Older and medically at risk driver laws by state: a 2026 guide
How states handle older driver renewal, medical reports, DMV review and restricted licenses
Picture a daughter who notices fresh scrapes on her 84 year old father’s car. Last week he rolled through a stop sign. Can she tell the state? Will he learn it was her? Will he lose his license on the spot?
The answers depend on where he lives. Each state writes its own rules for renewal, medical reporting and retesting. Those rules change. In 2025, Illinois rewrote its older driver law [4].
Here’s how both tracks of the law work, from reports to restricted licenses, plus a 5 minute way to check your state.
Two legal tracks: age based renewal and medical review
Older driver law has two separate parts:
- Age based renewal rules apply to everyone who reaches a set age. They can shorten the renewal cycle, add a vision check or require an office visit.
- Medical review applies to a driver of any age when a doctor, officer, relative or licensing clerk raises a concern. The agency may then ask for medical reports, retest the driver or restrict the license [2].
“Medically at risk” doesn’t mean old. It means a health problem affects how well someone sees, thinks or moves behind the wheel.
Renewal rules for older drivers: the national picture
Ages in parentheses mark where a rule starts [1].
Comparison compiled by Safety Behind the Wheel Foundation
| Renewal rule tied to age | States (our count, IIHS, Oct. 2026) | Examples |
|---|---|---|
| Shorter renewal cycle, required | 19 | Arizona (60), Hawaii (72), Indiana (75), Rhode Island (75), New Mexico (71; yearly from 79) |
| Shorter cycle, driver’s choice | 4 | Arkansas, Connecticut, New Jersey, Pennsylvania |
| Vision proof at every renewal from a set age | 19 | Maryland (40), Oregon (50, in person), Maine (62), Ohio (65), Massachusetts (75) |
| Mail or online renewal barred or limited | 17 + DC | Kansas (65), Washington (70), Nevada (71, with doctor reports), Nebraska (72) |
| Routine road test at renewal | 1 | Illinois (87, from July 1, 2026) |
| No age based renewal rule | 17 | Listed below |
The shorter cycle count includes Illinois, whose new cycle rules take effect July 1, 2027, per the table [1]. In 21 states and DC, every driver proves adequate vision at every renewal, so age is not the trigger [1].
Seventeen states have no age based renewal rule on the IIHS table [1]. They are Alabama, Colorado, Delaware, Georgia, Kentucky, Michigan, Minnesota, Mississippi and New Hampshire. The rest are New York, Oklahoma, South Carolina, Tennessee, Vermont, West Virginia, Wisconsin and Wyoming.
Virginia’s DMV confirms that drivers 75 and older renew in person every 5 years [12]. For Florida and Texas, see our older driver safety guide.
Why the trackers disagree
GHSA counts 37 states and DC with special provisions, partly because it also counts reduced or waived fees [3]. GHSA also lists no older driver rule for Ohio. But IIHS lists a 4 year cycle, vision checks and in person renewal from 65 [1, 3].
Wisconsin’s DMV says online renewal is open to drivers up to 64. Drivers 65 and older should renew in person [11]. The IIHS table shows no age limit there [1]. A tracker is a map. The state’s own site settles it.
Road tests at renewal: rare, and Illinois just moved the line
No state on the IIHS table makes every older driver retake a road test. Illinois was the exception. A 2025 law raised the age for its routine renewal road test to 87, effective July 1, 2026 [1, 2, 4].
That law, House Bill 1226, requires road tests for commercial license holders 75 and older. It also lets immediate family members file medical information with the state, the National Conference of State Legislatures (NCSL) reports [4].
New Hampshire tested drivers 75 and older until 2011, IIHS reports [2]. GHSA’s chart still lists that rule [3], one more reason to confirm with the state.
Research on Illinois’s former rule was mixed. Insurance claim rates for drivers 75 and older were lower than in neighboring states. But fewer people that age kept car insurance [2]. That hints some people stopped driving instead.
