Title
Receive a presentation on the County of Monterey Health Department Behavioral Health Bureau Community Assistance, Recovery, and Empowerment (CARE) Act Program.
Report
RECOMMENDATION:
It is recommended that the County of Monterey Board of Supervisors:
Receive a presentation on the County of Monterey Health Department Behavioral Health Bureau Community Assistance, Recovery, and Empowerment (CARE) Act Program.
SUMMARY:
The Community Assistance, Recovery, and Empowerment (CARE) Act established a civil court-based framework designed to connect individuals living with untreated serious mental illness to coordinated behavioral health treatment, housing, and supportive services. Monterey County implemented the CARE Act on December 1, 2024. The purpose of this presentation is to provide the Board of Supervisors with an updated overview of CARE Act implementation in Monterey County to date, including changes made pursuant to Senate Bill 27 (SB27), program structure, implementation activities, data, trends, successes, challenges, and opportunities.
DISCUSSION:
The CARE Act establishes a civil court process intended to connect individuals living with untreated severe mental illness to community-based behavioral health treatment, supportive services, and housing resources. Under the CARE Act, designated individuals such as family members, behavioral health providers, first responders, and others identified in statute may petition the court to initiate the CARE process. The court may then facilitate either a voluntary CARE Agreement or a court-ordered CARE Plan tailored to the individual’s identified needs.
CARE Agreements and CARE Plans may include behavioral health treatment, medication support, case management, supportive housing resources, and other community-based services intended to promote stabilization and recovery. The CARE Act is designed to serve as an upstream intervention strategy intended to reduce avoidable psychiatric hospitalizations, incarcerations, homelessness, and Lanterman-Petris-Short (LPS) Act conservatorships through earlier engagement, coordination, accountability, and support for individuals experiencing significant functional impairment due to severe mental illness.
Monterey County Behavioral Health (MCBH) continues to prioritize voluntary engagement and treatment in the least restrictive setting possible. CARE Court serves as one additional intervention tool within the broader continuum of behavioral health and justice-related services available to individuals experiencing serious mental illness and co-occurring conditions.
Prior to implementation, a multidisciplinary CARE Court Planning Committee was convened led by the Monterey County Superior Court beginning in January 2024. The planning effort included representatives from Behavioral Health, County Counsel, the Public Defender’s Office, District Attorney’s Office, Public Guardian/ Administrator/ Conservator, the Court Self-Help Center, healthcare providers, and other justice and community partners. Monterey County also conducted stakeholder outreach and participated in statewide CARE Act trainings, workgroups, and implementation convenings in preparation for program launch.
Effective January 1, 2026, Senate Bill 27 enacted several amendments to the CARE Act intended to clarify eligibility criteria and streamline implementation. These amendments expanded CARE Act eligibility to include individuals diagnosed with Bipolar I Disorder with psychotic features, excluding psychosis related solely to substance intoxication; defined “clinically stabilized in ongoing voluntary treatment” within statute; allowed certain court referrals to serve as CARE petitions; authorized nurse practitioners and physician assistants to complete affidavits supporting CARE petitions; and permitted criminal courts to consider CARE referrals earlier in cases involving individuals found incompetent to stand trial.
Since implementation of the CARE Act on December 1, 2024, a total of 44 petitions have been filed through April 30, 2026, including 24 petitions filed during calendar year 2025 and 18 petitions filed during the first four months of 2026. To date, the CARE process has resulted in 18 CARE Agreements and four court-ordered CARE Plans, with additional cases currently in progress toward agreement or plan development. CARE petition activity has continued to increase since implementation, and the County is currently on track to exceed the total 2025 petition activity by year-end.
Implementation successes include increased collaboration among Behavioral Health, the Superior Court, Public Guardian/Conservator, healthcare providers, and justice partners; improved coordination for individuals transitioning from custody to treatment and housing; and increased opportunities for family engagement and voluntary treatment participation. CARE participants experiencing homelessness have also been connected to supportive housing placements, including Hope Housing Marina, board-and-care facilities, transitional housing, and Interim Inc. programs.
