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CARE Act TTA Frequently Asked Questions
The following are frequently asked questions related to Community Assistance, Recovery, and Empowerment (CARE) Act training and technical assistance. For background information on the CARE Act, please visit our About page and/or visit the CalHHS CARE Act landing page.
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Senate Bill 1338 established the Community Assistance, Recovery, and Empowerment (CARE) Act to provide community-based behavioral health services and supports to eligible Californians living with schizophrenia spectrum or other psychotic disorders through a new civil court process. CARE Act is intended to serve as an upstream intervention for the most severely impaired Californians to prevent avoidable psychiatric hospitalizations, incarcerations, and Lanterman-Petris-Short Mental Health Conservatorships. The CARE Process provides earlier action, support, and accountability for both CARE participants and the local governments responsible for providing behavioral health services to these individuals. The CARE Act authorizes specified adult persons to petition a civil court to create a voluntary CARE agreement or a court-ordered CARE plan that may include treatment, housing resources, and other services.
Topics:
- CARE Act Process
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As specified in Section 5970.5 of SB 1338, training and technical assistance will be provided to county behavioral health agencies (including organizations and individuals that county behavioral health agencies include in the training and technical assistance opportunities as specified in Section 5983 (b)), volunteer supporters, CARE Act providers, counsel, and other relevant stakeholders to support the implementation of the CARE Act. Training and technical assistance are developed in consultation with relevant state departments, disability rights groups, county behavioral health and aging agencies, peers, the California Interagency Council on Homelessness, the Judicial Counsel of California, and other relevant stakeholders. Additional resources are developed for CARE Act respondents and family members.
Topics:
- CARE Act Process
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Cohort I counties began accepting CARE petitions in 2023 (Glenn, Kern, Los Angeles, Orange, Riverside, San Diego, San Francisco, San Mateo, Stanislaus, and Tuolumne). The remaining Cohort II counties began accepting CARE petitions December 1, 2024. All 58 counties have implemented CARE.
Topics:
- CARE Act Process
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Eligibility is determined on a case-by-case basis. Homelessness and mental illness alone are not enough to meet eligibility requirements.
A respondent must meet all the following criteria to be eligible for CARE:
- Be 18 years of age or older.
- Have a diagnosis of a schizophrenia spectrum disorder or another psychotic disorder in the same class.
- I am currently experiencing a mental illness that:
- Is severe in degree and persistent in duration,
- May cause behavior that greatly interferes substantially with activities of daily living, and
- May lead to an inability to maintain stable adjustment and independent functioning without treatment, support, and rehabilitation for a long or indefinite period.
- Not be clinically stabilized in ongoing voluntary treatment.
Additionally, at least one of the following must be true:
- The respondent is unlikely to survive safely in the community without supervision and the respondent’s condition is substantially deteriorating.
- The respondent needs services and supports to prevent a relapse or deterioration that would likely result in grave disability or serious harm to the respondent or others.
The respondent’s participation in a CARE plan or CARE agreement must:
- Be the least restrictive alternative necessary to ensure the respondent’s recovery and stability, and
- Be likely to benefit the respondent.
Petitioners are required to provide facts and supporting information at the time of filing to show that a respondent is eligible for CARE Act proceedings (see form CARE-050-INFO ). Supporting documentation must include either a declaration by a licensed behavioral health professional ( form CARE-101 ) or evidence that the respondent was detained for at least two intensive treatments, the most recent one within the last 60 days. See the Eligibility Fact Sheet and CARE Act Resources for Petitioners for more information.
Topics:
- CARE Act Process, Eligibility Criteria
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A CARE agreement and a CARE plan are documents that specify services to support the respondent’s recovery and stability.
- A CARE agreement is a voluntary agreement between the respondent and the county behavioral health agency after a court has determined that the respondent is eligible for the CARE process. If a CARE agreement is not reached, the court may order the creation of a CARE plan.
- A CARE plan includes a range of community-based services and supports ordered by the court. There will be status review hearings to review progress and challenges. Services and supports in the CARE plan can be changed to support the respondent’s success. If included in the CARE plan or agreement, stabilizing medications are prescribed by the treating licensed behavioral health care provider. The CARE team will work with the respondent to address medication concerns and make changes to the treatment plan as needed.
Topics:
- CARE Act Process
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Petitioners must be 18 years of age or older and fit one of the following categories:
- A person who lives with the respondent.
- A spouse or registered domestic partner, parent, sibling, child, or grandparent of the respondent.
- A person who stands in the place of a parent to the respondent.
- The director of a hospital, or their designee, in which the respondent is hospitalized.
- The director of a public or charitable agency, or their designee, who has within the last 30 days provided or who is currently providing behavioral health services to the respondent or in whose institution the respondent resides.
- A licensed behavioral health professional, or their designee, who is or has been supervising the treatment of or treating the respondent for mental illness within the last 30 days.
- The director of a county behavioral health agency, or their designee, of the county where the respondent resides or is found.
- A first responder who has had repeated interactions with the respondent.
- A judge of a tribal court located in California, or their designee.
- The respondent.
Note: After the initial appearance, the petitioner will be replaced by the director of the county behavioral health agency, or a designee.
For more information, see CARE Act Resources for Petitioners.
Topics:
- CARE Act Process
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A summary of the CARE process is outlined below:
- A case begins with the filing of a petition, followed by the court assessing eligibility.
- If a respondent is found to be eligible, and efforts at voluntary engagement by the county behavioral health agency are not successful, there is a process to develop a voluntary CARE agreement.
- If a CARE agreement is not likely to be reached, the court will order the county behavioral health agency to conduct a clinical evaluation of the respondent and provide a report to the court.
- If, based on that report, the court determines that the respondent meets the eligibility criteria, the court shall order a CARE plan. Both a CARE agreement and a CARE plan will outline services and supports that the individual is entitled to receive under the CARE proceedings.
- The court will monitor the respondent’s progress with the CARE plan or CARE agreement.
- If the respondent has a CARE plan, then after a year there will be a determination of next steps. The respondent may graduate or be reappointed to the CARE process for up to one additional year.
