CARE FAQ
Community Assistance, Recovery, and Empowerment
(CARE) Act
What is CARE?
The CARE Act will ensure mental health
services are provided to the most severely
impaired Californians who too often
languish without the treatment they
desperately need.
CARE goes upstream to divert and
prevent more restrictive conservatorships
or incarceration. It connects a person
in crisis with a court-ordered CARE plan or
agreement for up to 12 months, with
the possibility to extend for an additional
12 months.
A new approach is needed to act earlier
and to provide support and accountability
for individuals with severe untreated
mental illnesses as well as for local
governments responsible for providing
behavioral health services. Through
California’s civil courts earlier action,
support, and accountability is provided
through the CARE process.
CARE provides individuals with clinically
appropriate community-based
services and supports that are trauma-
informed and culturally and linguistically
competent, including stabilization
medications, wellness and recovery
supports, and connection to social services
and housing.
Advances in treatment models such
as new longer acting antipsychotic
treatments, along with the right clinical
team and housing plan, can successfully
stabilize and support individuals in the
community who have historically suffered
tremendously on the streets or during
avoidable incarceration.
What are the Criteria for
Participation in CARE?
CARE is NOT for everyone experiencing
homelessness or mental illness; CARE
focuses on people with schizophrenia
spectrum or other psychotic disorders who
meet specic criteria described below.
The CARE process is intended to be the
least restrictive alternative to help these
individuals before they are committed to a
State Hospital or become so impaired that
they end up in an involuntary Lanterman-
Petris Short (LPS) Mental Health
Conservatorship.
To be eligible, a person must meet the
following criteria:
• Is 18 years of age or older.
• Is currently experiencing a severe mental
illness, as dened in paragraph (2)
of subdivision (b) of Section 5600.3,
and has a diagnosis identied in the
disorder class: schizophrenia spectrum
and other psychotic disorders, as
dened in the most current version of
the Diagnostic and Statistical Manual of
Mental Disorders. This section does not
(rev 9/27)
Updated based on the enacted law SB 1338
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establish respondent eligibility based upon
a psychotic disorder that is due to a medical
condition or is not primarily psychiatric in
nature, including, but not limited to, physical
health conditions such as traumatic brain
injury, autism, dementia, or neurologic
conditions. A person who has a current
diagnosis of substance use disorder as
dened in paragraph (2) of subdivision (a)
of Section 1374.72 of the Health and Safety
Code, but who does not meet the required
criteria in this section shall not qualify for the
CARE process.
• Is not clinically stabilized in on-going
voluntary treatment.
• At least one of the following is true:
(1) The person is unlikely to survive safely in
the community without supervision and
the person’s condition is substantially
deteriorating.
(2) The person is in need of services and
supports in order to prevent a relapse or
deterioration that would be likely to result
in grave disability or serious harm to the
person or others, as dened in Section
5150.
• Participation in a CARE plan or CARE
agreement would be the least restrictive
alternative necessary to ensure the person’s
recovery and stability.
• It is likely that the person will benet from
participation in a CARE plan or CARE
agreement.
How do the CARE Proceedings Work?
Referral/ Petition Process
CARE proceedings begin with a petition
led by a family member, roommate,
rst responder, provider/clinician, public
guardian, authorized representative of the
county behavioral health services, adult
protective services, Indian health services/
tribal courts, or the respondent. The petition
is a presentation of facts supporting the
petitioner’s assertion that the individual meets
the criteria described above.
The court may also refer respondents to
CARE proceedings from assisted outpatient
treatment, conservatorship proceedings,
or misdemeanor proceedings pursuant to
Section 1370.01 of the Penal Code.
CARE Proceedings
Once a petition is led, the court promptly
reviews the petition to determine if a
respondent meets, or may meet, the criteria
for CARE. If not, the matter is dismissed.
If the petition is not dismissed, the court orders
the county to investigate and submit a written
report within 14 days with a determination
as to whether the respondent meets, or
is likely to meet, CARE criteria. The written
report must also include conclusions and
recommendations regarding the respondent’s
ability to voluntarily engage in treatment
and services. Counties may be granted an
additional 30 days to submit this report if
they are making progress to engage the
respondent.
If the respondent voluntarily agrees to receive
services, or if there is insufcient evidence that
the respondent meets the CARE criteria, the
case is dismissed. If the respondent is likely to
meet the CARE criteria and does not engage in
services voluntarily, the court will set an initial
appearance on the petition within 14 days.
