ALBANY — The Spitzer administration is overhauling how it markets and offers state-subsidized health care in an effort to remove the stigma of government health insurance and make it easier for people to stay enrolled in Medicaid and other federally backed programs.

The plan, which includes a mass-marketing campaign of television and radio ads, is central to Governor Spitzer’s four-year goal of achieving universal health care for children, one of his signature campaign promises.

Expanding coverage to include 211,000 more children will cost the state about $51.3 million, a small fraction of the $17.5 billion a year in the state-funded budget that goes toward Medicaid, according to state officials. They say insuring children will ultimately lead to health care savings as children receive more preventive care and are treated in routine office visits rather than more expensive emergency rooms. But to make that happen, they have to get the children’s parents to sign them up for the insurance, which isn’t always easy.

“This is not a question of if you build it, they will come,” the state’s Medicaid director, Deborah Bachrach, said in an interview. “The next challenge is to get folks enrolled.”

Earlier this month, the Legislature approved a major expansion of income eligibility for New York’s Children’s Health Insurance Program, which uses federal and state funds to provide health care to children whose families earn too much money to qualify for Medicaid. The income cut-off was raised to four times the federal poverty level, or $82,600 for a family of four, the highest income level in the nation for such a program.

Mr. Spitzer declared the expansion a “momentous achievement” that would provide “all children with access to health care.”

By itself, however, the increase of the income threshold represents only a first step toward covering the estimated 400,000 children in New York who are uninsured. The overwhelming majority of those children, in fact, were already eligible for state-subsidized health care. The change extends subsidized health insurance to only about 60,000 children who previously were not eligible, Spitzer administration officials said.

Of New York City’s births in 2005, 52% of them were paid for by Medicaid. Of the 2,473,000 children who are eligible for Medicaid and the Children’s Health Insurance Program (which in New York is called Child Health Plus), 2,089,000 are already enrolled, a coverage rate of 84%, according to administration officials. Their goal is to increase that rate to 93% by 2010, adding an estimated $51.3 million to state Medicaid costs. After that, the goal will increase to 95% coverage.

To get to that point, the Spitzer administration has adopted an approach different from that of Massachusetts, which passed a law last year requiring health care coverage for all of its residents. Such a mandate was deemed less feasible in New York, where almost half the people who are uninsured are eligible for a subsidized program, a figure much greater than in Massachusetts, which had done a better job of enrolling those who qualified for state-subsidized health insurance. New York is also adopting a different approach from that of Illinois, whose governor, Rod Blagojevich, in March proposed the largest tax increase in the state’s history, in part to expand health insurance coverage for adults.

“The first step toward universal coverage is to reach the people who are eligible for programs on the books,” Ms. Bachrach said.

To do so, the state is changing how it markets Medicaid and Child Health Plus by promoting the programs not as a government handout but as a universal entitlement. The idea is to remove the well-documented stigma of subsidized health insurance by de-linking it in people’s minds from welfare.

A 2004 study by two Georgetown University economists, Arik Levinson and Sjamsu Rahardja, found that stigma “plays a statistically and economically significant role in deterring Medicaid take-up.” The study found that people who are eligible for Medicaid are 8% less likely to enroll in the program if they strongly agree with the opinion that welfare “makes people work less.”

A common perception among eligible recipients is that Medicaid is available only for people who aren’t working. “Parents want health insurance coverage for their children, but most of the families have at least one parent who is working. Many of them assume that coverage is not for working families, especially for families not on other types of public assistance,” a policy analyst at Washington, D.C.-based Kaiser Family Foundation, Robin Rudowitz, said.

To confront that perception, the Spitzer administration is pointing to its expanded Child Health Plus program to convey a message that subsidized health insurance isn’t only for poor people.

“There’s no stigma anymore. It’s not like it’s for poor people. It’s for all people,” Mr. Spitzer’s health care adviser, Joseph Baker, said. “All people who have problems covering their kids that can’t afford other insurance can afford this insurance, whether they are at 150%, 250%, 400%, or even at 425%” (New Yorkers whose income level is more than four times the poverty level could pay full price for Child Health Plus at a rate of $120 a child a month, less than many private plans.)

To reach more people with its message, the Spitzer administration is assembling a Public Health Insurance Enrollment Team composed of staff from more than nine state agencies. The team’s job is to essentially figure out ways to mass market the state’s health insurance programs wherever people have contact with the state, from schools, to substance abuse clinics and welfare offices.

The Department of Health is putting together a print, radio, and television advertising campaign to be rolled out this year. Mr. Spitzer will not appear in the ads.

New York is also following in the footsteps of a number of states, such as Connecticut, Colorado, and New Mexico, that have taken recent steps to remove bureaucratic obstacles and paperwork in the way of recipients and potential ones. In New York, where Medicaid is administered at the county level, the bureaucratic hurdles were not created by accident. Until 2006, when lawmakers approved a cap on local Medicaid costs, counties trying to keep costs and taxes down had a disincentive to sign up more residents.

If New York gets federal approval, recipients applying for renewal will no longer need to show residence and income documents, such as pay stubs. The state government will verify eligibility through its wage reporting system and tax returns. Families will no longer have to come in for renewal more than once a year, regardless of changes in their circumstances.

Under the new law, parents signing up their children for Medicaid won’t be turned down if they are missing documents during their interview and will have a two-month grace period to locate the information.

“The point is to keep you in the system and provide you with preventive and primary care,” Mr. Baker said.