging and driving, how to report an at-risk
driver, decision to stop driving, and driving alternatives topics in its publication entitled
Michigan’s Guide for Aging Drivers.
Other outreach. Twenty-four states (47.1%) maintain a website with information specifically for
older drivers, and 20 (39.2%) maintain a website with information for medically-at-risk drivers.
A number of states, 14 (27.5%), make older driver safety materials available at local field
offices. In 18 states (35.3%), DMV staff give presentations to groups of older adults. Twelve
states (23.5%) provide information on available classroom driver refresher courses, and 13 states
(25.5%) provide information on resources for more in-depth assessment of driving skills. Five
states (9.8%) always have information on local alternative transportation options readily
available for drivers and publicize information at local offices. Fourteen other states (27.5%)
only make alternative transportation information available upon request.
Changes in outreach:
• Kansas added a website with information specifically for older and medically-at-risk
drivers.
• Michigan now has a website specifically for older drivers, but does not maintain a similar
website for medically-at-risk drivers.
• Nevada removed the previous website for older drivers and added a website for
medically-at-risk drivers.
• New Jersey no longer maintains a website for older or medically-at-risk drivers.
• Alaska, California, and Maine increased the frequency of licensing agency presentations
that are made to older adults.
• Alabama, Nevada, and New Hampshire decreased the frequency of presentations made
by their licensing agencies.
• Kansas added a medical and vision review page to its website for medically-at-risk and
older drivers, and made an older driver safety brochure available at local field offices.
• Michigan introduced the Safe Drivers Smart Options website, and made older driver
safety materials available at local branch offices.
17
• Nevada no longer has older driver safety materials available and has ceased providing
information on classroom driver refresher courses.
• Wisconsin no longer prints materials, but they are still available online.
• Oregon now provides information about refresher courses.
Discussion
The primary objective of this project was to update the existing Driver License Policies and
Practices database for older and medically-at-risk drivers by surveying knowledgeable personnel
from the driver licensing agencies of all 50 States and the District of Columbia. The survey was
largely the same as that conducted in 2009, although minor item revisions and additions were
made. State personnel from all 51 jurisdictions responded, verified whether the information from
the old database was still correct, and made updates if something had changed.
This document describes the revised DLPP database by providing a brief summary of the
findings of the survey in each major topic area and by highlighting changes in policies that have
taken place in the last 10 years. Respondents also noted reasons for some of these policy changes
(e.g., Real ID requirements impacting license renewal requirements). Many times, however, no
reason was provided, and the motivation for the change remains unknown.
The complete survey results presented in the web-based resource are intended for use by
policymakers, traffic safety stakeholders, and researchers. Anyone can search the database to see
a particular state’s full responses to the survey items. The results provide a snapshot of the
current licensing policies in the United States and can serve as a starting point for any future
research that is interested in analyses based on the existence of a particular policy in a state.
18
Appendix: Survey Items
Survey of State Driver License Agency Practices of Special Importance to Medically-At-
Risk and Older Drivers
Survey Login Page
19
Survey Navigation Page
20
Note: Any item below with a “*” has been modified from the original item that appeared in
the DLPP.
Renewal Requirements
1. Visual acuity requirements for licensure without restrictions other than corrective lenses
__________
2. Minimum visual acuity required for licensure, better eye or both eyes together, with or
without added restrictions or conditions
__________
3. Additional requirements for licensure if vision standards not met
__________
4. Are bioptic telescopes allowed for driving with, or without, added requirements or
restrictions?
Yes
No
5. Can bioptic telescopes be used to meet vision standards for licensure?
Yes
No
6. Minimum visual field requirements for licensure, in degrees
__________
7. *Standard length of license renewal cycle (in years)
__________
8. *Is the length of license renewal cycle different for older drivers?
Yes [Go to Q9]
No, same as standard [Skip to Q10]
9. *If length of license renewal is different for older drivers, provide the length of renewal
and age
__________
21
10. *Standard frequency for required in-person renewal
Every renewal
Every other renewal
Not required
Other (please describe): ___________
11. *Required in-person renewal frequency for older drivers, if different than standard
__________
12. Is visual acuity tested during routine in-person license renewal?
Yes
No
Other (please describe): ___________
13. Are visual fields tested during routine in-person license renewal?
Yes
No
Other (please describe): ___________
14. Is contrast sensitivity tested during routine in-person license renewal?
Yes
No
15. *Are applicants asked to report medical conditions during routine license renewals?
Yes, in-person renewal only
Yes, mail in or online renewals only
Yes, all renewals
No, not asked to report
16. Other routine requirements for license renewal
___________
17. Any age-based license renewal requirements? (Check all that apply)
More frequent renewal
In-person renewal
Vision testing
Road testing
Medical report
None
Other (please describe): ___________
18. *Additional information on license renewal requirements for older drivers in your state
_________________________________________________
22
Reporting of At-Risk Drivers
19. Does the driver license agency permit physicians to report medically-at-risk drivers?
Yes
No
20. Are there circumstances under which physicians are required to report an at-risk driver?
Yes
No
21. When physicians report a medically-at-risk driver, either by law or voluntarily, are
reports confidential?