For a more detailed description of each step in the process, please see the CARE Act Process Flow to Treatment, Housing, and Support resource or The Client’s Journey Through the CARE Act training.
Topics:
- CARE Act Process
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As specified in Welfare and Institutions Code 5985, subd. (e) and (f), the Department of Health Care Services (DHCS) will develop an annual report to examine the scope of impact and monitor the performance of CARE Act model implementation. The first annual report will be published in July 2025 on the DHCS website. The report will include information on the effectiveness of the CARE Act model in reducing disparities and improving outcomes in homelessness, criminal justice involvement, conservatorships, and hospitalization of participants.
Topics:
- Data Collection & Reporting
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The CARE Act specifies that the clinical evaluation, which may be ordered by the court pursuant to Welfare and Institutions Code (WIC) 5977.1(b), shall be conducted by the county behavioral health agency through a licensed behavioral health professional. The CARE Act defines the licensed behavioral health professional in conjunction with other applicable statutes. The clinical evaluation may be conducted by:
- a psychiatrist, psychologist, clinical social worker, marriage and family therapist or professional clinical counselor licensed in accordance with the Business and Professions Code; or
- individuals working under supervision to gain necessary experience to meet any of the above licensure requirements as long as they meet the professional training requirements applicable to their license as detailed in the Business and Professions Code, for up to five years; or
- the same type of clinicians who were recruited for employment from outside the state who have sufficient experience to gain admission to a licensing exam, for up to five years.
Topics:
- Behavioral Health, CARE Act Process, Eligibility Criteria
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The CARE Process is intended to encourage voluntary engagement. After the petition is filed, if the respondent is enrolled or likely to enroll in voluntary treatment, the court will dismiss the matter.
Topics:
- Behavioral Health, CARE Act Process
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If a CARE respondent does not want to or is unable to attend a hearing in person, there are several options the court may consider:
- Remote participation: If attending in person is a barrier, the court may allow the CARE respondent to participate remotely. Some counties have found it effective for county behavioral health staff to meet the respondent in the community and facilitate virtual attendance using a secure video or phone connection.
- Representation through counsel: A respondent may choose not to attend the hearing personally and instead participate through their attorney. In such cases, the attorney can appear and speak on the respondent’s behalf. This option is allowed under California Welfare and Institutions Code section 5977(b)(3).
- Proceeding without the respondent: If the respondent is not present and has not chosen to waive personal appearance and appear through counsel, the court may still move forward with the hearing under certain conditions:
- Reasonable efforts have been made to engage the respondent but were unsuccessful; and
- The court determines that proceeding without the respondent is in their best interest.
Topics:
- Behavioral Health, CARE Act Process, Counsel/Courts
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A supporter shall not be subpoenaed or called to testify against the respondent in any CARE Act proceedings. However, this provision only references CARE Act proceedings, and it does not prevent a supporter from being called to testify in any other civil or criminal proceedings.
Topics:
- CARE Act Process, Volunteer Supporter
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The court shall remove a supporter due to a conflict of interest with the respondent if the conflict cannot be managed in such a way to avoid any possible harm to the respondent. The process for removing a supporter will be determined by the court.
Topics:
- CARE Act Process, Volunteer Supporter
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Family members can take various roles in CARE Act proceedings. If the family member is the original petitioner, they shall have the right to participate in the initial hearing to determine the merits of the petition. The court may assign ongoing rights of notice to the original petitioner. The court may also allow participation in the respondent’s CARE Act proceedings, if the respondent consents. Additionally, the respondent may choose to elect a family member to serve as their volunteer supporter.
Topics:
- CARE Act Process, Volunteer Supporter
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During the CARE Act process, the goal is to optimize the respondent’s opportunities to make decisions. As the respondent’s symptoms fluctuate, their willingness and availability to participate in supported decisionmaking may likely also change. During a mental health crisis, an individual may not be able to communicate their preferences and wishes, and therefore supported decisionmaking may not always be possible. These scenarios must be evaluated on an individual case-by-case basis. Ideally, once the respondent is capable of understanding the decisions to be made, they can resume engaging in supported decisionmaking.
Topics:
- Serious Mental Illness & Evidenced-based Care, Volunteer Supporter
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If at any time in the CARE proceedings, the court determines that a respondent is not participating in the CARE process or is not adhering to their CARE agreement or CARE plan, the court may terminate the respondent’s participation in CARE. The court shall not consider nonadherence with medication under the CARE plan as reason for dismissal.
There are no penalties to a respondent who doesn’t complete their CARE agreement or CARE plan. If a respondent fails to complete their CARE plan (not a CARE agreement), the reasons for that failure shall be considered by the court in a subsequent Lanterman-Petris-Short (LPS) hearing, provided that hearing occurs within six months and provided that all the services and supports were offered to the respondent. The termination of a CARE plan does not automatically trigger LPS proceedings, and information about non-adherence to medications cannot be included. The failure to comply with a CARE plan will create a presumption for the LPS court that the respondent needs additional intervention beyond the services and supports provided by the CARE plan.
If the court has ordered a CARE plan (not a CARE agreement), it has the discretion to keep the case open for up to a year. If the court dismisses the case, county behavioral health and community support providers can continue outreach to the individual to offer treatment and other services and supports.
Topics:
- CARE Act Process
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The CARE process includes multiple legal representatives that serve specific roles, including:
- Respondent’s counsel: An attorney is provided to the respondent at no cost. The respondent’s counsel will work with the county behavioral health agency and respondent’s volunteer supporter (if applicable) to help the respondent access behavioral health treatment. They also represent the respondent in any court proceedings and advise on the CARE process.
- Judicial officers: Judicial officers – also known as judges – are responsible for making sure the court proceedings are conducted in a collaborative way. Additional responsibilities include determining eligibility, explaining the respondent’s rights, evaluating what services were or were not provided, and issuing orders to support the respondent’s access to services.
- Petitioner’s counsel: The “petitioner” is an adult person who petitions a civil court to consider the respondent for the CARE process. It is not required that the petitioner have an attorney help them file the petition, but they may choose to do so at their own expense. Alternatively, if a petition is filed by a county behavioral health agency, the agency may choose to be advised by counsel.
