Tulare County to opt out of unfunded Assisted Outpatient Treatment program, shift clients to Care Court services

The Tulare County Board of Supervisors voted unanimously to authorize the county Health and Human Services Agency (HHSA) Behavioral Health Branch to opt out of the unfunded Assisted Outpatient Treatment program (commonly known as Laura’s Law) effective July 1, 2025.

The move means individuals who would have been eligible for AOT will instead be served by the county’s Care Court program and an expanded “care at risk” arm that provides high‑intensity field‑based wraparound services, Behavioral Health Director Natalie Bullen told the board.

The nut graf: The county argued the opt‑out is a fiscal necessity and that Care Court and the expanded services already in place will provide comparable or greater levels of care for people with severe mental illness. Board members pressed staff on whether the small number of people served under AOT would be left without services; staff said the county has capacity to serve them through Care Court and related programs.

Bullen described program experience and costs: AOT referrals and enrollments have been low in Tulare County. HHSA reported total AOT program costs of about $7,046 for a 10‑month period (staff later clarified costs and a larger projected year‑end figure during discussion), and said funding sources included federal financial participation, realignment and MHSA funds. The Behavioral Health Branch asked the board to redirect resources to Care Court and the county’s field teams so implementation of Senate Bill 43 and other upcoming statutory changes can be sustained.

Care Court (Community Assistance, Recovery, and Empowerment) launched in Tulare County in December 2024 under contract with Kingsview. Bullen said the program is built to serve up to 20 Care Court participants and an additional 80 people through a voluntary “care at risk” track, for a combined capacity of up to 100 individuals who have untreated schizophrenia or other psychotic disorders and who would benefit from intensive community services such as in‑field counseling, medication supports, housing assistance and social services.

Board members asked whether the eight people previously served by AOT would “fall through the cracks.” Bullen and other HHSA staff said those individuals meet Care Court criteria and would receive the same or higher intensity services through the county’s new programs. Supervisors repeatedly emphasized the county’s objective to keep care local and to expand available in‑county beds and treatment infrastructure ahead of SB 43’s January 2026 changes to the Lanterman‑Petris‑Short (LPS) law.

Bullen and HHSA outlined infrastructure work under way: Casa Grande and Visalia campus projects that include locked substance use disorder treatment beds (slated for 2027), a proposed psychiatric health facility in Dinuba (support letters provided), and a Behavioral Health urgent care center in Tulare to triage individuals requiring higher care. Staff said these projects and the Care Court expansion are intended to reduce the need to transport patients out of county for inpatient care and to provide treatment closer to home.

The board moved and approved a motion directing staff to implement the opt‑out and transition eligible individuals to Care Court and the expanded care program. The motion passed unanimously (motion by Supervisor McCarrie, second by Supervisor Townsend).

The county will continue outreach and stakeholder engagement around SB 43 implementation, including work with law enforcement, hospitals and the state behavioral health directors association to develop evaluation tools and workflows for involuntary holds tied to severe substance use disorder and other criteria in the updated LPS framework.

Ending: HHSA officials said they will continue to update the board as Care Court enrollment grows and as SB 43 implementation clarifies placement and funding pathways.