Not that you can really put a price tag on it, but national organizations estimate that family caregivers in Michigan provide about $10.5 billion worth of services each year to relatives who are chronically ill, disabled or elderly. According to the National Family Caregivers Association and Family Caregiver Alliance, Michigan ranks eighth among states in numbers of family caregivers and the hours they give for such things as medical, social, financial and housekeeping services.

This is altogether commendable, and most of the people who do it ask nothing in return.

But the scope of family caregiving -- $306 billion worth of services nationally, based on 2004 estimates -- and the aging of the giant baby boomer generation raise questions about how effectively this informal system can be sustained.

That's why a statewide program in Vermont -- and similar pilot programs in Michigan -- makes so much sense.  Federal officials should follow these and other leads in rewriting Medicaid laws to make home care much more accessible and keep the elderly out of nursing homes and other, more expensive settings.

The Vermont program, called Choices in Care, makes it possible for the elderly to pay friends or relatives $10 an hour to provide care. In place for about a year, the program addresses the desire of the elderly to stay in their own homes and the shortage of caregivers. It also should be cheaper in the long run.

Michigan's MI-Choice program -- being piloted in Detroit, the Upper Peninsula and the Lansing and Battle Creek areas -- does not go quite as far, but its aim is similar.  It lets Medicaid recipients make their own choices on spending their long-term care dollars.

But to embark on these sensible programs, Michigan and other states have to apply for cumbersome waivers from the federal government.  The Medicaid program, which states administer, was designed when nursing home care was at its height, before doctors and patients learned that the longer you keep folks at home, the healthier and happier they'll be.

Last year, President George W. Bush indicated he knew this when he asked for more home care money for disabled people in his Medicaid budget. But Medicaid should be overhauled to make clear that people with conditions that qualify for institutional care should be able to decide whether to use those same funds to stay at home.