Yes, without exception
Yes, unless EITHER subpoenaed/evidence in review or requested by driver
Yes, unless subpoenaed/admitted as evidence in review
Yes, unless requested by driver
No
Other (please describe): ___________
22. Are physicians who report in good faith protected from civil damages incurred as a result
of a lawsuit?
Yes
No
Other (please describe): ___________
23. How can physicians report a potential medically-at-risk driver? (Check all that apply)
Write a letter to the licensing agency
Submit a special form to the agency [Go to Q24; If not selected skip to Q25]
Other (please describe): ___________
24. Where can physicians obtain a form to report a medically-at-risk driver? (Check all that
apply)
Central driver licensing office
Local branch driver licensing office
Website (provide link): ___________
Other source (please describe):___________
25. Does the DMV provide, or assist other agencies in providing, education to encourage
physician reporting of potential at-risk drivers?
No
Yes; Describe ___________
26. Are reports about medically-at-risk drivers accepted from concerned family members?
Yes
No
23
27. Are reports about medically-at-risk drivers accepted from friends or acquaintances?
Yes
No
28. When family/friends report an at-risk driver, is their identity kept confidential?
Yes, without exception
Yes, unless EITHER subpoenaed/evidence in review or requested by driver
Yes, unless subpoenaed/admitted as evidence in review
Yes, unless requested by driver
No
Other (please describe): ___________
29. Are anonymous reports about at-risk drivers accepted?
Yes
No
30. How can family and/or friends report a potential medically-at-risk driver? (Check all that
apply)
Write a letter to the licensing agency
Submit a special form to the agency [Go to Q31; If not selected, skip to Q32]
Other (please describe): ___________
Our agency does not accept reports from family and friends
31. Where can family and/or friends obtain a form to report a medically-at-risk driver?
(Check all that apply)
Central driver licensing office
Local branch driver licensing office
Website (provide link): ___________
Other source (please describe): ___________
32. *Additional comments about the family and/or friends reporting process
___________
33. Does law enforcement receive training in identifying and reporting medically-at-risk
drivers?
Yes [Go to Q34]
No [Skip to Q35]
Don’t know [Skip to Q35]
34. Does your agency take a role in, or have input into, this law enforcement training?
Yes
No
24
35. *How can law enforcement personnel report a potential medically-at-risk driver? (Check
all that apply)
Form [Go to Q36; if not selected, skip to Q37]
Write a letter to the licensing agency
Online system
Crash report
Other (please describe): ___________
None
36. *Where can law enforcement obtain a form to report a medically-at-risk driver? (Check
all that apply)
Law enforcement agency
Central driver licensing office
Local branch driver licensing office
Website (provide link): ___________
Other source (please describe): ___________
Medical Review Process
37. Does this state have an active Medical Advisory Board (MAB)?
Yes [Go to Qs 38-41 and skip Qs 42-46]
No [Skip to Q42]
38. Does the MAB advise on general policy regarding medically-at-risk drivers?
Yes
No
Don’t know
39. Does the MAB advise on driving privileges for individual medically-at-risk drivers?
Yes
No
Other (please describe): ___________
40. Is there an appeals process for drivers whose privileges are revoked or restricted as part
of the medical review process?
Yes
No
Other (please describe): ___________
41. *Additional comments regarding the medical review process
___________ [Skip to Q47 even if no information provided]
25
42. Is there another mechanism for seeking medical input on general policy for medically-at-
risk drivers?
Yes
No
Don’t know
43. *How is medical input obtained on general policy regarding medically-at-risk drivers?
Describe: ___________
No mechanism
44. *How is medical input obtained on individual medically-at-risk drivers? (Check all that
apply)
Driver's own physician
Physician on staff
Registered nurse on staff
Nurse practitioner on staff
Medical consultant and/or contractual specialists
Driver evaluation specialists (e.g., Driver rehabilitation specialists)
There is no mechanism for seeking medical input on individual medically-at-risk
drivers
Other (please describe): ___________
45. Is there an appeals process for drivers whose privileges are revoked or restricted as part
of the medical review process?
Yes
No
Other (please describe): ___________
46. *Additional comments regarding the medical review process.
___________
47. *Where do medical review staff refer a reported driver in need of evaluation or
assistance? (Check all that apply)
Driver’s own physician
Other specialty physicians
Vision specialists
Occupational therapists
Driver rehabilitation specialists
Driving schools
Local DMV examiner for road test or other evaluations
Medical review staff do not refer outside the agency
Other (please describe): ___________
26
Restrictions on Licenses
48. Can this state impose restrictions or conditions on the licenses of medically-at-risk
drivers? (Note: Do not include routine requirements for corrective lenses, or restrictions
that may be imposed for alcohol-related violations, excess points, etc.)