For more information, see the CARE Act Brief on Legal Roles in the CARE Act on the CARE Act Resource Center.
Topics:
- CARE Act Process, Counsel/Courts
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A progress review hearing is scheduled if the respondent and county behavioral health agency have reached a CARE agreement. The court will schedule a progress review hearing for 60 days from when it approves the CARE agreement (Welfare and Institutions Code Section 5977.1). The statute does not specify any additional progress review hearings; however, the court, at its discretion, may include additional hearings as it deems beneficial to monitor and encourage the parties’ progress in fulfilling the terms of the CARE agreement. The statute does not specify the content or structure of the progress review hearings.
Status review hearings will be scheduled by the court at least every 60 days after the court orders a CARE plan. The court will review the respondent’s progress on the CARE plan, what services were or were not provided, issues the respondent may be having with adhering to the plan, and recommendations for changes that would make the CARE plan more successful. The county behavioral health agency or the respondent may request, or the court may set, a hearing at any time during the CARE process to address a change of circumstances during the CARE process. (Welfare and Institutions Code Section 5977.2)
Topics:
- CARE Act Process, Counsel/Courts
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The court does not have a mandated process to ensure that a supporter follows a supported decisionmaking framework. However, if the court finds that the volunteer supporter is overstepping the boundaries of their role, such as (imposing their own beliefs on the respondent), the court may remind the supporter of their duties. A court may ultimately remove a supporter because of any conflict of interest with the respondent that cannot be managed.
For more information, see the Supported Decisionmaking for Volunteer Supporters training on the CARE Act Resource Center.
Topics:
- Counsel/Courts, Volunteer Supporter
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A volunteer supporter (also referred to as a supporter) is an adult chosen by the respondent to provide support throughout the CARE process. The supporter should help the respondent understand, make, and communicate decisions and express preferences throughout CARE proceedings. This could include assisting with the development of a CARE agreement or CARE plan, a graduation plan, and a Psychiatric Advance Directive (PAD). The supporter should use a supported decisionmaking framework to empower the respondent to make their own informed decisions.
The CARE Act Supporter Role Brief provides an overview of the Supporter Role, key operating principles of the supporter’s role, and available trainings for supporters.
Topics:
- Volunteer Supporter
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The CARE Act requires that the respondent be personally served notice of several events throughout the CARE process. During the initial stages, the county behavioral health agency is to personally serve the respondent with a copy of the petition packet as well as information on the process and their rights in the process. If personal service is not practicable, the county behavioral health agency may use any method reasonably calculated to give the respondent actual notice. The proof of service must explain why personal service was impractical and why the alternative method was thought to provide actual notice.
For more information, see the 2023 California Rules of Court (Rule 7.2235) or the Judicial Council of California’s FAQs for CARE Act Service Requirements.
Topics:
- CARE Act Process, Counsel/Courts
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Data will be collected on CARE respondents from the time of petition as follows:
- If the county behavioral health agency is the original petitioner, data collection begins at the time of petition.
- If the county behavioral health agency is not the petitioner, data collection begins when the court orders an investigation by the county.
Topics:
- Data Collection & Reporting
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Data metrics identified in Welfare and Institutions Code sections 5985 and 5986 for the Annual Report and Independent Evaluation is shared in accordance with the DHCS Public Reporting Guidelines to maintain privacy and security.
Topics:
- Data Collection & Reporting
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The CARE Act authorizes, and in some instances requires, the disclosure of a respondent’s health information, including protected health information and mental health records, to the county behavioral health agency and/or the court. The CARE Act requires that the county behavioral health agency notify the respondent of disclosure of their health information. That notice is to be sent to respondent’s last known address, if one exists, and to respondent’s counsel. The notification shall also be included with the next notice of hearing, if any, served upon the respondent. All information that was shared shall be disclosed to the respondent, their counsel, and (with the respondent’s consent) their supporter.
Topics:
- CARE Act Process
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A Psychiatric Advance Directive (PAD) is a type of Advance Health Care Directive. It is a self-directed legal document that states a person’s preferences and provides instructions for mental health treatment in advance of a mental health crisis. Physicians, hospitals, and other providers should refer to a PAD in situations when the individual is unable to articulate their own care preferences. A PAD may be incorporated into ongoing mental health treatment, serving as a blueprint for the individual’s preferences regarding their physical and mental health.
In California, the general provisions for an advance health care directive are found in Probate Code Sections 4600-4678 . For more information, see the PADs in the CARE Act training located in the Resource Library or visit the PADs Mental Health Services Act (MHSA) Multi-County Psychiatric Advance Directives Innovations Project .
Topics:
- Behavioral Health, CARE Act Process
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State law requires the Secretary of State to maintain an Advance Health Care Directive Registry (Cal. Probate Code Section 4800). This registry allows those with an Advance Health Care Directive to register information that can be made available upon request to the registrant’s health care provider, public guardian, or legal representative. Although this registry was not created for PADs, if a PAD meets the requirements for Advanced Health Care Directives (Cal. Probate Code Section 4670 – 4743), the owner of the PAD can register it with the state.
You can find information about how to register an Advance Health Care Directive or a PAD on the California Secretary of State’s Advance Health Care Directive Registry webpage.
Topics:
- Behavioral Health, CARE Act Process
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The development of a Psychiatric Advance Directive (PAD) should be considered a best practice for anyone receiving psychiatric treatment; PADs are a helpful tool for self-determination and empowerment. Although PADs are not mandated as part of the CARE process, PADs are referenced in the CARE Act statute as an option to be included in a graduation plan (Welfare and Institutions Code section 5977.3(a)(3)(A)).
A PAD can be used to:- Plan for a future event in which an individual may not be able to direct mental health and/or physical treatment.
- Provide an opportunity to outline preferences and to share that with others.
- Support an individual’s autonomy, dignity, and ability to self-direct care.
- Improve the ability to build trust and navigate care systems.
A PAD can be developed at any point in the CARE process, as long as the respondent has the capacity to make informed decisions about their own care. Examples of how a PAD might be incorporated into the CARE process are included in the PADs in the CARE Act training located in the Resource Library.
