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Biorefineries (BRFs) that process the organic fraction of municipal solid waste and generate bioproducts and bioenergies have attracted attention because they can simultaneously address energy and environmental problems/needs. The objective of this article was to critically review the microbial production of hyaluronic acid (MPHA) and its production profile for its integration into a GBAER-type BRF (a type of BRF based on organic wastes) and to identify the environmental and economic sustainability aspects of the modified BRF that would confirm it as a sustainable option. It was found that the MPHA by selected strains of pathogenic Streptococci was moderate to high, although the trend to work with genetically transformed (GT) (innocuous) bacteria is gaining momentum. For instance, A GT strain of Corynebacterium glutamicum reached a maximum HA production of 71.4 g L−1. MPHA reports that use organic wastes as sources of carbon (C) and nitrogen (N) are scarce. When alternative sources of C and N were used simultaneously, HA production by S. zooepidemicus was lower than that with conventional sources. We identified several knowledge gaps that must be addressed regarding aspects of process scale-up, HA industrial production, economic feasibility and sustainability, and environmental sustainability of the MPHA.