As Jackson's governing board prepares to vote Monday on a proposed budget for 2011, its two money-losing nursing homes stand as a symbol for the challenges the system faces as it attempts to cut losses. Almost 100 of the 289 nursing home patients in the Jackson Health System are uninsured. Half of those are undocumented immigrants under age 50. Many are quadriplegic, on ventilators -- hugely expensive patients who can cost up to three times as much as regular nursing home residents. Despite these and other challenges, Jackson must present a balanced budget to the Miami-Dade County Commission. The working proposal as of Aug. 6 projects a loss of $232.2 million if no initiatives are taken. Executives are counting on $221.4 million in new revenue and cost-saving moves to get the bottom line close to zero.