Topics:
- Behavioral Health, CARE Act Process
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Respondents may be able to identify a supporter through family advocacy and peer organizations, homeless outreach agencies, and/or other community-based organizations. Please note, the supporter must be chosen and approved by the respondent regardless of the relationship. See the Volunteer Supporter Toolkit for more information.Additionally, NAMI California is available to provide support/guidance to NAMI affiliates regarding the volunteer supporter role. Visit the NAMI California’s webpage for additional information.
Topics:
- CARE Act Process, Volunteer Supporter
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Every superior court offers assistance through their Self-Help Centers to individuals who are not represented by an attorney and are seeking resources and legal information. Self-Help Center staff can assist with filling out forms and providing resources; however, they cannot provide legal advice. Services may be provided in person, by phone, or online. Visit the Self-Help Center locator to find a center in your county.
In addition, the following resources and training materials are available to support petitioners in accurately completing petitions, which promotes an efficient court review process.
- Judicial Council
- CARE Act Resource Center:
- Petitioning at a Glance – Short Video
- Series: How-to Petition Tutorials
- CARE Act Resources for Petitioners
- Considerations for Petitioning in the CARE Act Process Training
- CARE Act Eligibility in Practice Training
- First Responders & the CARE Act – Brief
- Hospital & Emergency Department Roles in the CARE Act – Brief
- Public Guardian and Conservator Roles in the CARE Act – Brief
- Behavioral Health & Social Service Providers Roles in the CARE Act – Brief
- Justice System Partners Roles in the CARE Act – Brief
- NAMI
Topics:
- CARE Act Process, Counsel/Courts, Eligibility Criteria
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The CARE Act does not preclude and in fact contemplates the possibility of another county providing services or supports to a respondent. If a proposed CARE plan includes services and supports to be provided through another local governmental entity, the court may consider a motion by either the petitioner or the respondent to add the other local entity as a party to the CARE proceedings (W&I Code § 5977.1 (d)(4)). If the local entity is added as a party to the proceedings, either voluntarily or through court order, the court may order the local entity to provide the necessary service or support as part of the CARE plan. (See W&I Code § 5977.1(d)(2)&(4)).
Topics:
- CARE Act Process, Counsel/Courts, Housing/Community Supports, Policy/Advocacy
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Several amendments to the CARE Act outlined in Senate Bill 35 address the disclosure of health information to behavioral health agencies and the courts. Health care providers and covered entities are now authorized to disclose to a behavioral health (BH) agency certain health information pertaining to a respondent that is relevant to an investigation, evaluation, or other report or hearing, or to the provision, coordination or management of services and supports. This includes protected health information (PHI) and mental health records (excluding psychotherapy notes).
In matters where the health care provider or covered entity is the petitioner, the CARE Act now requires them to provide this health information to the county BH agency. As specified in Welfare and Institutions (W&I) Code section 5977.4, there is a process for a county BH agency to apply for a court order compelling a health care provider or covered entity to provide health information, if necessary. Further disclosure or redisclosure is not authorized except as expressly provided, and that information disclosed to a county BH agency by a health care provider is confidential and is not subject to disclosure or inspection under the Public Records Act. Additionally, health care providers or covered entities shall not be held civilly or criminally liable for any disclosure authorized or required by these provisions.
Providers should consult with their legal counsel if they have questions or concerns related to the sharing of an individual’s health information.
For a summary of substantive changes established by Senate Bill 35, view the CARE Act SB 35 Amendment Brief.
Topics:
- Behavioral Health, CARE Act Process, Counsel/Courts, Data Collection & Reporting, Policy/Advocacy
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The court may, in its discretion, assign ongoing rights of notice to the original petitioner. If the respondent consents, the court may allow the original petitioner to participate in the respondent’s CARE proceedings. There is no provision for ongoing participation without respondent consent.
Topics:
- Behavioral Health, CARE Act Process, Counsel/Courts
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Resources for services and supports outside the CARE process are available to the respondent through their county behavioral health agency, peer organizations, homeless outreach agencies, and/or other community-based organizations.
Topics:
- Behavioral Health, CARE Act Process, Housing/Community Supports
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The Department of Managed Health Care (DMHC) released All Plan Letter APL 23-016 – Implementation of SB 1338 (2022) – Community Assistance, Recovery, and Empowerment (CARE) to provide guidance about how health plans shall ensure they identify enrollees who are involved in CARE proceedings and process and pay claims arising from their enrollees’ CARE agreements or CARE plans.
Topics:
- CARE Act Process, Claims / Billing & Sanctions, Other
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Peers may serve in the CARE process as members of the treatment team, as volunteer supporters, or as part of a peer organization. For an overview of how peers can participate in the CARE Act, view the Role of the Peer in the CARE Process training on the CARE Act Resource Center.
Many peer organizations offer trainings for peers in California, including National Alliance on Mental Illness (NAMI) programs for county-specific training. For more information visit the NAMI Medi-Cal Peer Support Specialist Certification Training website.
Additionally, the California Mental Health Services Authority (CalMHSA) has a comprehensive website on the Medi-Cal Peer Support Specialists training, exam, best practices, study guide, and more. Below are links to the website.
Topics:
- CARE Act Process, Housing/Community Supports, Other, Volunteer Supporter
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Counties are permitted to submit claims to the Department of Health Care Services (DHCS) for administrative activities incurred while preparing for and/or transporting a respondent to and from their court hearing. DHCS will reimburse counties for these outreach and engagement activities to support CARE Act services, as outlined in Behavioral Health Information Notice (BHIN) 24-015: CARE Act Reimbursement Rates and Billing Guidance.
Topics:
- Behavioral Health, CARE Act Process, Case Worker / Case Manager, Claims / Billing & Sanctions, Counsel/Courts, Equitable & Person Centered Care, Housing/Community Supports, Other, Policy/Advocacy
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Counties are permitted to submit claims to the Department of Health Care Services (DHCS) for administrative activities incurred while attempting to locate or contact a CARE Act respondent, even if the county is unable to engage the respondent. DHCS will reimburse counties for these outreach and engagement activities to support CARE Act services, as outlined in Behavioral Health Information Notice (BHIN) 24-015: CARE Act Reimbursement Rates and Billing Guidance.
