Maryland's Assisted Outpatient Treatment Program Has Launched: What Community Behavioral Health Providers Need to Know

On August 21, 2026, the Maryland Department of Health officially launched the Assisted Outpatient Treatment program -- a court-based mechanism that allows mental health professionals, family members, and others to petition a circuit court to mandate that an individual with severe mental illness comply with a community-based treatment plan.

Maryland was one of the last three states in the country without an AOT program. That changed this week. If you operate a community behavioral health program, AOT is now part of the landscape you work in -- and understanding how it works, who it affects, and what your responsibilities may be is worth your time.

What AOT Is and How It Works

Assisted Outpatient Treatment -- sometimes called assisted outpatient commitment or, by critics, involuntary outpatient commitment -- is a legal mechanism designed for individuals whose severe mental illness impairs their ability to recognize that they need treatment. The target population is people who cycle repeatedly through psychiatric hospitalization and incarceration because they do not consistently engage with community-based care, often due to anosognosia (a symptom of some mental illnesses that prevents people from recognizing they are ill).

Under Maryland's AOT program, any of the following people can petition a circuit court for an AOT order for an individual:

• A licensed mental health professional who has treated or evaluated the person
• A family member or someone with a close personal relationship to the person
• The director of a mental health facility where the person has been treated

The petition triggers a court process. The respondent -- the individual for whom the petition is filed -- has the option to voluntarily enter the treatment plan. If they agree, the AOT plan is established without further court involvement. What happens if the individual does not cooperate with a court-ordered plan remains less clearly defined in the program's current implementation, and disability rights advocates have flagged this ambiguity as a significant concern.

When an AOT order is issued, it specifies a community-based treatment plan -- which typically includes outpatient mental health treatment, medication management, and potentially case management services. The community behavioral health system is expected to provide those services.

Where the Program Is Starting

The program launched in Baltimore City, Anne Arundel County, and the Eastern Shore counties. These are the first jurisdictions where circuit courts can accept and process AOT petitions.

Statewide implementation -- covering all 24 Maryland jurisdictions -- is planned for July 2027.

All 24 local jurisdictions deferred to the state health department to build and administer the program rather than developing county-run versions. The decision reflected uncertainty at the county level about implementation logistics and unanswered questions about program mechanics.

What This Means for Community Behavioral Health Providers

You May Receive AOT Referrals

If you operate in Baltimore City, Anne Arundel, or the Eastern Shore, you may begin receiving referrals for individuals under AOT orders. These clients are not voluntary in the conventional sense -- their treatment participation is court-ordered. That creates a different clinical and administrative context than typical community behavioral health enrollment.

From a documentation standpoint, an AOT client's chart should reflect the court order as the basis for enrollment, the specific treatment requirements specified in the AOT plan, and the monitoring activities your program performs. The connection between the court-ordered plan and your clinical documentation matters both for compliance and for any court reporting that may be required.

Case Managers Have a Monitoring Role

For TCM and CC programs, AOT creates a specific coordination responsibility. The AOT framework envisions case management as a vehicle for monitoring whether the individual is adhering to the court-ordered plan and connecting them to the services the plan specifies. Your monthly summary documentation should reflect AOT-specific monitoring activities if you are serving clients under AOT orders -- what services the client is required to attend, whether they are attending, and what coordination you are doing to support adherence.

Authorization and Billing Questions Are Not Yet Fully Resolved

AOT is new, and the billing and authorization mechanics for services provided to AOT clients are not yet fully established in Carelon's public guidance. Watch for provider alerts from Carelon addressing AOT-specific billing and authorization protocols as the program matures. In the meantime, bill for services as you normally would -- the AOT status of a client does not change the procedure codes or documentation requirements for the services themselves, but it may affect the authorization justification narrative.

Documentation of Clinical Necessity Takes on Additional Weight

Because AOT is court-involved, your clinical documentation for AOT clients may be subject to court review, not just Medicaid audit. Notes that document the client's clinical status, treatment participation, and response to services are potentially part of a legal record. This is a reason to ensure your documentation reflects genuine clinical observation and specificity -- not because auditors may see it, but because a judge or attorney may.

The Ethical Dimension Is Real

The disability rights community has raised substantive concerns about AOT -- primarily that court-mandated treatment overrides individuals' right to make their own medical decisions, and that coercive treatment experiences can damage trust in the mental health system and worsen long-term engagement. These are not fringe concerns; they are mainstream positions in clinical ethics and disability advocacy.

As a community behavioral health provider working with AOT clients, the clinical relationship still matters. A client who is court-ordered to attend your program is still a person whose engagement, trust, and therapeutic alliance will determine whether the treatment is actually effective. The legal mandate brings the person to the table; the clinical relationship is what produces outcomes. That distinction is worth keeping in mind as your programs adapt to working with this population.

The County Funding Question

One development worth flagging for practice owners: language added to Maryland's Budget Reconciliation and Financing Act during the 2026 session requires counties to begin reimbursing the state for AOT services starting in fiscal year 2028. Counties will reimburse 25% of state AOT costs in FY2028, with that share escalating to 100% by 2031 for jurisdictions using the state-run program.

This is a cost-shift that county officials say they were not adequately briefed on before it was embedded in the budget bill. The Maryland Association of Counties has flagged it as a concern and indicated counties are still working out what it means financially. The downstream effect on local behavioral health authority budgets -- and potentially on contracts with community providers -- is not yet clear but worth monitoring.

What to Do Right Now

If you operate in Baltimore City, Anne Arundel, or the Eastern Shore: Prepare for AOT referrals. Make sure your intake process can accommodate court-ordered enrollments and that your documentation templates reflect the additional context these clients bring.

Review the COMAR 10.63.07 repeal. As covered in the July 13 article on the COMAR 10.63 overhaul, the existing Outpatient Civil Commitment chapter of COMAR 10.63 was formally repealed effective August 3, 2026, and is being replaced by the AOT framework. The legal and regulatory underpinning for court-ordered outpatient treatment has shifted.

Watch for Carelon guidance. As AOT generates actual referrals and service requests, Carelon will need to address how these cases interact with authorization, billing, and care coordination requirements. Subscribe to Carelon provider alerts (maryland.carelonbh.com) to catch AOT-specific guidance when it comes.

Stay informed on statewide expansion. If you operate outside the initial launch counties, July 2027 is the target for statewide rollout. That gives you approximately 11 months to understand the program, prepare your clinical and administrative workflows, and position your practice to serve this population effectively.