Homeless people are among the most marginalized individuals in the United States and experience significant rates of morbidity and mortality. Los Angeles County, California, has the highest concentration of homeless individuals in the nation, and although it features the largest health and social services system available to homeless people, it faces significant challenges to provide cost-effective integrated care. Housing and highly coordinated or integrated care represents an efficient and effective way to serve homeless individuals. Based on content analysis of symposium proceedings that included multiple stakeholders who engaged in a daylong structured conversation about challenges and opportunities related to the development of a fully integrated system of care, this manuscript presents insights about the state of service integration in the largest county in the United States. We discuss implications for the health and social services system, including a call for developing an strategic plan to vertically integrate care to address issues of homelessness.