Topics:
- Behavioral Health, CARE Act Process, Case Worker / Case Manager, Claims / Billing & Sanctions, Equitable & Person Centered Care, Other, Policy/Advocacy
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Counties are permitted to submit claims to the Department of Health Care Services (DHCS) for administrative activities incurred while engaging family members to support a respondent during the CARE process. DHCS will reimburse counties for these outreach and engagement activities to support CARE Act services, as outlined in Behavioral Health Information Notice (BHIN) 24-015: CARE Act Reimbursement Rates and Billing Guidance.
Topics:
- Behavioral Health, CARE Act Process, Case Worker / Case Manager, Claims / Billing & Sanctions, Equitable & Person Centered Care, Other, Policy/Advocacy, Volunteer Supporter
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CARE and Lanterman-Petris-Short (LPS) Act conservatorship are two separate court processes. Each has its own statutory framework, procedural requirements, and eligibility criteria. While distinct processes, there are ways CARE and LPS may interact, especially in situations where an individual’s mental health condition and needs warrant consideration of choosing between which path is able to address the individual’s mental health condition and needs, in the least restrictive manner. The CARE Act provides that an LPS conservatorship court may refer an individual to CARE. If an LPS court makes a referral, the conservator or proposed conservator shall file the petition and the judge in the CARE proceeding shall determine if the individual is eligible for CARE.
The CARE Act does NOT provide for a direct referral from CARE to an LPS proceeding.
The statute, however, does provide that to ensure a respondent’s safety, a judge in a CARE proceeding may utilize their existing authority under LPS to have the individual evaluated for intensive treatment and potentially considered for a conservatorship. At any point throughout the CARE process, if there is a concern for the respondent’s safety, county BH, on its own accord or upon request of a judge, may initiate the process to have the individual evaluated for intensive treatment and potentially for conservatorship.
Also, if a respondent fails to complete their CARE plan (not a CARE agreement), the reasons for that failure shall be considered by the court in a subsequent LPS hearing, provided that hearing occurs within 6 months and provided that all the services and supports were offered to the respondent. This fact shall create a presumption for the LPS court that respondent needs additional intervention beyond the services and supports provided by the CARE plan. However, this provision is not triggered if the respondent’s only failure to adhere to their CARE plan is a failure to comply with a CARE plan medication order.
Topics:
- CARE Act Process, Case Worker / Case Manager, Policy/Advocacy
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The Lanterman-Petris-Short (LPS) Act requires that all available alternatives to conservatorship be explored with a goal of proceeding with the least restrictive, suitable alternative. SB 43 amends the LPS Act to specify the CARE process as one of those alternatives that should be considered. This means some individuals may be diverted from LPS proceedings to the CARE process, which is less restrictive. The individual would need to meet the CARE eligibility criteria.
For additional information on SB 43, please see the following DHCS resource: SB 43 Frequently Asked Questions (FAQs)
Topics:
- Behavioral Health, CARE Act Process, Eligibility Criteria, Other, Policy/Advocacy
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A county behavioral health (BH) agency may receive referrals to file a petition, such as from an Assisted Outpatient Treatment (AOT) program or from misdemeanor proceedings when the defendant is found to be incompetent to stand trial (IST). County BH will work with the referral source to assess whether the individual may be eligible for CARE and initiate the petition, if appropriate. County BH may also receive a referral from LPS conservatorship proceedings, in which case, the conservator would be the petitioner. See California Welfare and Institutions Code (W&I Code) section 5978 for more information.
Topics:
- CARE Act Process
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Data collection and reporting resources, including data-specific FAQS, are available on the the Data Collection and Reporting Resources page.
Topics:
- Data Collection & Reporting
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Listed below are recommended resources and trainings to get started learning about the CARE Act. You can also find these at the top of the Training Materials and Resources pages. Many of these materials are available in multiple languages.
Resources:
- The CARE Act at a Glance
- The CARE Process Flow to Treatment, Housing, and Support
- CARE Act Eligibility Criteria
- Volunteer Supporter Toolkit
- Legal Roles in the CARE Act
- Supporter Role in the CARE Act
Training Materials:
Topics:
- CARE Act Basics
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Information about the CARE Act Data Dictionary, including a link to the latest version, a Data Dictionary Walkthrough training, and summary table are available on the following page: https://care-act.org/library/data-collection-reporting-resources/
Topics:
- Data Collection & Reporting, Data Dictionary
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All CARE Act petitions must be filed on a Petition to Commence CARE Act Proceedings form. Instructions on how to complete the form can be found on Information for Petitioners- CARE-050-INFO.
The petition provides opportunities for the petitioner to include narrative information to support the petition. The petitioner may also attach supportive documents. The petition must be supported by one of two things: (1) a declaration from a mental health professional; or (2) evidence that the respondent was detained for at least two intensive treatments, the most recent one within the last 60 days.
The Judicial Council has developed a Mental Health Declaration Form (CARE-101) to be used if the petition is supported by a declaration from a behavioral health professional. The CARE-101 form can be filed by a licensed behavioral health professionals who do not work for the county behavioral health agency. The CARE Act statute does not require that the behavioral health professional who completes the CARE-101 form to be providing ongoing care for the respondent. However, this behavioral health professional would need specific information about the respondent’s mental health to support their determination that the respondent meets the criteria.
There is no specific form needed to demonstrate that the respondent has been detained for at least two intensive treatments, the most recent one within the last 60 days. Petitioners can include evidence in the form of documents or in the form of declaration based on the petitioner’s knowledge.
Based on the information in the CARE-100 form and the supporting documents, the court will determine if the respondent meets, or may meet, the criteria for CARE proceedings.Instructions on filing can be found on How to File the CARE-100 Form.
Additionally, Self-Help Centers can help fill out the petition; however, they cannot provide legal advice. You can find the Self-Help Center for your county here.
Topics:
- CARE Act Process
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Within 14 business days of receipt of a CARE Act referral from a facility, a county behavioral health (BH) agency is required to complete an assessment of the referred individual and file a petition if the county BH agency determines that the individual meets or is likely to meet criteria for the CARE process and the individual does not engage in voluntary treatment. For more information, see California Welfare and Institutions Code (W&I Code) section 5978.1.
