Alexander v. Amerigroup Iowa, Inc

IN THE COURT OF APPEALS OF IOWA

No. 24-0220
Filed July 2, 2025

C.A., by and through JENNIFER ALEXANDER, adoptive mother and legal
guardian as next friend, and JENNIFER ALEXANDER in her individual
capacity,
Plaintiffs-Appellants,

vs.

AMERIGROUP IOWA, INC., and ANTHEM, INC.,
Defendants-Appellees.
________________________________________________________________

Appeal from the Iowa District Court for Polk County, John Telleen, Judge.

A mother, on behalf of herself and her daughter, appeals from a district court

ruling that granted summary judgment for the defendant insurance companies.

AFFIRMED.

Alexander E. Wonio (argued) of Hansen, McClintock & Riley, Des Moines,

and Tyler M. Smith of Smith Law Firm, PLC, Altoona, for appellants.

James C. Martin (pro hac vice) (argued) and Colin E. Wrabley (pro hac vice)

of Reed Smith LLP, Pittsburgh, Pennsylvania, Rebecca R. Hanson (pro hac vice)

and Martin J. Bishop (pro hac vice) of Reed Smith LLP, Chicago, Illinois, and

Andrew Anderson and Shannon L. Sole of Faegre Drinker Biddle & Reath, LLP,

Des Moines, for appellees.

Heard at oral argument by Ahlers, P.J., and Badding and Buller, JJ.

Telleen, S.J., takes no part.
2

BADDING, Judge.

Jennifer Alexander adopted her daughter, C.A., from the foster care system

when the child was seven years old. For most of her childhood, C.A. was housed

in psychiatric medical institutions because of her severe behavioral needs. In

2016, Amerigroup Iowa, Inc., a managed care organization, began delivering

healthcare services for our state’s Medicaid recipients under a contract with the

Iowa Department of Human Services.1 In Alexander’s telling, once Amerigroup

and its parent company, Anthem, Inc., began administering C.A.’s Medicaid plan,

they pushed to have her moved to lower (and less expensive) levels of care.

Alexander alleges that, when she resisted, the insurance companies “caused five

wrongful child abuse reports” to be filed against her and “attempted to destroy the

familial and legal bond between” her and C.A. by suggesting that she should have

her daughter adjudicated as a child in need of assistance.

As her daughter’s guardian, and on her own behalf, Alexander sued

Amerigroup and Anthem for the insurance companies’ bad faith in administering

C.A.’s Medicaid plan; negligent and intentional infliction of emotional distress;

intentional interference with the parent-child relationship; and declaratory relief.

The district court granted the insurance companies’ motion for summary judgment

after reviewing thousands of pages of medical records and documents from

healthcare professionals that recommended C.A.’s transition to a lower level of

care. Alexander appeals.

1 The Iowa Department of Human Services was later merged with the Iowa
Department of Public Health and renamed the Iowa Department of Health and
Human Services. For this opinion, we refer to the agency by its name at the time
of the events giving rise to this lawsuit.
3

I. Background Facts and Proceedings

C.A.’s early childhood was traumatic. She was exposed to drugs and

alcohol in utero. After she was born in 2000, her biological parents neglected and

abused her—physically and sexually—until she was removed from their home

when she was four years old. From there, C.A. was placed in a series of foster

homes where she experienced further neglect and sexual abuse. By the time she

turned six years old, C.A.’s behaviors were too extreme for her foster family to

handle, and she was placed at a behavioral health facility.

Alexander, who had been a guidance counselor at a school C.A. attended,

adopted her in December 2007 when she was seven years old. Unfortunately,

C.A.’s behaviors did not improve in Alexander’s care. She was physically

aggressive with other children and Alexander. On one occasion, she threw a

candlestick at Alexander’s head and caused an injury that needed sutures. C.A.

was admitted to the child psychiatric unit at the University of Iowa Hospitals and

Clinics at least three times in 2009 for severe aggressive behavior. She was

eventually placed at Villa Santa Maria, a psychiatric medical institution for children

(PMIC)2 in New Mexico. C.A. was discharged from that facility in 2010. Alexander

blamed the discharge on funding and billing problems, while also reporting to her

own psychiatrist that the facility had accused her “of causing problems.”

Distressed at the thought of her daughter returning home, Alexander quickly

placed her at another PMIC in North Carolina. C.A. improved at that facility, where

2 An expert witness report for the defendants described a PMIC as “a non-secure

institution that provides 24 hours of continuous care and diagnostic or long-term
psychiatric services to children (under age 21).”
4

her medications were adjusted and she learned coping skills to deal with her anger.