Before the initial appearance, the court
appoints counsel for the respondent and
orders the county to provide notice of the
hearing to the petitioner, respondent, counsel,
and county behavioral health.
The petitioner as well as a representative from
the county behavioral health agency must
be present at the initial appearance, but the
respondent may waive personal appearance
and appear through counsel.
A tribal representative may also be
present if applicable.
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If the petitioner is not the county behavioral
health agency, the court will relieve
the petitioner and appoint the county
behavioral health agency as the substitute
petitioner. A petitioner who is relieved can
make a statement at the hearing on the
merits of the petition. If the petitioner is
a family member or roommate and the
respondent consents, the court may assign
ongoing rights of notice and allow for
continued participation and engagement in
the respondent’s CARE proceedings.
A hearing on the merits of the petition
is scheduled within 14 days of the initial
appearance, at which time the court
will determine if the respondent meets
CARE criteria. If the court nds that the
respondent meets the CARE criteria, the
court will order the county behavioral
health agency to work with the respondent,
respondent’s counsel, and the voluntary
supporter to engage in behavioral
health treatment and enter into a CARE
agreement, which is a voluntary settlement
agreement entered into by the parties.
Within 14 days, a case management
hearing will determine if the parties have
entered, or are likely to enter, into a CARE
agreement. If so, the court will approve or
modify the terms of the agreement and set
a progress hearing for 60 days.
If not, the court will order the county
behavioral health agency, through a
licensed behavioral health professional,
to conduct a clinical evaluation of the
respondent, unless there is an existing
clinical evaluation of the respondent
completed within the last 30 days and
the parties stipulate to the use of that
evaluation.
During the clinical evaluation hearing, the
county will present its ndings from the
clinical evaluation, and the respondent will
have an opportunity to address the court in
response to the evaluation. If the court nds
that the respondent meets the CARE criteria,
the court will order the county behavioral
health agency, the respondent, and the
respondent’s counsel to jointly develop and
submit to the court a CARE plan within
14 days.
During the CARE plan review hearing, the
court reviews the proposed CARE plan
and listens to all parties involved and
will adopt the elements of the CARE plan
that support the recovery and stability of
the respondent. The court may issue any
orders necessary to support the respondent
in accessing appropriate services and
supports, including prioritization for those
services and supports, subject to applicable
laws and available funding. The evaluation
and all reports, documents, and lings
submitted to the court shall be condential.
Once the court approves the CARE plan, the
CARE timeline begins for up to one year.
The court will have status review hearings
not less frequently than 60-day intervals
throughout the implementation of the CARE
plan. Status review hearings will provide the
following information:
• Progress the respondent has made on the
CARE plan.
• What services and supports in the CARE
plan were provided, and what services
and supports were not provided.
• Any issues the respondent expressed or
exhibited in adhering to the CARE plan.
• Recommendations for changes to the
services and supports to make the CARE
plan more successful.
Graduation
The court will hold a one-year status
hearing in the 11th month of the CARE
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process to determine whether to graduate
the respondent from CARE or reappoint
the respondent to the program for one
more year.
The respondent may elect to continue to in
the program or to be graduated from the
program. If they respondent elects to be
graduated, the court orders the creation of
a graduation plan and schedules a
graduation hearing in the 12th month. Upon
successful completion and graduation by
the court, the participant remains eligible for
ongoing treatment, supportive services, and
housing in the community to support long
term recovery.
If a respondent elects to remain in CARE,
the respondent may request any amount of
time, up to and including one additional year.
The court may permit the ongoing voluntary
participation of the respondent if the court
nds both of the following:
• The respondent did not successfully
complete the CARE plan.
• The respondent would benet from
continuation of the CARE plan.
The court will issue an order permitting the
respondent to continue in the CARE plan or
deny the respondent’s request to remain in
the CARE plan, and state its reasons on the
record.
A respondent may be involuntarily
reappointed to CARE only if the court nds
that the individual did not successfully
complete the CARE process, all services
and supports required through CARE
process were provided, the respondent
will benet from continuation in CARE, and
the respondent currently meets criteria.
Reappointment to CARE can only be once
and up to one additional year.
How is Self-Determination Supported
in CARE?
Supporting a self-determined path to
recovery and self-sufciency is core to CARE.
