As five states continue to lag behind in implementing a switch to digital commercial driver medical cards, the Federal Motor Carrier Safety Administration has issued a six-month exemption.

On April 11, the FMCSA issued a six-month exemption allowing motor carriers and drivers in all states and the District of Columbia to rely on a paper copy of the medical examiner's certificate as proof of the driver's medical certification for up to 60 days after the certificate was issued.

The move was in response to a request from the Commercial Vehicle Safety Alliance.

The exemption is effective April 11, 2026, and expires October 11, 2026.

"The purpose of the exemption is to ensure that drivers with valid medical certification and their employers are not penalized for delays outside of their control as five remaining States implement the Medical Examiner's Certification Integration final rule (NRII)," FMCSA said in its order.

What is NRII, and What’s the Delay?

Last June, after years of delays, the agency flipped the switch on a rule requiring commercial driver medical cards to go digital. But 14 states weren’t ready.

The FMCSA’s Medical Examiner’s Certification Integration rule was published in 2015 and was originally scheduled to take effect in 2018. It had been delayed several times, largely due to IT and cybersecurity challenges, before the agency flipped the switch last June.

The medical certificate, often referred to as a med card, confirms that drivers are physically qualified to drive a commercial motor vehicle under federal regulations, based on a medical exam by a professional on the FMCSA's National Registry of Certified Medical Examiners.

The change, which the FMCSA calls National Registry II, or NRII, meant that drivers would no longer have to provide a paper copy of their medical exam certificate to their state’s driver licensing agency.

Certified medical examiners would send the medical exam results directly to the national registry at FMCSA digitally. The FMCSA then electronically transmits those results to state licensing agencies, which link them up with that driver’s records.

Which States Are Not in Compliance?

As of the time the latest exemption was issued, the five states that still have not implemented NRII are:

• Alaska
• California
• Kentucky
• Louisiana
• New Hampshire