Despite that improvement, Alexander opposed the facility’s recommendation for

C.A.’s discharge because she was concerned that C.A. would become physically

violent with her again. Alexander’s psychiatrist discussed alternatives with her,

including having C.A. adjudicated as a child in need of assistance, which could

allow the family to access otherwise unavailable services. But in the end, C.A.

was discharged into Alexander’s home in August 2011.

By 2012, Alexander was reporting backslides in C.A.’s behavior, which led

to several more psychiatric hospitalizations. A social worker at one of the hospitals

again mentioned seeking a child-in-need-of-assistance adjudication for C.A., but

Alexander was not interested. Instead, she pursued another PMIC placement, this

time at Piney Ridge Center in Missouri, which offered a program for sexually

abusive youths.

C.A. stayed at Piney Ridge from 2013 through 2016. The facility at first

focused on stabilizing the residual effects of C.A.’s complex trauma. After about a

year, C.A. was “able to regulate her emotions to the point where her behaviors

were at the moderate to low severe level.” The facility then turned its attention to

C.A.’s sexual behavior and her relationship with Alexander, which had deteriorated

over the years. By the end of 2015, the treatment team at Piney Ridge was making

plans to discharge C.A. to a step-down program the following spring, after she

completed the program for sexually abusive youths. Service notes stated “that at

some point the insurance was going to also question” whether continued PMIC-

level care was necessary. The facility’s clinical director later told Alexander: “The

reality is—she has been with us for 3 years, she is starting to stagnate (as much
5

as I’m trying to remain creative), and the insurance company will have something

to say about that.”

Alexander did not take this news well. She wrote a letter to C.A. after a

therapy session that called her daughter a “liar” and “abuser.” When staff at Piney

Ridge recommended that Alexander not send this letter to C.A., Alexander

responded by email:

I can’t do this. I can’t see the sociopath she is and curb my
reactions. I’m sickened. I’m scared. I’m angry. . . .
. . . I felt really good about writing this and sending it. I guess
I wasn’t asking for feedback. I’m her mom, and I’ll say to her what I
want to say to her. If you think it’s abusive, you can take whatever
action you feel you need to take. I’m sure you yell at your kids for a
hell of a lot less than being a sick sociopath who enjoys toying with
others, namely you, as a cat plays with a mouse before the kill. I
have to DO something or I’m going to lose it here. My PTSD is off
the charts.

A clinical psychologist who tested C.A. in February 2016 did not agree with

Alexander’s view that C.A. was a sociopath. Despite pressure from Alexander, the

psychologist refused to diagnose C.A. with either antisocial personality disorder or

reactive attachment disorder, writing that she was “unable to ethically or morally

add” those diagnoses because she didn’t have the data to support them. That

psychologist agreed with C.A.’s treatment team at Piney Ridge that she should not

be reunified with Alexander but instead transitioned to treatment in an

independent-living setting.

A. Amerigroup Iowa, Inc. Enters the Picture

As the treatment team at Piney Ridge was preparing to discharge C.A. to a

lower level of care, the Iowa Department of Human Services executed a contract

with Amerigroup Iowa, Inc., a managed care organization, to administer health
6

insurance benefits and case management services to Iowa’s Medicaid recipients.

The contract’s start date was January 1, 2016, but Amerigroup did not begin

providing services in Iowa until April.

Alexander enrolled C.A. with Amerigroup while she was looking for new

PMIC-level treatment centers. She found one in Utah—the Provo Canyon School.

Alexander informed a case manager with Amerigroup that Provo Canyon had

approved C.A. for admission into their program, but Alexander refused to allow

Piney Ridge “to know anything about the new placement” or “to communicate with

Provo Canyon” without her present. A bed opened at Provo Canyon before C.A.

finished her sexually abusive youth program at Piney Ridge. Because she did not

want to lose the spot at Provo Canyon, Alexander moved C.A. there in mid-April.

B. The First Two Child Abuse Reports

A psychiatric evaluation completed two days after C.A. arrived at Provo

Canyon estimated that she would “require approximately 24 months in this

residential treatment program, followed by transition to an independent living

program with intensive outpatient follow-up.” But by July, the treatment team

recommended that C.A. discharge to a lower level of care or that Alexander

consider having C.A. adjudicated as a child in need of assistance. Alexander

refused the latter route and challenged the discharge recommendation,

maintaining that C.A. was manipulating her therapists into believing that she had

improved. In a series of long emails, Alexander called C.A. “sick,” “dangerous,” “a

budding criminal very sick girl,” and a “sociopath.” She made some similar

statements during family therapy sessions with C.A. The treatment team stopped

those sessions and reported Alexander to the Utah Division of Child and Family
7

Services and the Iowa Department of Human Services for emotional abuse. Utah

found the report was “unsupported,” noting that C.A. “did not disclose great

emotional distress” because of Alexander’s statements. Iowa did not investigate

the report since Utah had already opened an investigation.

