Mary Combs' average day caring for her only brother includes laundry, a Wal-Mart run and maybe a little cleaning of his northeast Minneapolis home. There's also the tube feedings, bathing and grooming. And the middle-of-the-night calls in case of emergencies. And the struggle of separating her duties from her own heartbreak as she watches him grow weaker.

Combs, 41, left behind a good-paying career in St. Louis to work as a personal care assistant for Billy, who has amyotrophic lateral sclerosis (ALS). She's paid about $11 an hour via a federal-state Medicaid program.

When the Legislature in 2011 passed a cost-saving amendment that would cut her wages by 20 percent simply because she's related to Billy, she was stunned.

"We're family and we care. We go the extra mile," she said. "I didn't really understand it."

More than 6,000 caregivers for the vulnerable or disabled and their relative clients cheered last month when the Minnesota Court of Appeals deemed the legislation unconstitutional, and exhaled last week when the Department of Human Services (DHS) decided not to appeal to the Minnesota Supreme Court. The cuts would have taken effect July 1, but many were already affected when their wages were pre-emptively cut by agencies that employed them. That back pay will be restored.

"It wasn't a very well thought-out stopgap measure," said David Bradley Olsen, an attorney who sued the DHS on behalf of eight home-care agencies and nine relative caregivers. "The Legislature didn't even determine that the value of their care was different. They assumed that relatives had some kind of moral bond and they would continue to work whether they were paid less or not."

DHS Commissioner Lucinda Jesson backed the decision not to appeal.

"In an ideal world we would have never done this," she said. "We had to cut about a billion dollars from our projected Health and Human Services budget in 2011 and we had to make a lot of difficult decisions. This is one that I'm glad we're able to move beyond."

'Unequal pay for equal work'

The proposed cuts came less than two years after a state audit found that the multimillion-dollar program was "unacceptably vulnerable to fraud and abuse." In several instances, the DHS paid agencies where care attendants supposedly worked more than 24 hours a day, or failed to enforce new limits on the number of hours that caregivers are allowed to work. This week, a Ramsey County couple were charged with medical assistance fraud and theft for overbilling the state for hours of care that were not provided. The Medicaid program provides medical care and services through DHS, which contracts with or enrolls health care providers.

The DHS calculated that the proposed cuts would save nearly $60 million over four years, estimating that 75 percent of relatives would continue PCA services even with lower wages. A Ramsey County judge upheld the law, although the Legislature and Gov. Mark Dayton temporarily reversed the cut, but only until next July. The Court of Appeals ruling that deemed the cuts unconstitutional means they now won't happen.

"The distinction created by the 2011 amendment between similarly situated individuals is arbitrary and does not provide a natural, reasonable or substantial basis to justify legislation providing for unequal pay for equal work," Appeals Court Judge Terri Stoneburner wrote in the majority opinion.

Terry Hagenah, 66, a retired nurse from Plymouth, says the money she makes assisting her daughter Jessica, a 38-year-old corporate travel agent who has muscular dystrophy, is a bonus for their family. Her problem with the legislation was its principle.

"It was that the Legislature didn't grasp the issue," Terry Hagenah said. "It was demeaning to the lives of people with disabilities that needed that level of care, and the lack of knowledge of what it takes to be a relative PCA."

Jessica, who also interviews and hires non-relative caregivers through her agency Break-Thru Home Care, said the cuts show that the Legislature may focus on the wrong areas.

"Just like they need to make sure clients are well taken care of, we need to have quality caretakers who are well taken care of," she said.

Johnnell Lane, 26, has spent the past five years cooking, cleaning and running errands for his 48-year-old mother, Tracee Adams of Fridley, who has asthma, high blood pressure and other conditions. Adams, who also suffers from anxiety, said she prefers to be cared for by her son. Lane said the DHS' initial prediction was correct -- he would have continued caring for his mother, even with lower wages. But that didn't mean it was right.

"She's my mom," he said. "I know I'd do it anyway."

Abby Simons • 612-673-4921