If county BH possesses sufficient information but is unable to complete an assessment at the conclusion of the 14 business days of receipt of a CARE Act referral, the county BH agency may file a petition.
Topics:
- Behavioral Health, CARE Act Process
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Facilities may use existing forms and/or procedures to make a CARE referral to a county behavioral health agency. Existing forms must include contact information for the referred individual, including a telephone number and address. County behavioral health agencies are required to accept facility referrals in any form or manner received.
Topics:
- Behavioral Health, CARE Act Process
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Any facility that provides assessment, evaluation, and crisis intervention as defined in California Welfare and Institutions (W&I) Code section 5150, subdivision (a), or a designated facility as defined in W&I Code section 5008, subdivision (n) can make a CARE referral. If a facility is treating an individual under an involuntary hold, who they believe meets or is likely to meet CARE criteria, then the facility can make a referral to the county BH agency in the county of the individual’s residency or the county where treatment is occurring.
Topics:
- Behavioral Health, CARE Act Process
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Early in the CARE process, a judge reviews every CARE petition to determine if it shows that the respondent meets or may meet the CARE eligibility criteria. This is called a prima facie review. The term “prima facie” refers to “at first sight” or based on “first impression.” Judges have broad discretion in determining if prima facie has been met.
CARE Act statute (California Welfare & Institutions Code (W&I Code) § 5975) states that the Petition to Commence CARE Act Proceedings (CARE-100) must include:
- Facts that show that the respondent meets the CARE criteria; and
- Either:
- A declaration from a licensed behavioral health practitioner that they believe the respondent meets the diagnostic criteria.
or - Evidence that the respondent was detained for two intensive treatments (pursuant to W&I Code § 5250), one of which was in the previous 60 days.
- A declaration from a licensed behavioral health practitioner that they believe the respondent meets the diagnostic criteria.
Petitioners who believe that the respondent meets the CARE criteria may not be able to provide outside documentation. They can, however, include any evidence or other information they have that demonstrates the respondent’s eligibility and whether the respondent has been detained for intensive treatment. This could include personal experience; it could also include observation of the respondent’s behavioral health history and current condition, including if the respondent has been hospitalized. This information may be included in the narrative portion of the petition or in an attachment. Based on the totality of the petition packet, the judge will determine if prima facie is met.
For more information, see CARE Act Resources for Petitioners.
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An individual who is participating in ongoing voluntary treatment may be eligible for CARE if they are not clinically stabilized and if they meet the other eligibility requirements. For more information, see the CARE Act Eligibility Criteria Fact Sheet.
Topics:
- Behavioral Health, Eligibility Criteria
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As outlined in the Behavioral Health Information Notice (BHIN) 24-015: CARE Act Reimbursement Rates and Billing Guidance, DHCS will reimburse counties an hourly rate for time spent performing the following administrative activities: Court Hearing Time, Court Report, Outreach and Engagement, Notice, and Data Reporting. The BHIN provides details and examples of these activities and outlines the rate for each CARE activity. Hours spent performing each CARE Act activity include time ancillary to the performance of the activity, which is limited to preparation time, internal meeting time, and oversight by supervisors and managers related to the activities. For more information, review the CARE Act Sanctions and Claiming Process training. For additional questions, contact care_claiming@dhcs.ca.gov.
Topics:
- CARE Act Process, Claims / Billing & Sanctions, Other
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County behavioral health agencies may not claim for CARE Act costs incurred for county counsel staff. The rates established include an “overhead” increase based on Bureau of Labor Statistics Mean Wage data, which accounts for legal services. For more information, review the CARE Act Sanctions and Claiming Process training. For additional questions, contact care_claiming@dhcs.ca.gov.
Topics:
- CARE Act Process, Claims / Billing & Sanctions, Other
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Counties are able to claim for administrative functions outlined in Behavioral Health Information Notice (BHIN) 24-015: CARE Act Reimbursement Rates and Billing Guidance that are completed by a subcontractor. The county would need to include the subcontractor’s name and role in the claim form. For more information, review the CARE Act Sanctions and Claiming Process training. For additional questions, contact care_claiming@dhcs.ca.gov.
Topics:
- CARE Act Process, Claims / Billing & Sanctions, Other
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Counties may claim on a quarterly basis similar to the current administrative claiming process. Claims for a quarter may be submitted after the end of the quarter. Claims must be received by the Department of Health Care Services (DHCS) within one year following the end of the quarter. Upon CARE Act implementation, counties can begin filing for claims, even if a county chooses to implement early. For more information, review the CARE Act Sanctions and Claiming Process training. For additional questions, contact care_claiming@dhcs.ca.gov.
Topics:
- CARE Act Process, Claims / Billing & Sanctions, Other
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County behavioral health agencies should not bill for public defender services to the Department of Health Care Services (DHCS). Public defenders should bill 100% of their CARE contracts with the Legal Services Trust Fund Commission (LSTFC). For additional questions, contact care_claiming@dhcs.ca.gov.
Topics:
- CARE Act Process, Claims / Billing & Sanctions, Other
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A substance/medication-induced psychotic disorder (SIPD) is an eligible CARE diagnosis. The individual must also meet the other CARE criteria, including that the disorder is severe in degree and persistent in duration. A person who has a current diagnosis of substance use disorder, but who does not have a qualifying diagnosis, will not be eligible for the CARE process. For additional information, please review the CARE Act Eligibility Criteria Fact Sheet.
Topics:
- Behavioral Health, Eligibility Criteria
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Yes, counties are permitted to submit claims to the Department of Health Care Services (DHCS) for outreach and engagement activities incurred prior to filing a petition. Counties may submit claims to the Department of Health Care Services (DHCS) for outreach and engagement activities as outlined in Behavioral Health Information Notice (BHIN) 24-015: CARE Act Reimbursement Rates and Billing Guidance. Senate Bill 1400 and Senate Bill 42 require counties to engage and track respondents before a petition is filed, making pre-petition outreach and engagement activities eligible for reimbursement. You can also review the summary briefs Senate Bill 1400 and Senate Bill 42.
