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Both Fitch and Moody’s Investors Services say they expect a “stable” — neither positive nor negative — year ahead, thanks to a consistent but slow economic recovery. That outlook would improve if growth in tax revenues for state and local governments picks up speed, according to a pair of Moody’s reports issued Wednesday. Those conclusions are largely in line with an analysis of state governments from Fitch ratings agency earlier this week, which found that states enjoy mostly stable ratings for the year ahead. There are some risks to the outlook, though: namely pressures from anti-tax sentiment, building expenses for programs such as Medicaid and overall economic volatility. (Chokshi, 12/4)

In health policy circles, they are called “super-utilizers,” but the name isn’t meant to connote any special powers. Just the opposite. They are people whose complex medical problems make them disproportionately heavy users of expensive health care services, particularly emergency room treatment and in-patient hospitalizations. The cost of treating them is huge: Just 5 percent of Medicaid’s 68 million beneficiaries account for 60 percent of the overall spending on the program. Using a provision of the Affordable Care Act, many state Medicaid agencies are trying to diminish use of medical services by super-utilizers by better managing their care. The goal is to not only reduce costs, but to achieve better health outcomes for these patients. (Ollove, 12/5)

You'd expect the socially progressive states of the Northeast and Midwest to score well in a new state-by-state ranking of mental health services, and indeed, by some measures they do. When the advocacy group Mental Health America released the first-ever such rankings Wednesday, Massachusetts, Vermont, Maine, North Dakota, and Delaware received the highest overall scores when prevalence of mental illness is compared to access to care. Arizona, Mississippi, Nevada, Washington, and Louisiana received the lowest marks. (Bernstein, 12/4)

The rising number of workforce dropouts has troubling implications for the state's competitiveness, entitlement programs, consumer spending and more, economists said. An economic forecast released Wednesday by Chapman University suggested that the slack labor market still has room to grow. A shrinking labor force could force employers to recruit outside the state, raising immigration and visa issues. Households with fewer breadwinners might scale back spending. A disproportionately small pool of earners may mean less tax revenue for public programs such as Medicare. (Hsu, 12/4)

In Florida, as in the rest of the nation, the number of children without healthcare coverage has declined during the last five years — but the Sunshine State still has one of the country’s highest rates of uninsured children, a challenge that could be met or missed depending on policy decisions on the state and federal levels, according to a brief published this week by the Georgetown University Center for Children and Families. While the number of uninsured children aged 18 and younger in the state has decreased from about 668,000 in 2008 to 445,000 in 2013, according to the report, Florida has the highest rate in the South and fifth highest in the nation. (Chang, 12/4)

North Dakota's Insurance Department has levied $60,000 in fines against the state's largest health insurer for what Insurance Commissioner Adam Hamm calls "egregious" violations of state law. A months-long state examination prompted by consumer questions and complaints uncovered several violations and "deficiencies" in the way Noridian Mutual Insurance Co. did business between March 2010 and May 2013, Hamm said Thursday. Noridian operates as Blue Cross Blue Shield of North Dakota. (Nicholson, 12/4)