Such was the case in 2008, in which ten medals were handed out on an ordinary basis, but two were granted in an extraordinary manner to Queen Sofía and the former President of the Government of Extremadura, Juan Carlos Rodríguez Ibarra.

However, any citizen of Extremadura or entity can submit a candidature before the regional administration, which can then be taken into consideration by a commission and subsequently approved by the Governing Council.

Thus, the medal has gone to people in the world of arts and sports, political personalities, local corporations, financial institutions, associations, religious congregations, and monasteries, among others.

[6] The award ceremony took place in Trujillo on 29 April, on the occasion of an official visit by the Prince and Princess of Asturias, Felipe and Letizia, to the town's National Cheese Fair.

[7] In 2014, after the death of Adolfo Suárez on 23 March, the regional government granted him the Medal posthumously for being the country's first democratic Prime Minister after Francoist Spain, driving the Spanish Transition to Democracy.

The only withdrawal of the Extremadura Medal was proposed in 2014, specifically that awarded to the Paralympic swimmer Enrique Tornero in 1996, due to his judicial conviction for prevarication and fraud in his time as a councilor in the City of Plasencia.