After the investigations closed, Provo Canyon moved Alexander and C.A.

to supervised communications, while Alexander looked for a new PMIC to care for

C.A. In October, the treatment team at Provo Canyon made a second child abuse

report to the Iowa Department of Human Services, alleging that

[C.A.] has been in out of home placements for many years. It is
alleged that her mother, Jennifer Alexander, is unable to recognize
her progress or accept that she is improving. Jennifer tells [C.A.] that
she is a sick person, is a sexual predator and that she will never [b]e
well. It is alleged that these allegations are not based on facts, are
internalized by [C.A.] and are impeding her ability to make
therapeutic progress. The child reacts with verbal and physical
aggression, property destruction, demeaning self-talk and panic
attacks.

The report was not confirmed.

As she had with Piney Ridge, Alexander refused to allow staff at Provo

Canyon to participate in her search for a new facility for C.A. She eventually

located a PMIC in Colorado—Devereux Cleo Wallace—that would accept C.A.

Even though Devereux was an out-of-network provider and provided a higher level

of care than was recommended for C.A., Amerigroup made an individual contract

with them and approved C.A.’s admission there. C.A. started at Devereux in

December 2016.

C. The Third Child Abuse Report

By April 2017, C.A.’s providers at Devereux determined that she was ready

for a lower level of care. Devereux and Amerigroup started planning for C.A.’s
8

discharge, while Alexander actively fought it. With Alexander refusing to

participate in the planning, Amerigroup tried to find step-down programs that would

accept C.A. They reached out to Piney Ridge, but that facility had one requirement

for C.A.’s readmission: “Mom cannot have any involvement with [C.A.] or her

treatment, here, including treatment planning.” Alexander then revoked

Amerigroup’s permission to speak to providers on C.A.’s behalf.

To keep things moving forward, Amerigroup’s case manager recommended

that Alexander explore Lakes Life Skills, a life-skills training center for adult women

in Iowa. Alexander informed the case manager that she had talked to the facility

and that they would not take C.A. until she was eighteen. When the case manager

followed up with Lakes Life Skills, a provider there responded:

[C.A.’s] mother called me today. I found her a little
overwhelming to be honest. . . . I discovered she really was doing
reconnaissance for reasons why we would be inappropriate for her
daughter! Mum feels her daughter needs somewhere that provides
restraints. I explained we were trauma informed and did not utilize
restraint. . . .
She feels that this is a plot by Amerigroup to cut costs and not
in her daughter’s best interest and as her guardian she calls the
shots. . . .
Long story short, if I have a bed I would consider her recent
behaviors and progress and seriously look at taking her. Mum may
be a barrier to appropriate goals.

A couple of weeks later, providers at Devereux made the third child abuse

report in Iowa against Alexander:

It is alleged [C.A.] (age 17) is in a residential treatment facility
in Colorado and has been recommended for a lower level of care by
three different treatment facilities due to the progress she has made
overall. Mother, Jennifer Alexander, refuses to participate in
discharge planning or cooperate with referrals to agencies that can
provide a lower level of care. As a result of mother’s refusal to
participate in discharge planning, [C.A.] is not receiving care
commensurate with her needs.
9

This report, which was reviewed by the Iowa Department of Human Services as a

family assessment, determined that C.A. was safe.

While the parties worked on a discharge plan, Amerigroup approved a

funding extension, and Devereux set C.A.’s discharge for October. Amerigroup

gave Alexander a list of step-down facilities to contact, but according to Alexander,

none of them were willing to admit C.A. When Devereux staff saw what Alexander

had told the facilities about C.A., they noted some of the behaviors she listed were

either questionable or outright mischaracterizations. With no step-down or other

treatment facility in place, the plan changed to discharge C.A. to Alexander’s home

with outpatient services. Alexander continued to push for residential treatment in

increasingly agitated emails that maintained C.A. was dangerous. Devereux

agreed to keep C.A. for another week but remained firm with Alexander that they

were not going to seek funding authorization from Amerigroup beyond that date.

To aid in her transition home, the treatment team formulated a safety plan, which

included an instruction to “[l]ock all prescription and over-the-counter medications.”

D. The Fourth Child Abuse Report

C.A.’s first three weeks at home went well, and she asked Alexander for

more responsibility. So, despite the safety plan from Devereux, Alexander agreed

to let C.A. manage a week’s worth of her night-time medications. After an

argument with Alexander, C.A. took all the medication available to her in a suicide

attempt. She was admitted to Allen Hospital at the beginning of November. After

Alexander notified Amerigroup and others about C.A.’s hospitalization, the
10

healthcare management director with Amerigroup asked employees of the Iowa

Department of Human Services to do a safety check:

We remain concerned about the safety of this child in the
mother’s home. We are concerned mother is creating situations that
are provocative to [the] extent child is attempting to end her life. She
is in Allen Hospital presently due to an overdose of trazedone.
We would like to ask that someone from [the department] do
a check with [C.A.] while in the hospital to assess her safety again,
now that she is living in her mother’s home.

