This study assessed the responsiveness of the exemption measure in providing healthcare services among older persons in the Lindi region. A cross-sectional research design using a mixed approach was conducted among 369 older persons (60+) living in Nachingwea and Kilwa districts. Data were collected through a questionnaire covering seven non-health aspects of care, based on the WHO responsiveness assessment framework. Descriptive analysis was used to determine the variable distribution, while binary logistic regression analysed the association between variables and Health Systems Responsiveness. The strength of association was determined using an adjusted OR (AOR) with a 95% CI, with statistical significance set at p<0.05. The overall responsiveness of the exemption measure was 60% poor. The choice (94.3%) and autonomy (70.8%) domains performed poorly, whereas confidentiality (84.7%) and dignity (54.7%) showed good performance. Multivariable logistic regression revealed that sex (AOR 0.578, 95% CI: 0.358-0.931), education (AOR 2.313, 95% CI: 1.116-1.549), specialists (AOR 1.614, 95% CI: 1.339-2.448), and place of residence (AOR 6.195, 95% CI: 3.591-10.687) were significantly associated with the responsiveness performance. Based on the findings, the exemption measure performed poorly in service provision to more than half of older persons. The Ministry of Health should expand geriatric services in public facilities and improve the choice of care and autonomy in healthcare provision.