gos27371 Dang, made it the furthest with these steps. (T-Mobile, Pixel 9a). Really appreciate everyone's help they're providing here.
I can get to "Connected" but won't actually send as anything but SMS / MMS.
I've also tried a lot of the other fixes including one where I removed the number off my Google account and re-add, no luck.
Weirdly (Or maybe not, new to GOS) the Carrier Services app doesn't show up in the app list, even when "Show system apps" is selected. When I go to uninstall it via the Play Store I can click "More Options" and it'll open the Carrier Services app info screen, but Permissions/Force Stop/etc. are greyed out. The only button I can click is "Enable" but it doesn't seem to do anything.
Having a heavy reliance on RCS between friends & family means I'll probably have to come back to GrapheneOS - either I'll convince enough of the people I message to swap to something like Signal or maybe there will be a better solution by then haha