Later that day, an administrator of the department’s mental health and

disability services made the fourth child abuse report against Alexander, alleging

that she “permitted her daughter to have access to medications knowing the child

has a recent history of suicidal attempts,” and that “[C.A.] overdosed on

medications and required medical intervention as a result of her mother allowing

her access to the medications.” The report was not confirmed.

After a week at the hospital, the doctor caring for C.A. believed that she was

ready to be discharged to a lower level of care. He explained that C.A. “has to be

managed in the community in order to plan for her future” and that “further

institutionalization is not going to help with her behaviors.” The hospital’s social

worker told Alexander the insurance company had found a bed for C.A. at Lakes

Life Skills, but Alexander explained that she had already rejected that facility

because she did not believe C.A. was “ready for that level of care or assistance.”

E. The Fifth Child Abuse Report

C.A. returned to Alexander’s home towards the end of November.

Unfortunately, at the beginning of January 2018, C.A. was hospitalized again—this

time at Mercy Hospital—after she swallowed a battery. The doctor who discharged

her noted the relationship between C.A. and her mother “is severely pathological
11

and very dysfunctional.” He observed that Alexander displayed “significant

provoking behavior from the patient. She will constantly negatively criticize the

patient for no apparent reason. She also displayed significant anger towards the

patient.” The doctor concluded, “In [my] professional opinion she appear[s] to be

constantly provoking this child into explosive anger outbursts.”

Just a few weeks later, C.A. was back at Mercy Hospital for suicidal

thoughts. During her hospitalization, she told her doctor that “she was not really

suicidal[,] she just wanted to get away from her mother” and be in “a safer setting.”

Alexander continued to push for residential treatment, which the doctor did not feel

was needed. He later noted, “It appears that at every turn in the close of the

treatment the adoptive mother continues to be sabotaging the treatment plan as

well as [the] recovery of this patient.”

Before C.A. was discharged home, Amerigroup’s healthcare management

director made the fifth child abuse report to the department:

It is alleged Jennifer’s systematic verbal down grading and
forcing her daughter [C.A.] (17) into institutions over the past ten
years has caused [C.A.] to make extreme behavior choices like
taking an over dose of medications and swallowing a battery to try
and harm herself. [C.A.] has not been able to gain the skills to be
able to sustain herself alone once she turns age eighteen due to
being institutionalized but, Jennifer refuses to allow [C.A.] to
participate in a program that will help her gain those skills in a
supported environment. Jennifer provokes [C.A.] with degrading and
disparaging language causing [C.A.] not to be able to function on a
daily basis.

Like the prior reports, this one was also not confirmed.

C.A. was back in the hospital in early February after she ran away and

threatened to cut herself. She was discharged to the Cherokee Mental Health

Institute, where she did well. Within a month, the treatment team at Cherokee “felt
12

she had reached maximum benefit of acute psychiatric hospitalization.” But, as

had been the case with C.A.’s other facilities, discharge planning was difficult.

In May, when C.A. turned eighteen, a social worker at Cherokee presented

Lakes Life Skills to Alexander as an option—not knowing Amerigroup had

recommended that facility before. Alexander felt Amerigroup was behind the

recommendation, although the social worker explained that was not the case.

Alexander, who by then had obtained guardianship over C.A.,3 refused to sign

releases that would authorize Cherokee to make referrals to facilities offering a

lower level of care. So C.A. languished at Cherokee until September, when an

administrator at the Iowa Department of Human Services notified Alexander that

C.A. was being discharged because the facility was “currently over census and/or

has unmet demands for new admissions.” Alexander obtained an injunction

preventing C.A.’s discharge. In response, the department petitioned to have

Alexander removed as C.A.’s guardian. The parties eventually agreed that C.A.

would move to Lakes Life Skills, and Alexander would remain her guardian.

F. The Lawsuit

In August 2019, Alexander filed suit against Amerigroup in her individual

capacity and on behalf of C.A. She broadly alleged that the insurance company

denied C.A. medically necessary care and then, when Alexander persisted in

seeking that care, conditioned its provision on Alexander “relinquish[ing] custody

of C.A. to the State of Iowa.” Alexander alleged that after she refused “to remove

herself from the picture voluntarily,” Amerigroup “initiated and coordinated a series

3 An employee at Amerigroup described this as “the worst possible outcome” in a

conversation with C.A.’s providers at Cherokee.
13

of false child protective services investigations and related court proceedings”

against her. Under that framework, Alexander brought claims against Amerigroup

and its parent company, Anthem, Inc., for bad faith in administering C.A.’s

Medicaid plan; negligent and intentional infliction of emotional distress; and

intentional interference with the parent-child relationship. She also sought

declaratory relief.