Topics:
- CARE Act Process, Claims / Billing & Sanctions, Other
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A substance use disorder (SUD) program that is explicitly designated as a federally-assisted SUD program or a “Part 2 program” has specific laws on how they share information. These designated programs are required to obtain the respondent’s consent or a court order before sharing treatment or diagnosis records originating from that program. Title 42 Code of Federal Regulations (CFR) Part 2 outlines the necessary process and findings for a court to compel the release of SUD records without a patient’s consent (see 42 CFR Part 2, 42 CFR Part 2 Fact Sheet.
Other services, programs, and providers (which may include county behavioral health (BH) agencies) not designated as a federally-assisted SUD program or a Part 2 program must follow federal and state privacy laws when sharing information during CARE Act proceedings. Records that originated from a Part 2 or federally assisted SUD program continue to be subject to the Title 42 CFR Part 2 rules, including the process for sharing these records with the court.
County BH agencies should consult with their county counsel for clarification on procedures to share information between the county and the courts with regards to federal and state privacy laws and whether the agency is designated as a federally-assisted SUD program or a “Part 2 program”. Please see the resources for additional information: 42 CFR Part 2, 42 CFR Part 2 Fact Sheet, and Senate Bill 35.
Topics:
- CARE Act Process, Counsel/Courts
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The CARE Act allows for conservatorship courts to refer an individual to the CARE process with the conservator or proposed conservator serving as the original petitioner. The CARE process may be a less restrictive alternative to conservatorship, supporting an individual to engage with county behavioral health (BH) services while remaining involved in a civil court process.
The CARE Act does not specify the process for this referral. While the statute does not set out a required timeframe for filing a CARE petition, the petition should be filed as soon as practical.
In addition to developing a referral process, the courts will also have to determine how to navigate overlapping conservatorship court and CARE court jurisdictions. This includes when and if to terminate the conservatorship proceedings, as well as the role of a conservator in the CARE process after the petition has been filed.
It should be noted that Senate Bill 42 requires that the conservator attest that they have considered CARE as a less restrictive alternative prior to petitioning for reappointment, and a professional must attest to consideration of CARE prior to making a recommendation to the court for appointment to temporary guardianship or reappointment (see Senate Bill 42 Amendments brief).
Topics:
- CARE Act Process, Counsel/Courts
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Separate from the reporting requirements to DHCS outlined in the CARE Act Data Dictionary, Counties may be asked to coordinate with the independent evaluator, RAND Corporation, in support of the CARE Act Independent Evaluation (due in Years 3 (i.e., 2026) and 5 (i.e., 2028)).
RAND is a nonprofit sub-contractor to DHCS selected to conduct an independent evaluation of the implementation process and outcomes of the CARE Act, as stipulated in W&I Code Section 5986. RAND’s independent evaluation of the CARE Act includes several sources of data:- Interviews with county-level implementation partners (e.g., behavioral health staff, judges, public defenders, county counsel, community-based partners), CARE participants, and petitioners
- Surveys completed by CARE participants
- Analysis of CARE data submitted by counties to HMA and other administrative data sources (e.g., data on emergency department use and hospitalizations)
Because the bulk of the CARE Act implementation activities are occurring at the county level and within county infrastructure, RAND will be selecting 12 counties to participate in the data collection efforts that involve interviews. This will likely include 3-4 cohort I sites and 8-9 Cohort 2 sites. RAND anticipates data collection to begin with counties in early 2025.
Topics:
- Data Collection & Reporting
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We encourage you to join the listserv and select your CARE Act role as “Data Collection & Reporting” to receive data-specific messages.
If you are already on our listserv, you can modify your profile to update your role—see instructions below:- Open a past CARE Act TTA newsletter from your inbox.
- Scroll down to the footer section at the bottom of the email.
- Select the “update your preferences” link.
- Select the “email me a link button” link.
- You will receive a separate email to securely update your preferences.
- Click the “update your preferences” link in the email.
- Modify your selections and information as needed.
- Click the “update profile” button.
Topics:
- Data Collection & Reporting
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Referrals to CARE for individuals deemed Incompetent to Stand Trial (IST), which include both Misdemeanor IST (MIST) and Felony IST (FIST), are made by the criminal court. A petition would then need to be filed to initiate the CARE process.
Misdemeanor IST (MIST): In MIST cases, the county behavioral health (BH) agency serves as the petitioner. Charges are dismissed six months after the referral to CARE unless the case is referred back to criminal court before that time.
Felony IST (FIST): For FIST cases, the statute does not specify that county BH must be the petitioner. County BH should collaborate with county counsel and justice partners to manage FIST referrals effectively. Charges in FIST cases are dismissed if the individual is accepted into the CARE program.
IST CARE referrals are discussed in Penal Code Section 1370 and Welfare and Institutions Code Section 5978.
Topics:
- CARE Act Process, Counsel/Courts
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If the individual is stabilized in involuntary treatment, they cannot be said to be stabilized in voluntary treatment. This means that an individual stabilized in a Lanterman-Petris-Short (LPS) conservatorship is not stabilized in voluntary treatment. This is consistent with the intent of CARE, which is to provide an opportunity to step down to less restrictive treatment.
For additional information, see the CARE Act Eligibility Criteria Fact Sheet.
Topics:
- CARE Act Process, Counsel/Courts, Eligibility Criteria
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Evidence that the respondent was detained for intensive treatments (5250s) is not a requirement for a CARE petition. One of two options is required to support the petition: (1) Evidence of at least two 5250 holds, the most recent one within the last 60 days, or (2) a completed CARE-101 (Mental Health Declaration).
See CARE Act Resources for Petitioners for more information.
Topics:
- CARE Act Process, Counsel/Courts, Eligibility Criteria
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A petition that is missing an address, legal name, or other identifying information may be accepted by the court. It is important for petitioners to include any detailed information available (e.g., street name, physical description) to assist the county behavioral health agency in identifying and locating the respondent to begin outreach and engagement.
The petition and any subsequent case documents may be amended when the legal name and other specific information is known about the respondent.