Each respondent is offered legal counsel
and may choose a volunteer supporter in
addition to their full clinical team. The role
of the supporter is to help the respondent
understand, consider, and communicate
decisions to ensure the respondent is able to
make self-directed choices to the greatest
extent possible.
The Department of Health Care Services, in
consultation with disability rights groups,
county behavioral health and aging
agencies, individuals with lived expertise,
families, racial justice experts, and other
appropriate stakeholders shall provide
optional training and technical resources for
volunteer supporters on the CARE process,
community services and supports, supported
decision-making, people with behavioral
health conditions, trauma-informed care,
and psychiatric advance directives.
The CARE plan ensures that supports and
services are coordinated and focused on
the individual needs of the respondent.
A Psychiatric Advance Directive provides
further direction on how to address potential
future episodes of a mental health crisis
that are as consistent as possible with the
expressed interest of the respondent.
Why doesn’t CARE include all
Behavioral Health Conditions?
CARE is meant for people with a focused
diagnosis that is both severely impairing
and highly responsive to treatment,
including stabilizing medications. Broader
behavioral health redesign is being led by
the Administration, so all Californians have
easy access to high quality and culturally
responsive behavioral health care.
This includes expansion of behavioral health
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capacity through treatment and workforce
infrastructure improvements and reducing
fragmentation in the behavioral health
system.
What does a Respondent in
CARE Receive?
CARE provides respondents with a
clinically appropriate, community-based
set of services and supports that are
culturally and linguistically competent.
This includes short-term stabilization
medications, wellness and recovery
supports, and connection to social
services and housing. Respondents will
also be provided with legal representation
for court proceedings.
What Housing is Available to a
Respondent in CARE?
Housing is an important component
to CARE, since nding stability and
staying connected to treatment is next
to impossible while living outdoors, in a
tent or a vehicle. Respondents served by
CARE will need a diverse range of housing,
including clinically enhanced interim or
bridge housing, licensed adult and senior
care facilities, supportive housing, or
housing with family and friends. The court
may issue orders necessary to support
the respondent in accessing housing,
including prioritization for these services
and supports.
In the 2021 Budget Act, the state made a
historic $12 billion investment to prevent
and end homelessness, included funding
for new community based residential
settings and long-term stable housing
for people with severe behavioral health
conditions. Additionally, the 2022- 2023
budget includes $1.5 billion to support
Behavioral Health Bridge Housing,
which will fund clinically enhanced
bridge housing settings that are well
suited to serving CARE respondents.
CARE respondents will be prioritized
for any appropriate bridge housing
funded by the Behavioral Health Bridge
Housing program.
What is meant by Court-ordered
Stabilization Medications?
Stabilization medications may be
included in the CARE plan. Court-
ordered stabilization medications
cannot be forcibly administered. Seeking
an involuntary medication order for
a respondent would be outside the
proceedings and subject to existing law.
Stabilization medications would be
prescribed by the treating licensed
behavioral health care provider, and
medication management supports
will be offered by the care team. The
treating behavioral health care provider
will work with the respondent to address
medication concerns and make changes
to the treatment plan as necessary.
Stabilizing medications will primarily
consist of antipsychotic medications,
which are evidence-based treatments to
reduce the symptoms of hallucinations,
delusions, and disorganization that
cause impaired insight and judgment
in individuals living with schizophrenia
spectrum and other psychotic disorders.
Medications may be provided as long-
acting injections which reduce the day-
to-day adherence challenges many
people experience with daily medications.
What if a Respondent does not
Participate in the Court-ordered
CARE plan?
A respondent who does not participate
in the court-ordered CARE plan may be
subject to additional court hearing(s). If a
respondent cannot successfully complete
a CARE plan, the respondent may be
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terminated from the CARE proceedings.
They will still be entitled to all services and
supports for which they are eligible. The
Court may utilize existing authority under
the LPS Act to ensure the respondents
safety. The court will notify the county
behavioral health agency and the Ofce of
the Public Conservator and Guardian if the
court utilizes that authority.
If the respondent was provided all the
services and supports in the CARE plan,
the respondents failure to participate in
the CARE process will be considered in any
subsequent hearings under the LPS Act that
occur within 6 months, and shall create
a presumption at that hearing that the
respondent needs additional intervention
beyond the supports and services provided
by the CARE plan.