Four and a half years of litigation ensued, and both parties ultimately moved

for summary judgment. The defendants’ motion asked the district court to dismiss

each of Alexander’s claims. Alexander’s motion sought declaratory relief related

to the parties’ rights and duties under the managed-care contract, as well as a

ruling on estoppel issues. The district court denied Alexander’s motion, granted

the defendants’, and dismissed Alexander’s petition. Alexander appeals.4

II. Standard of Review

“We review summary judgment rulings for correction of errors at law.”

Myers v. City of Cedar Falls, 8 N.W.3d 171, 176 (Iowa 2024) (citation omitted).

The record is viewed “in the light most favorable to the nonmoving party, who is

4 We reject one of Alexander’s claims from the start. Her summary judgment
motion asked the district court to disregard the separate corporate identities of
Amerigroup and Anthem in establishing Anthem’s liability on her claims. The court
declined to do so, finding “that the facts of this case do not justify piercing the
corporate veil” and Alexander had “not shown sufficient evidence that Amerigroup
is the alter ego of Anthem.” The court continued that “[e]ven if it were proper to
pierce the veil, the Court finds no liability accrues to Amerigroup, thus no liability
accrues to Anthem.” On appeal, Alexander argues the court erred in ignoring her
“claims that Anthem incurred direct, personal liability for its own tortious actions.”
But Alexander did not call this oversight to the court’s attention. See 33 Carpenters
Constr., Inc. v. State Farm Life & Cas. Co., 939 N.W.2d 69, 75 (Iowa 2020). And
our supreme court has routinely held “that when an issue is raised in a motion but
not decided in the district court ruling, the issue is not preserved for review.” Id.
As a result, we analyze the remaining claims only as they relate to Amerigroup.
14

entitled to every legitimate inference that we may draw” from it. Id. (citation

omitted). “Summary judgment is proper when the movant establishes there is no

genuine issue of material fact and it is entitled to judgment as a matter of law.” Id.

(citation omitted).

III. Analysis

To give some context to Alexander’s claims on appeal, we start by

summarizing the Medicaid program in Iowa. “The Medicaid program is a

cooperative state-federal program, and while participation is voluntary, ‘once a

state chooses to participate, it must comply with the federal statutory

requirements.’” Colwell v. Iowa Dep’t of Hum. Servs., 923 N.W.2d 225, 237

(Iowa 2019) (citation omitted). As one federal court has explained:

The Medicaid Act requires that beneficiaries be permitted to receive
healthcare services from participating, qualified providers of their
choice (the “freedom-of-choice” provision), and that the state pay
those providers directly on a fee-for-service basis according to state-
established fee schedules. States may seek waivers from the
requirements of that traditional fee-for-service program. In particular,
states may seek a waiver of the “freedom-of-choice” provision to
provide healthcare services to Medicaid beneficiaries through
managed care systems. In such systems, private contracting
managed care organizations (“MCOs”) administer the Medicaid
program for their members, contract with a network of providers,
arrange for care, and pay providers for their services. Medicaid
beneficiaries enrolled in managed care plans receive care from only
those providers designated by the MCO, except that emergency care
providers cannot be restricted. Both the waiver itself and the
contracts between MCOs and the state must be approved by the
federal government, and the contracts must comply with a series of
statutory and regulatory requirements.

Medevac MidAtlantic, LLC v. Keystone Mercy Health Plan, 817 F. Supp. 2d 515,

517 (E.D. Pa. 2011) (footnotes omitted) (citing 42 U.S.C. §§ 1396–1396v).
15

The Iowa Department of Human Services manages Iowa’s Medicaid

program through the managed-care model. See Good v. Iowa Dep’t of Hum.

Servs., 924 N.W.2d 853, 858 (Iowa 2019). Under this system, the “MCO is

required to ‘provide, at a minimum, all benefits and services deemed medically

necessary that are covered under the contract with the agency’ in accordance with

the [department’s] standards.” Id. (quoting Iowa Admin. Code r. 441-73.6(1)). The

department entered into a managed-care contract with Amerigroup in 2015, with a

stated purpose of providing “high quality healthcare services in the least restrictive

manner appropriate to a member’s health and functional status.” Amerigroup

began providing services under that contract in April 2016.