Medical review: how licensing agencies judge fitness
More than half of states have a medical advisory board (MAB) or a similar arrangement with their health department. That’s according to Countermeasures That Work, a guide from the National Highway Traffic Safety Administration (NHTSA), citing a 2017 study [5]. These boards of physicians and other health professionals usually advise rather than decide [5].
Virginia’s board, for example, may restrict or revoke a license [12]. Medical expertise seems to help. In an NHTSA study of 4 states, more than 90% of referrals in the 3 with an MAB or medical staff led to a licensing action. Elsewhere, fewer than half did [5].
The national benchmark is the 2009 Driver Fitness Medical Guidelines from NHTSA and state licensing officials. These voluntary guidelines let each state choose a board, staff review or both. Only the licensing agency can suspend a license [7].
A review often includes:
Physician reporting: required in a few states, allowed in all
In all 50 states and DC, physicians may report a patient they think is unsafe to drive [5]. As of 2019, 6 states required reports for certain conditions, such as epilepsy or dementia [5]. Our medical conditions guide covers Pennsylvania’s and California’s rules.
Oregon shows how a broad mandatory law works [10]:
- Who must report: physicians and many other licensed providers, including nurse practitioners, optometrists and therapists.
- What triggers it: a cognitive or functional impairment that is both severe and uncontrollable, in a driver 14 or older. Severe means it substantially limits daily activities, including driving. Uncontrollable means treatment or devices can’t fix or offset it.
- What not to report: problems expected to clear within 6 months.
- What happens: a suspension that takes effect 5 days after notice, then medical review and testing.
- Protections: reports are confidential. Providers are immune from civil liability for good faith reports and for not reporting.
A study of older drivers in 37 states from 2004 to 2009 found no significant link between mandatory reporting laws and crash related hospital stays [5]. NHTSA notes that 27 states give legal immunity to physicians who report [5].
HIPAA, briefly. The federal health privacy rule lets providers share information when another law requires it [14]. It also permits good faith disclosure to someone reasonably able to prevent a serious and imminent threat to health or safety [14]. Oregon says its mandatory referral form complies with HIPAA [10]. State laws add rules, so clinicians should check with counsel.
Family, police and others: how referrals work
A national survey of licensing agencies, published in 2005, found police made 37% of referrals, medical professionals 35%, and family and friends 13% [5]. In Oregon today, medical professionals file about 60% of reports and police more than 35% [10].
States differ on the paperwork:
Comparison compiled by Safety Behind the Wheel Foundation
| State | Who may report | Signed or anonymous | Reporter’s identity |
|---|---|---|---|
| Florida | Any physician, person or agency | Not stated on the state’s page | Confidential by statute; no legal action against the reporter [13] |
| Oregon | Anyone, including family, police, courts and clinicians | Must be signed; anonymous reports barred by law | Confidential unless a court orders or in a hearing; police reports excepted [10] |
| Virginia | Anyone, in writing or on form MED 3 | Written report required | DMV may not release the source or reason when a relative or treating clinician reports [12] |
| Wisconsin | Clinicians, police, family and other citizens, on form MV3141 | Citizen reports need 2 signatures; no anonymous reports | Withheld as far as the law allows if you sign a confidentiality pledge (MV3454) at the DMV [11] |
Confidential is not anonymous. Wisconsin’s DMV knows who filed and will try to keep the name from the driver. But its open records law lets the driver see what was reported [11].
Oregon can’t accept a report based only on age, a diagnosis, general health or medicines [10]. Florida says referrals must rest on medical conditions or symptoms, not age [13].
How a referral usually works
- A written report arrives. It names the driver, gives a birth date and describes specific driving, with dates and places [10, 11].
- The agency screens it for specifics and a basis beyond age or diagnosis [10, 13].
- The driver gets a letter. It may request a medical report, schedule tests or set a suspension date [10, 12].
- A medical reviewer weighs the evidence, sometimes with the advisory board [5, 12].
- The driver takes any required tests: vision, knowledge or road [2, 10].
- The agency decides: no action, periodic review, restrictions or suspension [5, 12].