Implementation challenges continue to include extensive data reporting requirements, limited placement options for certain high-acuity populations, significant legal and administrative coordination requirements, and the reality that CARE is a resource intensive program in terms of staffing associated with the provision of direct client care and the court-related requirements. .
On May 7, 2026, Monterey County Behavioral Health hosted a number of State representatives and local partners for a CARE Act site visit. The visit occurred at the initiation of California Health and Human Services (CALHHS) Agency following increased statewide attention and accountability efforts related to CARE Act implementation and county performance following Governor Newsom’s March 2, 2026, press conference where he named Monterey as one of 10 underperforming counties as CARE Improvement and Coordination Unit (ICU) counties, along with Los Angeles, Orange, San Francisco, Santa Clara, San Bernardino, Kern, Riverside, Yolo and Fresno based only on a single data point, the number of per capita CARE petitions filed in calendar year 2025. The site visit was an opportunity for MCBH and our partners to provide a comprehensive overview of Monterey County’s CARE Act implementation efforts, program data that demonstrates Monterey is not “underperforming”, operational processes and broader continuum of behavioral health, housing, conservatorship, and supportive services available to this population at the local level.
The delegation also toured the County’s Behavioral Health Bridge Housing (BHBH) grant-funded Hope Housing Marina program, where they heard firsthand from individuals sharing their lived experience regarding housing stability, treatment engagement, sense of community, recovery, and coordinated support services. Site visit participants engaged in discussions regarding implementation successes, operational challenges, legal and policy considerations, and potential opportunities for targeted technical assistance and enhanced statewide collaboration related to CARE reimbursement maximization, cost-saving strategies, coordination with Department of State Hospitals (DSH), and strengthening collaboration between Behavioral Health and Public Guardian/Public Administrator/Conservator programs across counties.
This presentation supports the County of Monterey Health Department 2025-2028 Strategic Plan Goal 2: Provide Exceptional Person-Centered Care through Accessible, Community-Focused Health Services. It also supports the following of the ten essential public health services, specifically: 7. Link people to needed personal health services and assure the provision of health care when otherwise unavailable.
OTHER AGENCY INVOLVEMENT/COMMITTEE ACTIONS:
The Monterey County Superior Court, County of Monterey County Counsel, Public Defender’s Office, District Attorney’s Office, Public Guardian/Administrator/Conservator, local hospitals, law enforcement / first responder agencies, and community-based organizations have collaborated with Monterey County Behavioral Health in CARE Act implementation planning and ongoing operations.
FINANCING:
Assembly Bill 179 provided statewide funding for CARE Act implementation, including startup funding allocated to County of Monterey in the amount of $328,604 to support implementation activities. The Governor’s Budget also includes ongoing statewide General Fund support for CARE Act operations, including court hearings, outreach and engagement, reporting, and data collection activities. To date, MCBH has received $38,031 in reimbursement for eligible CARE-related activities in FY 2024-25 and has billed an additional $333,423 through the third quarter of FY 2025-26. CARE Act implementation continues to require significant staff and operational resources associated with court coordination, case management, outreach and engagement, reporting requirements, and legal and administrative support activities.
BOARD OF SUPERVISORS STRATEGIC PLAN GOALS:
The recommended action supports the Board of Supervisors' Strategic Plan Goals of Well-Being and Quality of Life and Safe and Resilient Communities by enhancing access to behavioral health services for individuals with untreated serious mental illness. The CARE Act promotes early intervention, coordinated care, and system accountability, contributing to improved individual outcomes and community stability.
Mark a check next to the related Board of Supervisors Strategic Plan Goals:
X Well-Being and Quality of Life
____ Sustainable Infrastructure for the Present and Future
X Safe and Resilient Communities
____ Diverse and Thriving Economy
____ Dynamic Organization and Employer of Choice
Prepared by: Melanie Rhodes, Behavioral Health Bureau Chief / Director, 755-1742
Fabricio Chombo, Behavioral Health Assistant Bureau Chief 755-4578
Approved by: Elsa Mendoza Jimenez, Director of Health Services, 755-4526
Attachments:
Board Report
PowerPoint presentation