With this background, we turn to Alexander’s first claim on appeal—that the

district court erred in dismissing her cause of action for Amerigroup’s bad faith in

administering C.A.’s Medicaid plan.

A. Third-Party Beneficiaries

Alexander’s bad-faith claim asserted that Amerigroup owed an implied “duty

of good faith and fair dealing” under its “contract to [a]dminister Plaintiff C.A.’s

Medicaid plan.” She alleged Amerigroup breached that duty “based on its

continuous and ongoing bad faith denial of health care claims for C.A. and

Amerigroup’s unlawful interference with Alexander’s parental rights.” Amerigroup

sought summary judgment on that claim, arguing that it did not owe Alexander or

C.A. a duty of good faith and fair dealing because they were not third-party
16

beneficiaries to its contract with the department. The district court agreed with

Amerigroup,5 and we do too.

“To sue for breach of contract, one normally needs to be a party to the

contract.” Rath v. Arch Ins., No. 23-0157, 2024 WL 1548794, at *4 (Iowa Ct. App.

Apr. 10, 2024). “But Iowa law recognizes an exception to this general rule—an

intended third-party beneficiary of a contract may sue under the contract to remedy

the breach of a duty benefitting the third party.” Id. “[T]he primary consideration

in deciding whether nonparties to an agreement are third-party beneficiaries

thereof is whether the contract manifests an intent to benefit those parties.”

Walters v. Kautzky, 680 N.W.2d 1, 4 (Iowa 2004).

This standard comes from our supreme court’s adoption of the Restatement

(Second) of Contracts § 302 (Am. L. Inst. 1979), which provides:

(1) Unless otherwise agreed upon between promisor and
promisee, a beneficiary of a promise is an intended beneficiary if
recognition of a right to performance in the beneficiary is appropriate
to effectuate the intention of the parties and either
(a) the performance of the promise will satisfy an obligation of
the promisee to pay money to the beneficiary; or
(b) the circumstances indicate that the promisee intends to
give the beneficiary the benefit of the promised performance.

(Emphasis added.)

5 In challenging the district court’s summary judgment ruling, Alexander relies on

an earlier ruling by a different judge partially denying Amerigroup’s motion to
dismiss. That ruling adopted Alexander’s third-party beneficiary argument and
found “the Contract when read as a whole does not exclude nor prevent a member-
beneficiary from seeking reprieve under its terms.” But a “district court judge may
review and change a prior interlocutory ruling of another district court judge in the
same case,” as happened here. McCormick v. Meyer, 582 N.W.2d 141, 144
(Iowa 1998).
17

Under this provision, “[w]hen a contract expressly negates the creation of

third-party beneficiaries, we have rejected the claim that such status exists.” RPC

Liquidation v. Iowa Dep’t of Transp., 717 N.W.2d 317, 320 (Iowa 2006).

Amerigroup’s contract with the department includes such an express disclaimer in

its “General Terms for Services Contract”:

No Third Party Beneficiaries. There are no third party
beneficiaries to this Contract. This Contract is intended only to
benefit the State and the Contractor.

The supreme court considered an almost identical disclaimer in Walters,

where prison inmates claimed to be third-party beneficiaries of an agreement

between the Iowa Department of Corrections and the state public defender to

provide legal assistance to inmates. 680 N.W.2d at 2–3. The court rejected the

inmates’ claim, finding the agreement—which provided “[t]here are no third party

beneficiaries to this Agreement” and “[t]his Agreement is intended only to benefit

the DOC and the Public Defender”—expressly negated any intention to benefit the

inmates. Id. at 3–4. Similarly, in RPC Liquidation, the supreme court considered

whether a material supplier was a third-party beneficiary to contracts between the

Iowa Department of Transportation and bridge contractors. 717 N.W.2d at 318.

Each of the contracts provided, “it is specifically agreed between the parties

executing this contract that it is not intended by any of the provisions of any part of

the contract documents to create in the public or any member thereof a third party

beneficiary hereunder.” Id. at 320–21 (emphasis removed). The court concluded

that language “clearly express[ed] the intent of the parties to exclude anyone from

having third-party beneficiary status.” Id. at 322.
18

The district court relied on these cases in finding that Alexander and C.A.

were not third-party beneficiaries of Amerigroup’s contract with the department.

Alexander argues the court erred in reaching that conclusion because it “failed to

consider the language of the contract as a whole and the circumstances of its

execution.” She contends the express disclaimer here must be disregarded

because it conflicts with more specific provisions in the contract that identify

“various rights of Medicaid beneficiaries.” Typically, “when a contract contains

both general and specific provisions on a particular issue, the specific provisions

are controlling.” Homeland Energy Sols., LLC v. Retterath, 938 N.W.2d 664, 688

(Iowa 2020) (citation omitted). But we do not see any conflict that requires

application of this principle of contract construction.

