Might be sarcasm - a dig pointjng out that the Medal of Freedom is basically a political reward for friends, whereas the Medal of Honor has to be earned at risk of life and limb. If sarcasm, not a great idea to air it in public against one of his biggest donors, Miriam Adelson. There were rumors of tensions with her, so this might have bubbled to the surface.
https://okmagazine.com/p/donald-trump-erratic-outburst-republican-mega-donor-maggie-haberman/
Biden gave Fulton County ballot harvesters Ruby Freeman and Shaye Moss the Medal of Freedom.