Additional Needs for a Medical Diet (Krankenkost) in Bürgergeld Denied — How to Push Back

Q: Can I get the additional needs retroactively?

Yes. If you object on time, the additional needs are paid back to the application month. If you missed the objection period, the review application under § 44 SGB X still comes into consideration — usually for up to one year retroactively.

Your doctor has prescribed a particular diet — for example because of celiac disease, kidney disease or tumour therapy. You applied to the Jobcenter for the additional needs (Mehrbedarf) for an expensive diet (kostenaufwändige Ernährung). The reply comes back cold: "Your diet is not scientifically recognised" or "wholesome mixed diet is sufficient". That is annoying — and very often open to challenge.

The Most Important Points in 30 Seconds

The legal basis is § 21 Abs. 5 SGB II. Under this rule, you are entitled to additional needs (Mehrbedarf) in "appropriate amount" if you need a special diet for medical reasons.
The amount is not a flat rate. Orientation comes from the recommendations of the Deutscher Verein für öffentliche und private Fürsorge (2020, since updated). Typical values: celiac disease about 70–80 EUR per month, kidney insufficiency stage 4–5 about 50–60 EUR, cystic fibrosis about 80–100 EUR, tumour disease with malnutrition individually higher.
Requirement: a medical certificate (ärztliches Attest) with diagnosis and the concrete dietary form that is medically necessary.
The Jobcenter must review each case individually. A blanket rejection citing a catalogue is unlawful.
You have one month objection period (Widerspruchsfrist) against the rejection notice. Success rates in this case group are experience-based high.

We review your decision within 24 hours. Free and non-binding.

Why Jobcenters Reject These Additional Needs So Often

The additional needs for an expensive diet — in administrative jargon often called the medical diet supplement (Krankenkostzulage) — are a very old benefit. Anyone who must eat more expensively due to illness should receive the additional money. The legislator intentionally regulated no fixed amount and no exhaustive catalogue in § 21 Abs. 5 SGB II. There is a reason: every illness pattern is different.

In practice, however, Jobcenters work with internal lists oriented towards the recommendations of the Deutscher Verein — and reject everything not listed there. Typical wording from rejection notices: "The diet you have specified is not scientifically recognised." "A wholesome mixed diet is sufficient." "Additional needs are not necessary, since the diet can also be implemented within the standard needs."

These boilerplate phrases often do not fit the individual case. The case law of the Federal Social Court demands a concrete individual review — not the ticking off of a checklist.

A concrete example: A woman with celiac disease (gluten intolerance) must eat strictly gluten-free. Gluten-free products are on average two to three times more expensive than standard goods. The Deutscher Verein here provides for around 72 EUR monthly. The Jobcenter refuses: "Celiac disease is not an illness with expensive nutrition within the meaning of the guidelines." She loses 864 EUR per year, which she would have to cut out of her standard needs (563 EUR in 2025). On objection the additional needs are granted — citing the current version of exactly these recommendations.

Your Rights in Concrete Terms

1. Entitlement under § 21 Abs. 5 SGB II. You have a statutory entitlement to additional needs (Mehrbedarf) in "appropriate amount" if you need an expensive diet for medical reasons. The Jobcenter has no discretion on the "if" — only on the amount is an individual case assessment provided.

2. No exhaustive list. § 21 Abs. 5 SGB II contains no catalogue of illnesses. The Deutscher Verein's recommendations are only an orientation aid, not an exhaustive enumeration. Illnesses not listed there can still trigger additional needs in an individual case.

3. Plausibility instead of "scientific recognition". The medically necessary dietary form must be plausible — that is, comprehensible by diagnosis and medical recommendation. A formal admission as a "scientifically recognised therapy" is not required.

4. Medical certificate as evidence. The certificate from your doctor is the central piece of evidence. It should contain: diagnosis (preferably with ICD code), the concrete dietary form (e.g. gluten-free, lactose-free, low purine, defined protein) and a brief reason why a wholesome diet is not sufficient.

5. Individual case review. The Jobcenter must concretely consider your life situation, illness and dietary form. A pure boilerplate rejection ("not on the catalogue") violates the duty of official investigation (Amtsermittlungspflicht) under § 20 SGB X.

6. Right of objection under § 84 SGG. You can file an objection (Widerspruch) against the rejection notice within one month of receipt — in writing or on record at the Jobcenter.

7. File inspection under § 25 SGB X. You may see which internal notes, expert information or medical opinions the Jobcenter has based its decision on.

Current Case Law

The Federal Social Court (Bundessozialgericht) has repeatedly decided: the additional needs for an expensive diet must be determined individually. A purely schematic rejection — "is not on the list" — is not enough. The Jobcenter must examine the concrete illness, the prescribed dietary form and the actual additional costs that arise. If additional needs cannot be safely excluded, they must be recognised in principle ([URTEIL-REFERENZ]).

The recommendations of the Deutscher Verein für öffentliche und private Fürsorge are a permissible aid, but not binding. If the actual costs differ in the individual case — for example because the illness is particularly severe or several diagnoses come together — a higher amount is possible ([URTEIL-REFERENZ]).

