Organizational aspects of the medication management process (MMP) have been investigated in hospital and nursing home settings. However, the amount of literature on medication management in residential care facilities (RCF) for individuals with ID is limited to two studies from the Netherlands, focusing only on drug administration errors. To assess the organization of the MMP in Belgian RCFs for people with ID, the authors undertook a cross-sectional observational study in 34 Belgian RCFs for people with ID. Structured interviews were performed using a questionnaire: the first part (for the RCF directors) addressed administrative and policy issues. The second (for unit employees) and third parts (for medical office employees) addressed practical aspects of the MMP. The fourth part (for physicians) focused on the physician's role in the MMP, on the therapeutic drug formulary, and on communication with staff and delivering pharmacist. Standard operating procedures concerning the MMP were not available in 32% of the RCFs. About one-quarter of the RCFs did not have a medication error reporting system, and most RCFs did not systematically (i.e., at least annually) review their MMP for failures. Only two participating RCFs were equipped with an electronic prescribing system. The role of the pharmacist was mainly limited to delivery of medication. Medication was mostly administered by nonmedically qualified staff (e.g., educators). Most frequently cited problems by the interviewees were problems in the medication preparation and administration stage. Most frequently cited possible improvement actions were education/sensitization of staff and improved communication among all stakeholders. The authors note that as this study revealed operational inadequacies, problem areas can be identified and targeted quality improvement actions can be undertaken.