Still, Adelson is not the first political supporter to be granted the award by a US president.
"Orrin Hatch ... he liked me right from the beginning, so I like him", the President joked, drawing laughs.
Adelson wasn't shy about touting her conservative ideals in a statement from Las Vegas Sands Corp., a massive casino and hotel company owned by her husband.
The Presidential Medal of Freedom and the Congressional Gold Medal are the joint highest civilian awards in the US.
Other recipients today include Senator Orrin Hatch (R-Utah).
Trump's homage to Elvis - who once met with president Richard Nixon at the White House in 1970 - paused for a recording of the gospel song "How great thou art".
Trump also recalled that he had attended an Elvis performance himself decades ago, where overexcited fans were "ripping the place apart, screaming".
The Adelsons are also avid supporters of Israel. Orrin Hatch of Utah, one of the longest-serving senators in US history; Alan Page, who was elected to the Minnesota Supreme Court after an National Football League career with the Minnesota Vikings and Chicago Bears; and Roger Staubach, the Hall of Fame Dallas Cowboys quarterback.
The Adelsons were the most prolific individual donors of the 2018 midterms, according to an analysis by OpenSecrets, with the couple giving at least $113 million during the cycle, all of it to Republican causes.
Some questioned Trump's decision to recognize Miriam Adelson so soon after the November 6 election.
They were major proponents of Trump's decision past year to formally recognize Jerusalem as Israel's capital and formally move the U.S. embassy there, which the president recognized during Friday's ceremony. He contrasted her award with those given by President Barack Obama to Chita Rivera, Robert De Niro, Barbra Streisand, Ellen DeGeneres and Warren Buffett, among others. "I think you can criticize a judge but it ought to be done in a formal way", Hatch said at the time.
Washington to veto United Nations vote on occupied Golan Heights
The US ambassador to Israel, David Friedman, said in September he expects Israel to keep the Golan Heights in perpetuity. Chairman of the Yesh Atid party, Yair Lapid, thanked Haley and reiterated that the Golan Heights is part of Israel.