Washington (CNN) When Tom Stevens got an email from the White House saying that President Donald Trump was considering giving his grandfather, baseball legend Babe Ruth, a posthumous Medal of Freedom , he thought it was spam.

"This email from the White House pops up and I put (it) in the same class as a Nigerian prince wanting me to help him liberate $5 million. I paid zero attention," Stevens, who often represents Ruth's family in public, told CNN.

It wasn't until another email came in that Stevens saw the news. A few months later, he was standing in the East Room of the White House to receive his grandfather's award, which Trump has granted to more than a dozen supporters, conservative figures, athletes and deceased celebrities.

Trump's selections for the Medal of Freedom -- the nation's highest civilian honor -- seem to vary greatly and the process is largely held under wraps.

But some honorees gave CNN insight into how they were picked. A few were recommended for the award during previous administrations. Others say the selection seemed to be totally out of the blue. And others are close allies or friends of the President.

Though President Barack Obama's Medal of Freedom list was long and diverse -- with honorees who came from a variety of industries and racial backgrounds, and who were nearly equally male or female -- Trump has opted for a different course. His honorees have been overwhelmingly male, predominantly white and a majority are also either Republican figures or athletes.

In addition, Trump has opted for smaller ceremonies with individual honorees at the White House, rather than following Obama's preference for large-scale events with several honorees getting the medal at the same time.

Asked for more information about the administration's Medal of Freedom selection process, a White House official told CNN that much like past administrations, "the office of the staff secretary coordinates decisions to award presidential medals."

"In addition to receiving recommendations from the public and applicable presidential advisory bodies, the staff secretary has solicited nominees from the Cabinet and White House senior staff. These nominees are then vetted for presentation to the President," the official said.

Posthumous awardees

Hall of Famer Babe Ruth hit 60 home runs in 1927.

Stevens is not necessarily a Trump fan, but he said the Babe's nomination to receive the Medal of Freedom by Trump was "long overdue."

Ruth is among more than a dozen pro-baseball players to receive the award since it was established in its most modern iteration by President John F. Kennedy in 1963.

"The family was most grateful to President Trump for having recognized -- finally recognized, long overdue, pleased that the award was made," Stevens said. "To be a little bit special every once and in a while is a lot of fun."

Ruth isn't the only recipient to obtain the award posthumously from Trump.

Elvis Presley and Supreme Court Justice Antonin Scalia were also given the award during a ceremony last year.

Representatives for Graceland similarly were stunned to learn that Trump would be granting the award to Presley.

Christian Ross, a spokesperson for Elvis Presley Enterprises, told CNN, "We don't know how or why the President chose to honor Elvis" beyond what the White House had said in its public announcement for the award.

Conservative figures

Like Scalia, several conservative leaders among the Republican Party's ranks have made it onto Trump's list.

More recently, the White House announced that Reagan-era Attorney General Edwin Meese will receive the Medal of Freedom. And retired Utah Republican Sen. Orrin Hatch, who endorsed Trump ahead of the Republican National Convention in 2016, received the Medal of Freedom in 2018.

Trump held his first Oval Office ceremony for famed economist Art Laffer, whose work gained popularity under the Reagan administration, this summer. Trump has diverged from some of his predecessors, who took to celebrating several Medal of Freedom honorees at large, public ceremonies inside the White House. The President has instead, in recent months, chosen to hold ceremonies for individual honorees, sometimes with limited press in the Oval Office.

Laffer's concepts have been adopted by Trump administration officials, whom the economist calls friends, including White House chief economic adviser Larry Kudlow. Laffer also co-wrote a book with ex-Federal Reserve Board of Governors nominee Stephen Moore, titled "Trumponomics," and is a self-labeled "fan" of Trump.

Trump told Laffer he wanted to give him the Medal of Freedom "out of the blue" during a White House visit, Laffer told CNN, adding that he was "quite taken aback" by the President's announcement.

At a subsequent meeting, Trump and Laffer joked about holding the ceremony with pro golfer Tiger Woods.

"He asked, with a twinkle in his eye, 'Would you like to have it at the same time as Tiger Woods?' I said, 'I don't think that's such a good idea,' " Laffer remarked.

He called the day of the Medal of Freedom ceremony a "blur."

"We met in the Roosevelt Room. They described what would happen (during the ceremony). I could barely follow it. I was just so giddy," Laffer said.

The "Laffer Curve" creator said he also got the impression that he was among the President's personal selections, alongside Ruth, Presley and Woods.

"Now, what he said to me was that I was his choice -- whether other people supported it or mentioned it or not -- he said, 'I want you for it,' " Laffer said, adding that Trump told him he didn't know why Ruth and Presley didn't previously get the award when they were "major contributors to Americana."

"It makes you feel really proud someone cares. You work all your life and you hope someone notices," Laffer added.

Athletes

The President has honored several pro athletes with the medal since taking office, including former NFL star and Minnesota Supreme Court Justice Alan Page, former Boston Celtics point guard Bob Cousy, former Lakers player Jerry West, Woods, former Yankee Mariano Rivera and former NFL quarterback Roger Staubach.

Page told CNN that he had been also contacted "sort of out of the blue" about the medal, but said he thinks the decision for Trump to give him the award stems from a letter sent to the White House during the Obama administration in 2016. Page said the letter was signed by a group of current and former prominent Minnesota politicians. He is under the impression that Obama-era submissions for the medal, including Page's earlier recommendation, were screened by staff and submitted to Trump.

Page said he has no connection to Trump.

"Beyond (the letter) I don't really know what or how or why" I was selected, Page remarked, adding that it was "quite an honor."

"I'm trying to think of a way to say this," Page said, taking a pause. "One would not have anticipated that I would have been high on his list."

In the span of a month earlier this year, moderate Democratic Sen. Joe Manchin, from West Virginia, was spotted at two Medal of Freedom ceremonies, first for Cousy and then West.

Trump's public remarks from the ceremonies indicate that they were suggested for the award by Manchin.

West is a West Virginia native, but Cousy is not. However, like Page, Cousy had been recommended by members of Congress from his home state of Massachusetts in letters to the White House in 2014 and 2017.

Still, it appears that their letters did not have as much sway as Manchin's personal recommendation over the phone.

Trump said during Cousy's Medal of Freedom ceremony that "Joe called me up quite a while ago and suggested this idea," later calling Manchin "a big part of this."

Trump also maintains some personal and political connections to some of the recipients.

He's known Woods for years, and was spotted with him on the links this year. Woods is also involved in some of Trump's businesses. Staubach is a self-described conservative who has donated to conservative causes. And Rivera is a vocal Trump supporter who sits on the President's Council on Sports, Fitness & Nutrition.

Political supporters

Rivera also co-sponsored a $50,000-per-couple, pro-Trump fundraiser in 2018, according to the New York Post

But no Medal of Freedom recipient has gotten as much scrutiny for their family's GOP donor ties as Miriam Adelson, the spouse of billionaire Republican donor Sheldon Adelson.

She was commended by the White House for her philanthropy, which includes founding research centers committed to fighting substance abuse and establishing the Adelson Medical Research Foundation, which supports research on life-threatening illness. The Adelsons were among the Republican Party's largest benefactors this midterm election, donating more than $100 million to GOP super PACs in 2018.