The Alabama Rural Hospital Investment Program Board finalized its list of hospitals eligible for 2026 donations and their levels of financial need during its Monday meeting.
The investment initiative, aimed at assisting struggling rural hospitals, was established by the Rural Hospital Investment Act of 2025, legislation sponsored by Representative Terri Collins, R-Decatur, which passed earlier this year.
The program will allow individual donors and businesses to receive a tax credit for contributions to support rural hospitals, and grants nonprofit third-party organizations the authority to solicit, administer or manage qualified donations for eligible hospitals.
During its meeting, the board heard a report from Alabama Hospital Association Vice President of Finance Wesley Ashmore on the methodology used to rank participating hospitals based on their financial need and voted unanimously to approve the list of hospitals and their rankings.
The full list of eligible hospitals, including their level of need, was published on the Alabama Department of Revenue website, later in the day, in accordance with the Rural Hospital Investment Act.
Although the act allows donors to specify which hospitals they wish to support, the grouping of facilities’ neediness into five tiers will determine how much money individual hospitals receive when donors don’t designate which facility they want to help fund.
Hospitals ranked as having the greatest need for investments will receive 30 percent of undesignated funds. Hospitals in the tier with the second most need will receive 25 percent of funds, the third tier will receive 20 percent, the fourth tier will receive 15 percent, and the tier for hospitals of least concern will receive ten percent.
Ashmore explained that eligible hospitals’ financial states were ranked based on a score ranging from 1 to 100, with 100 representing the facility in the most need of investment.
The scores were aggregated using financial data from hospitals’ most recent Medicare Cost Reports detailing their current assets and liabilities, uncompensated care percentages and current operating margins.
The severity of a hospital’s current asset-to-liability ratio accounted for 50 percent of its final score, while the severity of its total operating margin and level of uncompensated care as a percentage of total operating expenses both accounted for 25 percent.
Alabama State Treasurer Young Boozer commended Ashmore and the board for the ranking methodology.
“I went through the charts and looked at how it was structured,” Boozer said. “In my view, the methodology is excellent, and it is simple. It’s easy to understand, and I think it’s going to be a very positive impact, and it will be something that will be able to be used for some time.”
Board Chair Rob Pearson also expressed thanks to the board for its efforts in setting up the investment program.
“I will again, brag on this board,” he said. “I’m very, very happy about the results that we’ve come to. So, thank you all, for again, for your engagement and your attention to the details of this. And I believe we’ve got something that the legislature intended.”
“I look forward to seeing it—seeing it improve our rural hospitals around the state,” Pearson added.
The Rural Hospital Investment Program will begin accepting reservations for tax credits through an online portal on January 5, 2026.
After making their reservation, donors will have 30 days to provide a monetary donation equal to the amount reserved to an eligible hospital or third party.
The hospitals ranked as most financially in need consist of: Lake Martin Community Hospital, Tanner Medical Center-East Alabama, Medical Center Barbour, Marion Regional Medical Center, Jackson Medical Center, Atmore Community Hospital, Whitfield Regional Hospital, Red Bay Hospital, Grove Hill Memorial Hospital and Highlands Medical Center.
Hospitals included in the tier for the second most need are: Community Hospital, Inc. of Tallassee, DeKalb Regional Medical Center, Evergreen Medical Center, UAB St. Vincent’s Blount, Crenshaw Community Hospital, UAB St. Vincent’s St. Clair, Russellville Hospital, Mizell Memorial Hospital, Monroe County Hospital and Fayette Medical Center.
Hospitals ranked in the third tier consist of: Marshall Medical Center South, Marshall Medical Center North, Regional Medical Center of Central Alabama, Hale County Hospital, Clay County Health Authority, J. Paul Jones Rural Emergency Hospital, Cullman Regional Medical Center, D.W. McMillan Memorial Hospital, Lakeland Community Hospital and UAB St. Vincent’s Chilton.
The hospitals ranked in the fourth tier are: Northwest Medical Center, Inc., The Russell Hospital Corporation, Inc., Athens Limestone Hospital, Bibb Medical Center, North Baldwin Infirmary, Wiregrass Medical Center, East Alabama Medical Center-Lanier Rural Emergency Hospital, Coosa Valley Medical Center, Troy Regional Medical Center and Citizens Baptist Medical Center.
Dale Medical Center, Hill Hospital of Sumter County, Andalusia Health, Vaughan Regional Medical Center, Baptist Health Walker Hospital, Atrium Health Cherokee Medical Center, Washington County Hospital, Medical Center Enterprise, Baldwin Health and Greene County Hospital are the hospitals classified as having the lowest level of financial need.