- The driver can contest it. Oregon drivers can request a hearing by the deadline on the notice [10].
Wisconsin stresses that it never cancels a license based on a citizen’s report alone [11].
Restricted licenses: a middle path
NHTSA reports that 49 states and DC can place at least some restrictions on older or medically at risk drivers [5]. Common ones limit driving to daytime, certain roads or speeds, a set area, or certain trip purposes [5].
Wisconsin’s list for medical professionals includes daylight only driving, a 15 mile radius from home (or another distance), and no freeway or interstate driving [11]. Some states also require adaptive equipment. Our medical conditions guide gives Pennsylvania’s codes.
The evidence is mostly encouraging. A 2018 NHTSA study found drivers generally followed their restrictions [5]. Restricted drivers in Iowa and Maryland had lower crash rates, while Virginia saw a slight rise [5]. In Iowa, location or speed limits were tied to about 25% fewer crashes, but daytime only limits were not [5].
Driver rehabilitation specialists match the limit to the problem. Glare suggests daylight only driving. Trouble with fast merges suggests no freeways.
Function, not diagnosis: what guidelines and laws say
The 2009 guidelines ask whether a condition affects a person visually, physically or cognitively in a way that endangers the public [7]. They call for case by case decisions and note that mild and moderate dementia may still allow safe driving [7].
NHTSA’s 2023 dementia fact sheet says a diagnosis alone isn’t enough reason to suspend a license [8]. A 2010 American Academy of Neurology (AAN) guideline found that a patient’s own rating of safe is not useful. A caregiver’s rating of marginal or unsafe is useful [9]. In studies the AAN reviewed, many people with very mild or mild dementia still passed road tests [9].
For families, that means a useful report reads “ran the red light at Main and 5th on May 3,” not “has Alzheimer’s.”
Do age based renewal laws work?
The best known study, from the AAA Foundation for Traffic Safety, covered 1985 to 2011 [6]. Requiring in person renewal was tied to 9% lower fatal crash involvement rates for drivers 55 and older, and 25% lower for drivers 85 and older [6].
Drivers 85 and older had lower rates in states with vision tests. But changes in vision rules weren’t linked to changes in crashes [6]. Shorter cycles, knowledge tests and road tests showed no significant benefit [6]. The study couldn’t tell whether gains came from removing unsafe drivers or from people quitting too early [6].
A 2025 study cited by IIHS linked longer gaps between renewals to higher injury rates for drivers 75 and older [2]. Allowing remote renewal was linked to more crashes for drivers 65 to 74 [2].
NHTSA’s Countermeasures That Work gives referral systems and license restrictions 4 of 5 stars. In person renewal with vision tests, and medical review protocols, get 2 stars [5].
Passing renewal is the legal minimum, not proof of safety. Pair it with yearly eye exams and medicine reviews.
How to verify your state's rules in 5 minutes
- Find your agency through USA.gov. Search its site for “medical review,” “unsafe driver” and “mature driver.”
- Check renewal rules for your age. Compare them with the IIHS table and note its date.
- Open the report form. Note who may file, whether signatures are needed and what it says about confidentiality.
- Find the statute. DMV pages often cite it, as Oregon’s does. Check whether clinicians must report and what immunity applies.
- Check for recent changes in NCSL’s bill database, then write down the date. Our state law lookup hub explains each step.
Frequently asked questions
Do older drivers have to retake the driving test?
Usually not. On the IIHS table, only Illinois requires a routine renewal road test, starting at 87 [1]. Licensing agencies can also order one after a medical referral [2].
Can I report an elderly parent to the DMV anonymously?
Often not. Oregon can’t accept anonymous reports. Wisconsin requires 2 signatures on citizen reports [10, 11]. Many states keep the reporter’s name confidential instead.
Will my parent find out I reported them?
It depends on the state. Virginia may not release the source of a report from a relative [12]. Wisconsin’s open records law lets the driver see what was reported [11].
The bottom line
Recommendation from Safety Behind the Wheel Foundation
Know your state’s renewal rules for your age and how its medical review works. If you’re worried about a driver, file a specific, signed report about what you saw. Ask about a restricted license before anyone hands over the keys.
