I get all text notifications. Sometimes, maybe 50% of the time, the MMS photos don't come through to my alt profile. Two or three times (I get maybe 10 or 20 calls a day), I have had a phone call ring, with no visible notification that the phone was ringing. When I press the phone app, it comes up with a number pad and no option to answer it. I just have to wait for the ring tone to stop ringing and a missed call notification pops up and I can call the number back. To clarify, that's 2-3 times, ever. I've had GrapheneOS for about 4 or 5 months.
I use an alternate profile 100% of the time. My main profile is only used as an "admin" profile for downloading apps.