LLMs absolutely understand and write good Elixir. I've done complex OTP and distributed work in tandem with Sonnet/Opus and they understand it well and happily keep up. All the Elixir constructs distinct from ruby are well applied: pipes, multiple function clauses, pattern matching, etc.
I can say that anecdotally, CC/Codex are significantly more accurate and faster working with our 250K lines of Elixir than our 25K lines of JS (though not typescript).