States vary greatly in their approach to licensing and renewal practices and in the use, composition, and function of their medical advisory boards (MABs). For many policies and practices, evidence of their effectiveness is limited or unclear. The objective of this study was to assess stakeholder opinions on current and future directions for Massachusetts to strengthen its MAB and Registry of Motor Vehicles activities regarding medically at-risk drivers. Twenty-three structured, in-depth interviews were conducted on the following topics: immunity for reporting at-risk drivers; mandatory versus voluntary reporting practices; confidentiality for reporters; licensing and renewal practices; vision requirements; counter personnel training; MAB role, composition, and activities; and transition to mobility options. Stakeholders participating in this study included representatives from the state legislature, government agencies, advocacy organizations, the licensing authority, medical communities, driving assessment centers, mobility planners, academic communities, and law enforcement. Results indicated that stakeholders believed Massachusetts was ready for a change in licensing and renewal practices and in the medical review of impaired drivers. With the exception of continued support for voluntary reporting practices, a majority of the respondents disagreed with most of the current practices discussed in the interviews. Recommendations included granting immunity to physicians; strengthening the role, function, and composition of the MAB; developing clear guidelines and standards to report impaired drivers; and training for licensing authority counter personnel.