As Alexander recognizes, the specific provisions that she relies on

“expressly incorporate[d] a variety of ‘rights’ that the federal government requires

Medicaid administrators to afford to ‘enrollees’ under 42 C.F.R. § 438.100.” But,

as other courts have concluded, specific provisions in a managed-care contract

requiring “compliance with existing statutory or regulatory provisions do not

indicate mutual intent to benefit a non-party; they evince intent to comply with

applicable law.” Medevac MidAtlantic, 817 F. Supp. 2d at 529; accord Prince

George’s Hosp. Ctr. v. Advantage Healthplan Inc., 985 F. Supp. 2d 38, 48

(D.D.C. 2013) (finding the inclusion of a term requiring reimbursement from an

MCO as a matter of statutory obligation “is not indicative of any intent on the part

of the signatories to benefit” a third party to the contract); Allen v. Tex. Child.’s

Health Plan, 649 S.W.3d 830, 836 (Tex. App. 2022) (concluding Medicaid

recipients “cannot carry their burden to demonstrate they are third-party
19

beneficiaries under the [MCO] Contract merely by reference to the Contract’s

purpose or the intended use of services provided under the Contract”).

We agree with the reasoning of these courts and find that the contract’s

inclusion of federally-required terms in its special terms appendix does not override

its express third-party beneficiary disclaimer. This conclusion does not leave

Alexander or others in her position without a remedy, as she suggests on appeal.

Amerigroup members also have access to a grievance process, an appeal

process, and a fair-hearing system, which are outlined in their member handbooks.

See Iowa Code § 249A.4(11); Iowa Admin. Code r. 441-7.4. For these reasons,

we affirm the district court’s grant of summary judgment on Alexander’s bad-faith

claim.

B. Qualified Immunity

Alexander next claims that the district court erred in finding Amerigroup was

immune under Iowa Code section 232.73 (2019) from any liability stemming from

the five child abuse reports on her claims for negligent and intentional infliction of

emotional distress. Section 232.73(1) provides that a “person participating in good

faith in the making of a report . . . or aiding and assisting in an assessment of a

child abuse report pursuant to section 232.71B, shall have immunity from any

liability, civil or criminal, which might otherwise be incurred or imposed.” This

section grants a form of qualified immunity—a question of law appropriate for

summary judgment. Nelson v. Lindaman, 867 N.W.2d 1, 7 (Iowa 2015).

To determine good faith under section 232.73(1), courts use a subjective

standard, where “reasonableness and the objective standard play no part.” Id. at 8

(citation omitted). The inquiry “rests on a defendant’s subjective honest belief that
20

the defendant is aiding and assisting in the investigation of a child abuse report.”

Garvis v. Scholten, 492 N.W.2d 402, 404 (Iowa 1992). Negligence is not enough.

Id. “To avoid summary judgment, the plaintiff must have evidence the defendant

acted dishonestly, not merely carelessly, in assisting” the department. Nelson, 867

N.W.2d at 8. We agree with the district court that “[s]uch evidence is totally absent

from this case.”

On appeal, Alexander still fails to identify evidence that Amerigroup acted

dishonestly, either with the one report that it made or with the others Alexander

contends that it orchestrated.6 See Buboltz v. Birusingh, 962 N.W.2d 747, 754–55

(Iowa 2021) (“Summary judgment is not a dress rehearsal or practice run for trial

but rather the put up or shut up moment in a lawsuit, when a nonmoving party must

show what evidence it has that would convince a trier of fact to accept its version

of events.” (cleaned up)). Instead, she argues the court “disregarded Plaintiffs’

evidence from which a jury could have inferred that Amerigroup’s explanations

were pretextual.” Even if that were the correct standard, which we doubt,

Alexander offers nothing beyond speculation and conclusory statements that

“Amerigroup tried to reduce its costs by pushing [child-in-need-of-assistance]

proceedings on Alexander, and met [by] her resistance, retaliated by filing, or

causing to be filed, false and retaliatory reports.” See Nelson, 867 N.W.2d at 7

(“Speculation is not sufficient to generate a genuine issue of fact.” (citation

omitted)). Each of the reports was supported by contemporaneous medical

6 We question the premise of this latter allegation, considering that each of the

reporters for the other reports testified in their depositions that Amerigroup did not
ask or encourage them to make those reports. But we accept it for the sake of
argument.
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records, as detailed in the background facts. While the reports were not confirmed,

that does not mean they were false, as Alexander suggests on appeal. We agree

with Amerigroup that such a conclusion would undermine the statute’s purpose,

which is “to encourage those who suspect child abuse to freely report it to

authorities without fear of reprisal if their factual information proves to be faulty.”