What if a Local Government does
not Provide the Court-ordered CARE
plan?
If the court nds that the county or other
local government entity is not complying
with court orders, the court will report
that nding to the presiding judge of the
superior court. If the presiding judge nds
that the local government entity has
substantially failed to comply, the presiding
judge may issue an order imposing a
ne up to one thousand dollars ($1,000)
per day, not to exceed $25,000 for each
individual violation.
Fines collected will be deposited in the
CARE Act Accountability Fund and will be
used to support the efforts of the local
government entity that paid the nes to
serve individuals who have schizophrenia
spectrum or other psychotic disorders
and who are experiencing, or are at risk of,
homelessness, criminal justice involvement,
hospitalization, or conservatorship.
If the court nds that the local government
entity is persistently noncompliant, the
presiding judge may appoint a receiver
to secure court-ordered care for the
respondent at the local government entity’s
cost. The court will consider whether
there are any mitigating circumstances
impairing the ability of the local
government entity to fully comply with
court orders, and whether they are making
a good faith effort to comply.
How is CARE funded?
County behavioral health agencies are
responsible for Medi-Cal Specialty Mental
Health Services, substance use disorder
treatment, and community mental health
services.
Most respondents in CARE will be Medi-Cal
beneciaries or eligible for Medi-Cal.
For a respondent who has commercial
insurance, CARE requires that a health plan
reimburse the county for eligible behavioral
health care costs.
Existing funding sources for CARE-related
services and supports include nearly $10
billion annually for behavioral health care,
including the Mental Health Services Act
and behavioral health realignment funds.
Additionally, various housing and clinical
residential placements are also available
to cities and counties, including over $14
billion in state funding that has been made
available over the last two years to address
homelessness. CARE process participants
will be prioritized for any appropriate bridge
housing funded by the Behavioral Health
Bridge Housing program which provides
$1.5 billion in funding for housing and
housing support services.
In addition, the state will provide funding for
technical assistance, data and evaluation,
legal representation for the respondent,
and funding to support court and county
administration.
California Health & Human Services Agency | chhs.ca.gov
How will CARE be Evaluated?
The Department of Health Care Services
(DHCS) will produce an annual CARE Act
report which will include information on
the effectiveness of CARE in improving
outcomes and reducing disparities,
homelessness, criminal justice
involvement, conservatorships, and
other outcomes as specied by law. The
annual report will include measures to
examine the impact and monitor the
performance of CARE implementation.
Data in the report will be stratied by
age, sex, race, ethnicity, languages
spoken, disability, sexual orientation,
gender identity, health coverage source,
and county, to the extent statistically
relevant data is available.
DHCS will also contract with an
independent, research-based entity
to conduct an evaluation of the
effectiveness of CARE. The independent
evaluation shall highlight racial, ethnic,
and other demographic disparities, and
include causal inference or descriptive
analyses regarding the impact of CARE
on disparity reduction efforts.
DHCS will provide a preliminary report
to the Legislature three years after the
implementation date of the CARE Act
and a nal report to the Legislature ve
years after the implementation date of
the CARE Act.
How will the State support
Implementation?
CalHHS will convene a working group
to provide coordination and on-
going engagement with, and support
collaboration among, relevant state and
local partners and other stakeholders
during implementation of CARE. The
working group shall meet no more
than quarterly and end no later than
December 2026.
Will CARE be Available Statewide
and When?
Yes—all counties will participate in CARE
through a phased-in approach. The
rst cohort of counties to implement the
CARE Act include the counties of Glenn,
Orange, Riverside, San Diego, Stanislaus,
Tuolumne, and San Francisco. This
cohort will be required to implement
the CARE Act by October 1, 2023,
with all remaining counties to begin
implementation by October 1, 2024,
unless the county is granted additional
time by DHCS. Counties will not have an
option to opt-out.
Plans will include housing. Individuals
who are served by CARE will have
diverse housing needs on a continuum
ranging from clinically enhanced interim
or bridge housing, licensed adult and
senior care settings, supportive housing,
to housing with family and friends.
Various housing and clinical residential
placements are also available to cities
and counties, including over $14 billion
in state funding that has been made
available over the last two years to
address homelessness. CARE process
participants will also be prioritized for
any appropriate bridge housing funded
by the Behavioral Health Bridge Housing
program, which provides $1.5 billion in
funding for housing and housing support
services.
