The "Rural Hospital Investment Act of 2025" seeks to improve the financial sustainability of rural hospitals in Alabama by creating the Rural Hospital Investment Program, which will be managed by the newly established Rural Hospital Investment Program Board. This board will oversee the distribution of state tax credits—specifically income, excise, premium, and utility tax credits—in exchange for donations to eligible rural hospitals. The act defines terms such as "eligible rural hospital," "qualified donation," and "third party," and sets forth requirements for hospitals to qualify, including service provision to Medicare and Medicaid participants and the submission of a five-year financial viability plan.

The bill introduces new regulations for donations, mandating that third parties involved in fundraising provide a comprehensive list of eligible hospitals to potential donors. Starting in March 2027, hospitals must file annual reports detailing the donations received and their intended use, while the board and department will compile an annual report on donations and tax credits for legislative review. The act establishes a tax credit system for donors, with a total annual cap of $20 million for 2026, increasing to $30 million in subsequent years, and sets limits on individual hospital contributions. The program is set to begin on January 1, 2026, and unused tax credits can be carried forward for up to three years.