Id. at 8 (citation omitted).

The district court did not err in finding that Amerigroup was entitled to

qualified immunity under Iowa Code section 232.73(1). Amerigroup is accordingly

shielded from liability for Alexander’s claims for negligent and intentional infliction

of emotional distress, which were based on the child abuse reports.7 While

Alexander argues on appeal that “Amerigroup’s outrageous and injurious conduct

extended well beyond making false abuse reports,” the district court did not

consider any other conduct in evaluating Alexander’s claims, and she did not seek

to enlarge its ruling. We accordingly find that argument was not preserved for our

review. See Meier v. Senecaut, 641 N.W.2d 532, 537 (Iowa 2002).

C. Tortious Interference with the Parent-Child Relationship

Alexander’s claim for tortious interference with the parent-child relationship

alleged that Amerigroup “refused to approve medically necessary care for C.A.

unless [she] agreed to relinquish custody of C.A. to the State of Iowa, which would

then mean that her treatment was not paid for by Amerigroup.”8 The district court

7 To the extent that Alexander’s claim for negligent infliction of emotional distress

was also based on Amerigroup’s alleged breach of its contract with the
department, that claim fails based on our rejection of Alexander’s third-party
beneficiary argument.
8 Alexander also alleged that Amerigroup interfered with the parent-child

relationship by “initiat[ing] false accusations that [she] had abused or neglected
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granted Amerigroup summary judgment on this claim, reasoning that “Iowa law

does not presently recognize a cause of action for tortious interference with the

parent-child relationship.”

Amerigroup concedes this was incorrect. See Lennette v. State, 975

N.W.2d 380, 390 (Iowa 2022) (collecting cases recognizing the tort). But it seeks

to uphold the court’s ruling on an alternate ground that it urged in its summary

judgment motion. See Tate v. Derifield, 510 N.W.2d 885, 887 (Iowa 1994) (“On

appeal we may affirm the district court ruling upon any ground raised in district

court even if the ground is not one relied upon by the court.”). That ground was

Amerigroup’s argument that Alexander “had no evidence” to establish the

elements of the tort. We agree.

To establish a claim for intentional interference with the parent-child

relationship, a plaintiff must show:

(1) the plaintiff has a legal right to establish or maintain a parental or
custodial relationship with his or her minor child; (2) the defendant
took some action or affirmative effort to abduct the child or to compel
or induce the child to leave the plaintiff’s custody; (3) the abducting,
compelling, or inducing was willful; and (4) the abducting,
compelling, or inducing was done with notice or knowledge that the
child had a parent whose rights were thereby invaded and who did
not consent.

Lennette, 975 N.W.2d at 390 (citation omitted). There is no evidence that

Amerigroup “took some action or affirmative effort to abduct the child or to compel

or induce the child to leave the parent’s custody.” Id. We accordingly affirm the

district court’s grant of summary judgment on this claim.

C.A.” But, as we concluded above, Iowa Code section 232.73(1) immunizes
Amerigroup from liability on that ground.
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D. Declaratory Judgment

This leaves us with Alexander’s claim for declaratory relief. Alexander’s

petition asked the court to declare that (1) “Amerigroup’s pattern of retaliation . . . is

illegal, a violation of Iowa law and against the public policy of the State of Iowa”;

and (2) neither the contract nor Iowa law “authorizes Amerigroup to condition the

approval of medically necessary health care on the relinquishment of custody of

the child to the State of Iowa or the surrendering of any parental or guardianship

rights.”

The district court’s ruling only addressed the first ground, finding that

Alexander did “not ask the Court to declare that the alleged violations [of the

contract] would be a violation, instead they ask the Court to declare that the alleged

violations do constitute bad faith.” The court granted summary judgment on that

claim because “a request for declaratory judgment must be prospective.” See

Livingood v. City of Des Moines, 991 N.W.2d 733, 747 (Iowa 2023) (“Generally, a

declaratory judgment is meant to define the legal rights and obligations of the

parties in anticipation of some future conduct, not simply to proclaim liability for a

past act.” (cleaned up)).

Because the court did not address Alexander’s prospective claim for relief,

and she did not file a motion requesting a ruling, error has not been preserved for

our review. See Meier, 641 N.W.2d at 537. And Alexander does not challenge

the court’s dismissal of the retrospective claim on appeal. As a result, we affirm

the court’s entry of summary judgment on Alexander’s request for declaratory

relief.
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IV. Conclusion

After considering all of Alexander’s arguments on appeal, whether

specifically addressed or not, we conclude the district court correctly granted

Amerigroup’s motion for summary judgment and dismissed Alexander’s petition.

AFFIRMED.