Related articles
- Older driver safety: how to keep driving safely and confidently
- Medical conditions and driving: why function, not diagnosis, decides
- Returning to driving after brain injury or surgery: are you really ready?
- Driving with a disability: adapted vehicles, hand controls and next steps
- State traffic safety laws: how to look up and verify your state’s rules
Sources and further reading
- 1Insurance Institute for Highway Safety (IIHS). License renewal procedures for older drivers (state table, including footnotes). Current as of October 2026. iihs.org/…/license-renewal-laws-table
- 2IIHS. Older drivers (research area: licensing, medical referrals and restrictions; summarizes Tefft 2014, Hamann et al. 2025 and HLDI 2016). Updated July 2026. iihs.org/research-areas/older-drivers
- 3Governors Highway Safety Association (GHSA). Mature & elderly drivers (state law summary and chart). Overview updated June 2026; laws last reviewed by state highway safety offices June 2025. ghsa.org/state-laws-issues/mature-elderly-drivers
- 4National Conference of State Legislatures (NCSL). Traffic safety trends: state legislative action 2025 (Older drivers section; Illinois HB 1226). Updated September 9, 2026. ncsl.org/transportation/traffic-safety-trends-state-legislative-action-2025
- 5National Highway Traffic Safety Administration (NHTSA). Countermeasures That Work, Older Drivers chapter: Licensing agency referrals; Medical review protocols; License restrictions; In-person renewal and vision test. No edition date shown; accessed October 2026. referrals; medical review; restrictions; in-person renewal
- 6Tefft BC, AAA Foundation for Traffic Safety. Driver License Renewal Policies and Fatal Crash Involvement Rates of Older Drivers, United States, 1985 to 2011. July 2014. aaafoundation.org/…/OlderDriverLicenseRenewalReport.pdf
- 7NHTSA and American Association of Motor Vehicle Administrators (AAMVA). Driver Fitness Medical Guidelines. DOT HS 811 210. September 2009. nhtsa.gov/sites/nhtsa.gov/files/811210.pdf
- 8NHTSA. Dementia: Driving-Related Fact Sheet for Medical Professionals. DOT HS 812 888e. July 2023. rosap.ntl.bts.gov/view/dot/68397
- 9Iverson DJ, Gronseth GS, Reger MA, Classen S, Dubinsky RM, Rizzo M. Practice Parameter Update: Evaluation and Management of Driving Risk in Dementia. Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 74(16):1316 to 1324. April 20, 2010. pmc.ncbi.nlm.nih.gov/articles/PMC2860481
- 10Oregon Department of Transportation, Driver and Motor Vehicle Services (DMV). At-Risk Driver Program (mandatory reporting for health care providers); Voluntary reporting; and At-risk suspensions. No dates shown; accessed October 2026. program; voluntary reporting; suspensions
- 11Wisconsin Department of Transportation, Division of Motor Vehicles. Citizens and family members (reporting an unsafe driver); Medical professionals; Reporting an unsafe driver; and Aging drivers. No dates shown; accessed October 2026. citizens; medical professionals; reporting; aging drivers
- 12Virginia Department of Motor Vehicles. Mature driver safety; Reporting an impaired driver; and Periodic review. No dates shown; accessed October 2026. mature drivers; reporting; periodic review
- 13Florida Department of Highway Safety and Motor Vehicles (FLHSMV). Medical review. No date shown; accessed October 2026. flhsmv.gov/driver-licenses-id-cards/medical-review
- 14Electronic Code of Federal Regulations. 45 CFR 164.512, Uses and disclosures for which an authorization or opportunity to agree or object is not required (paragraphs (a) and (j)). Current as of October 1, 2026. ecfr.gov/…/section-164.512
This article reflects the priorities of traffic medicine, driver rehabilitation and transportation law. It is general education, not legal, medical or professional advice for any individual. Laws, forms and data change, so verify details with your state licensing agency and statutes. Reviewed October 2026.
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