BackgroundWhen older adults seek support through formal community-based services, they or their family caregivers have determined a need for assistance with ongoing functional needs. Eligibility for long-term services and supports is often based on clinically evaluated need determined by a professional clinical health assessment. MethodsUsing state agency data, we explored the relationship between clinically evaluated functional needs and the likelihood of receiving services to address specific needs among 1322 adults aged 60+ requesting assistance through Virginia's Area Agencies on Aging in 2014–2015. ResultsMost older adults (77.4%) received at least one service. Older adults who received at least one service tended to have fewer personal activities of daily living needs [t(1298)=2.716, p = 0.007] and instrumental activities of daily living needs [t(1298)=2.900, p = 0.004)] than older adults who did not receive any services. Few clinically evaluated functional needs were significantly associated with the older adults receiving services explicitly aligned with their limitations. ConclusionsFindings raise questions about service allocation and alignment of needs. A large body of research documents how receiving insufficient help is associated with adverse health consequences; it is a serious public health concern for older adults. We recommend aging services organizations assess their approach to service allocation to ensure evaluated need better aligns with service receipt.