Yes
No [Skip to Q57]
49. *What types of driving conditions or restrictions can be imposed? (Again, please do not
include restrictions that may be imposed for alcohol-related violations or other
nonmedical situations.) (Check all that apply)
Daytime/daylight driving only
Time of day (e.g., not during rush hour)
Speed
No Freeway/Interstate/Limited Access
Distance/radius from home
Trip duration
Specific trip destination or purpose
Passenger presence required
Passenger presence prohibited
Vehicle equipment [If selected, go to Q50. If not selected, skip to Q51]
Periodic or more frequent re-evaluations
Telescopic device required
Other possible restrictions used (please describe): ___________
50. *What type of vehicle equipment can be required? (Check all that apply)
Additional mirrors
Pedal extensions
Seat pads and cushions
Hand controls
Adaptive steering wheel devices
Steering wheel covers
Automatic transmission
Other (please describe): ___________
51. Additional details on restrictions
___________
52. Who can make decisions about imposing restrictions or conditions on licenses of
medically-at-risk drivers? (Check all that apply)
Medical review staff
Central licensing office staff
Local examiners [If selected, go to Q53; If not selected, skip to Q56]
Other (please describe): ___________
27
53. *Do local examiners follow guidelines when imposing restrictions on licenses?
Follow standardized guidelines for imposing license restrictions (e.g., a restriction
to daylight driving only based on vision test performance)
Follow standardized guidelines, but also have discretion in imposing additional
restrictions where they feel a need exists
There are no standardized guidelines for licensing restrictions imposed by local
examiners. All licensing restrictions and/or conditions are imposed at the
discretion of the examiner.
Other (please describe): ___________
54. *Can a local examiner’s decision to restrict the license of a medically-at-risk driver be
appealed?
Yes
No
55. *Can a local examiner’s decision to revoke the driver's license of a medically-at-risk
driver be appealed?
Yes
No
Local examiner’s cannot revoke the driver’s license of a medically-at-risk driver
56. Additional comments regarding restricted licenses or the appeals
___________
Examiner/Staff Training
57. *Are local examiners required to complete any training on older and/or medically-at-risk
drivers?
Yes, all local examiners [Go to Q58]
Yes, only specialized examiners [Go to Q58]
No [Skip to Q60]
28
58. *What topics are included in the specialized training? (Check all that apply)]
Medical conditions that may affect driving
ability
Medications that may affect driving ability
Effects of normal aging on driving ability
Aging sensitivity training (e.g., what it is like to have cataracts or joint
stiffness)
Crash and injury rates or crash characteristics of
older drivers
Uses and benefits of restricted or customized licensing
When and how to refer drivers for a comprehensive driving evaluation
How to counsel older adults who are unable to renew their license
Resource materials for older and/or medically impaired drivers and their
families
How to observe for potential medical impairments
Other (please describe): ___________
59. Additional comments regarding frequency of examiner training and/or training topics
___________
60. *Which of the following topics are covered in the state driver license handbook? (Check
all that apply)
Health and driving fitness
Aging and driving
How to report an at-risk driver
The decision to stop driving or surrender one’s license
Driving alternatives (e.g., information on state or local transportation resources)
None of the above
Outreach
61. *Does your agency maintain or sponsor a website that includes information especially for
older and/or medically-at-risk drivers? (Check all that apply)
Yes, we have a website that includes information especially for medically-at-risk
drivers; Provide link: ___________
Yes, we have a website that includes information especially for older drivers;
Provide link: ___________
No
62. *Do DMV staff give presentations to groups of older adults (e.g., at a senior center,
church, or retirement community)?
Yes, often
Yes, occasionally
Seldom or never
Don’t know
29
63. Additional comments regarding talking with older adults
___________
64. *Do local field offices have older driver safety materials available to customers?
Yes, offices are required to have materials available
Yes, all or most offices have materials available
Yes, only selected offices have materials available
No
Don’t know
65. *Do local licensing offices provide information on the following regarding in-depth
assessment/remediation of driving skills to older adults and families?
Classroom driver “refresher” courses, such as those offered by AAA or AARP
Local resources for more in-depth assessment and/or remediation of driving skills
None of the above
66. *Do local licensing offices provide information on local alternative transportation options
and how to access them?
Yes, we require that information is made available to the driving public and
publicized at local offices
Yes, information is always available to the driving public and publicized at local
offices
Yes, information is made available to individuals as appropriate or upon request
No
Don’t know
67. *Additional comments regarding providing information to seniors about driving safety
___________
Licensing Evaluation/Data
68. *Which of the following does your agency maintain computerized data on? (Check all
that apply)
Numbers and types of restrictions on drivers’ licenses
Sources of referrals for medically-at-risk drivers
Reasons for referrals of medically-at-risk drivers (e.g., medical condition or
diagnosis)
Outcomes (e.g., license status) of referrals for medically-at-risk drivers
None of the above
69. To your knowledge, has the effectiveness of any of your agency’s policies or
programs pertaining to older or medically-at-risk drivers been evaluated?
(Please include both formal and less formal, “in-house” evaluations.)
Yes [Go to Q70]
No [End of survey]
Don’t know [End of survey]
30
70. Please provide a one or two sentence description below of what was evaluated,
who carried out the evaluation, when it happened, and the final results:
___________
71. Use space below to provide any additional comments about program evaluation activities
and data:
___________