After years of delays, the process of sending commercial driver medical cards to state licensing agencies is finally going digital — unless a driver is commercially licensed in one of 14 states that still aren't ready.

The Federal Motor Carrier Safety Administration’s Medical Examiner’s Certification Integration rule was published in 2015 and scheduled to go into effect in 2018. It has been delayed several times, largely due to IT and cybersecurity challenges. 

As of June 23, 2025, the integration rules are supposed to now be in effect. However, some states apparently still aren't ready.

This rule modernizes the way commercial drivers’ medical certification information is collected, stored, and shared. 

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 Old Process For Handling Commercial Driver Medical Cards

Drivers with commercial driver’s licenses for the past several years have been responsible for providing a paper copy of their medical examiner’s certificate to their state’s driver licensing agency.

The medical professionals performing those exams were required to submit results to the FMCSA registry of certified examiners, but that process was often delayed or incomplete, explained Brandon Wiseman of Trucksafe Consulting in an article on the company's website.

Meanwhile, state licensing agencies had to manually update license records, “a process prone to human error and paperwork bottlenecks,” Wiseman said.

What Has Changed in the CDL Driver Med Card Process?

Under the new integration rules in effect June 23, 2025, drivers will no longer have to provide a paper copy of their medical exam certificate to their state’s driver licensing agency.

Certified medical examiners will send the medical exam results directly to the national registry at FMCSA.

The FMCSA then electronically transmits those results to state licensing agencies, which link them up with that driver’s records.

The state licensing agency must downgrade a driver’s commercial driver's license or permit within 60 days if it gets notification that the driver is no longer medically qualified or has an expired medical card. 

Drivers must still self-certify their type of commercial operation, but they will not need to submit a physical copy of their medical card. 

The new regulation does not change the process for non-CDL drivers.

What If My State's Not Ready?

As of June 20, several states have failed to meet the June 23 deadline, according to the transportation attorneys at Scopelitis, Garvin, Light, Hanson & Feary, 

The list of states that have not yet implemented National Registry II, or NRII, can be found at the bottom of the NRII Learning Center page. As of June 20, they include:

• Alaska

• California

• Florida

• Illinois

• Iowa

• Kentucky

• Louisiana

• New Hampshire

• New Jersey

• New York

• North Carolina

• Oklahoma

• Vermont

• Wyoming

The FMCSA issued an Information Sheet for Medical Examiners and Drivers in States That Have Not Implemented NRII. According to that information sheet:

• Medical Examiners must continue to issue paper medical cards to drivers.

• Drivers must continue to manually submit their new medical cards to SDLAs in states that have not implemented NRII. SDLAs must change a driver’s status to “not certified” if the driver fails to submit the new medical card within 10 days of the medical card’s expiration and must initiate downgrading procedures within 60 days from the change in status.

• Carriers should require the driver to submit a copy of the new medical card to the carrier, and carriers should then obtain a motor vehicle record from the SDLAs within 15 days of the issuance of the medical card.

For more details, see the information sheet. As states come into compliance, FMCSA said it will update its NRII page.

Less Paperwork Doesn’t Equal Less Fleet Responsibility

The new integration means trucking employers will no longer need to manually verify the medical examiners’ credentials of their commercial drivers.

Although the change means less paperwork for motor carriers, it doesn’t mean less responsibility. Fleets are still responsible for verifying their drivers are medically qualified at all times. Under the new program, this will be done via CDLIS/MVR checks for CDL drivers.

According to Foley Services, fleet employers that don’t track medical certification properly could have compliance violations and fines of up to $16,864. 

“Fleets should recognize that the rule won’t eliminate their obligations to monitor driver qualification,” said Brandon Wiseman of Trucksafe Consulting. “It merely shifts the process from paper forms to electronic records for CDL drivers.”