For frequent case groups, orientation values have established themselves in case law and the recommendations (all approx. values, monthly):

Celiac disease (gluten intolerance): about 70–80 EUR.
Kidney insufficiency stage 4–5 (defined-protein diet): about 50–60 EUR.
Cystic fibrosis (high-calorie nutrition): about 80–100 EUR.
Tumour disease with malnutrition or wasting illnesses: individually higher, depending on disease stage and dietary recommendation.

More recent rulings have made clear that illnesses such as chronic inflammatory bowel disease, severe lactose intolerance with concomitant symptoms, metabolic disorders or certain allergies can also trigger additional needs if the medically prescribed diet is demonstrably more expensive than wholesome food ([URTEIL-REFERENZ]).

How to Proceed Now

1. Note the deadline. The date of the rejection notice is decisive. Receipt is presumed three days after dispatch. From then the one-month objection period runs. Enter the end immediately in your calendar.

2. Examine the rejection grounds in detail. Read carefully why the Jobcenter is rejecting. Common boilerplate: "not scientifically recognised", "wholesome diet sufficient", "not contained in the recommendations". Exactly these wordings are the entry points for your objection.

3. Ask the doctor for a meaningful certificate. The certificate should contain: name and date of birth, diagnosis with ICD code, the medically necessary dietary form (as concrete as possible: "strictly gluten-free", "defined protein ≤ 0.8 g/kg body weight" etc.) and a sentence explaining why a normal wholesome diet is not enough. Family doctor or specialist — both work.

4. File the objection — short first. If time is too tight for detailed reasons, send a short objection: "I hereby file an objection against the notice dated [date], reference [...]. I will submit the reasons later." By registered mail or on record. That preserves the deadline.

5. Submit reasons. Good arguments are: the Deutscher Verein recommendations are not an exhaustive list. The diet is medically grounded and plausible. The Jobcenter has not carried out an individual review. Attach the certificate, optionally also receipts or a brief overview of how much the special diet concretely costs you.

6. If still rejected: lawsuit at the Social Court. If your objection is dismissed, you again have one month for a lawsuit at the Sozialgericht. No court fees apply to you. With ongoing need an urgent application (Eilantrag) is additionally possible if you can no longer advance the diet from the standard needs.

Common Mistakes to Avoid

Missing the objection period. After one month the notice becomes final. Then only the review application under § 44 SGB X (Überprüfungsantrag) remains — harder and usually only retroactive for one year.
Keeping the certificate too vague. A one-liner "patient needs a diet" is not enough. Without a concrete dietary form and diagnosis, the Jobcenter quickly rejects again.
Buying into the Jobcenter's list logic. Do not argue only about whether your illness "is in the recommendations". The core is § 21 Abs. 5 SGB II — the recommendations are only orientation, not a precondition for entitlement.
Selling self-designed diets as "medical diet". For the additional needs the diet must be medically grounded. Pure lifestyle diets (low carb out of conviction, vegan diet without medical necessity) are not covered.

Frequently Asked Questions

Which illnesses count as expensive in the first place?

Classic case groups are celiac disease, advanced-stage kidney insufficiency, cystic fibrosis, certain metabolic disorders and tumour diseases with malnutrition. Many individual cases are also recognised for chronic inflammatory bowel disease, severe allergies or wasting diseases. What matters is not the list but the concrete medical finding.

Does the diet have to be "scientifically recognised"?

No, not in that strict sense. What is required is that the diet is plausibly medically indicated — comprehensible by diagnosis and medical recommendation. A formal recognition as therapy or a guideline of the specialist society is not necessary.

How high are the additional needs typically?

That depends on the illness. For celiac disease the recommendations are currently around 70–80 EUR per month, for kidney insufficiency stage 4–5 50–60 EUR, for cystic fibrosis 80–100 EUR. With severe courses or multiple diagnoses the amount can be higher. Fixed percentages as for the single-parent additional needs do not exist.

What if my Jobcenter calls in a public health doctor?

That is permissible and happens often. The public health doctor then reviews the certificate submitted. If a deviating assessment results, you have a right of file inspection under § 25 SGB X and can submit a more detailed specialist certificate — that is often the decisive step.

Can I get the additional needs retroactively?

Yes. If you object on time, the additional needs are paid back to the application month. If you missed the objection period, the review application under § 44 SGB X still comes into consideration — usually for up to one year retroactively.

What if I have multiple diagnoses?

If several illnesses with dietary relevance come together — for example celiac disease plus lactose intolerance plus diabetes — an individual, higher assessment is possible. The Deutscher Verein recommendations note that aggregation is not automatic but the individual case must be reviewed.

Have Your Decision Reviewed Now

We review your decision within 24 hours. Free and non-binding.

Send us the rejection notice and — if available — the medical certificate. We check whether the Jobcenter's reasoning holds up, whether the amount has been plausibly assessed and what your objection should concretely look like.