Topics:
- CARE Act Process, Counsel/Courts, Eligibility Criteria
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Following the prima facie review that the respondent meets or may meet the CARE eligibility criteria, a county behavioral health (BH) agency may be required to investigate and provide a report to the court. The process for submitting the report is dependent upon who filed the petition.
For a CARE petition filed by county BH, if the court determines the petition does not include all of the necessary information, the court will order county BH (via CARE-105 form or another form as determined by the court) to submit a written supplemental report within 14 court days.
For a CARE petition filed by someone other than county BH, the court shall order county BH (via CARE-105 form) to investigate, as necessary, and file a written report with the court as soon as practicable but within 30 court days. The court shall also order the county to provide notice (via CARE-106 form) to the respondent and petitioner that a report has been ordered.
Upon the request of county BH, if the court finds that the county is making progress to engage the respondent, the court may grant up to 30 additional days to continue to engage and enroll the individual in voluntary treatment and services. County BH shall provide notice to the respondent and petitioner that an extension for filing a report has been granted.
For more information, see California Welfare and Institutions Code section 5977.
Topics:
- CARE Act Process, Counsel/Courts, Eligibility Criteria
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Ancillary activities include time spent preparing for a primary activity outlined in Behavioral Health Information Notice No: 24-015. These ancillary activities account for extra or supporting time included in the hours spent performing each primary CARE Act activity—namely preparation, internal meetings, and oversight by supervisors and managers.
- Preparation: Time spent getting ready for a task. For example, preparing for a hearing can be reported under Court Hearing Time.
- Internal Meetings: Discussions and planning related to specific activities. For instance, meetings to develop outreach strategies for a CARE respondent may be reported under Outreach and Engagement.
- Supervisory Oversight: Time spent by supervisors and managers overseeing the work done in each category. For example, time spent reviewing and approving a court report may be claimed under Court Reporting.
For additional information, please review our relevant claims, billing, and sanctions FAQs here, as well as the CARE Act Sanctions and Claiming Process training. For additional questions, contact care_claiming@dhcs.ca.gov.
Topics:
- CARE Act Process, Claims / Billing & Sanctions, Other
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The Employee Type by Category/Activity dropdown in the CARE Act Claiming Workbook are examples, not a complete list of all possible staff types. Select the employee type that best matches the staff performing the activity. CARE Act activity rates are based on the Category/Activity (e.g., Court Hearing, Court Report, Notice), not the employee type.
Claims may be submitted for CARE Act administrative activities performed by multiple employees for the same task by adding each additional employee on a separate line in the Claiming Workbook. For example, if two employees serve a notice or participate in an outreach and engagement activity, both employees can be included in the claim.
For additional information, please review our relevant claims, billing, and sanctions FAQs here, as well as the CARE Act Sanctions and Claiming Process training. For additional questions, contact care_claiming@dhcs.ca.gov.
Topics:
- CARE Act Process, Claims / Billing & Sanctions, Other
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If an individual declines to participate in an assessment as part of the county investigation, county BH should include all available collateral information to complete the report.
County BH should document:
- Engagement attempts, including any reasons the individual may have provided in choosing not to participate.
- Observations from engagement efforts, including any visible symptoms or behaviors (e.g., paranoia, hallucinations, agitation).
- Relevant history from prior behavioral health services, hospitalizations, or chart reviews.
- Statements from providers, outreach teams, and the petitioner.
The goal of the county investigative report is to help the court make a determination if the individual is eligible for CARE and whether the individual can be voluntarily engaged in services. It will be up to the court to determine if the information is sufficient for the case to move forward or how to proceed given the individual’s unwillingness to participate. If requested, the court may grant an extension to file the report to allow county BH more time to build rapport with the respondent so that they feel more comfortable with the assessment process.
Topics:
- Behavioral Health, CARE Act Process, Case Worker / Case Manager
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There are several ways that county BH can promote a CARE respondent’s participation in court hearings. County BH should use a trauma-informed approach and consider the following strategies:
- Facilitate attendance by providing transportation to the hearing.
- Describing the court process ahead of time.
- Showing pictures of the courtroom in advance.
- Explaining the roles of court personnel.
- Offering food, clothing or other incentives in the courtroom to encourage participation.
- To the extent possible, county BH and the court may consider scheduling hearings at a time when the respondent is more likely to attend.
- If the court offers an option for virtual attendance, county BH staff may meet the respondent in the community and provide remote access to the hearing.
For more information, review the Trauma-Informed CARE for County Behavioral Health training series to learn more about trauma-informed approaches.
Topics:
- Behavioral Health, Case Worker / Case Manager, Counsel/Courts, Equitable & Person Centered Care
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If the county determines it is necessary to terminate the CARE participant from services, the county must first present to the court the reasons for the proposed termination of services. This can be done at a progress or status review hearing, or the county may request a hearing be set at any time during the CARE process. County legal counsel can provide guidance on how to engage the court and the respondent’s counsel in these situations.
Topics:
- Behavioral Health, CARE Act Process, Counsel/Courts
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A peer is an individual self-identified as having lived experience with the recovery process who can help others experiencing similar situations. Peer workers (including peer support specialists) that serve in a professional role on the county behavioral health team build trust with the respondent, participate in outreach and engagement efforts, and provide recovery-oriented support.
A volunteer supporter is an adult chosen by the respondent to provide support throughout the CARE process and to promote the respondent’s preferences, choices, and autonomy. The volunteer supporter may be a family member or friend, and may or may not have lived experience. It is not recommended that a peer worker serving on the CARE team also act as a volunteer supporter, as it may compromise their ability to serve as a neutral advocate in the volunteer supporter role.
For more information, see Role of the Peer in the CARE Process and the Volunteer Supporter Toolkit.
Topics:
- Behavioral Health, CARE Act Process, Equitable & Person Centered Care, Volunteer Supporter
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Reimbursement rates for each CARE Act administrative activity are listed in the CARE Act Claiming Workbook. These rates will be updated each fiscal year. Counties should always reference the most current version of the workbook to ensure accurate claiming.
For more information, see the Claiming for Administrative Activities Related to CARE brief. For additional questions, contact care_claiming@dhcs.ca.gov.
Topics:
- CARE Act Process, Claims / Billing & Sanctions